Optimization of a behavioral intervention to increase physical activity in older adults living with HIV

优化行为干预以增加艾滋病毒感染者老年人的体力活动

基本信息

批准号：
10693938
负责人：
Jason V Baker
金额：
$ 68.86万
依托单位：
BUTLER HOSPITAL (PROVIDENCE, RI)
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2027-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10693938
关键词：
Accelerometer Address Affect Age Aging Behavior Therapy Behavioral Behavioral Research Cardiovascular Diseases Caring Chronic Classification Clinical Trials Cognitive Cognitive Therapy Conduct Clinical Trials Coping Skills Counseling Data Development Disease Elderly Enrollment Evaluation Exercise Fatigue Friends Future Goals Guidelines HIV Health Benefit High Prevalence Individual Intervention Interview Life Life Style Mediation Mediator Mental Depression Mental Health Mental disorders Modeling Monitor Outcome Pain Participant Persons Phase Phenotype Physical activity Preparation Primary Care Privatization Public Health Quality of life Recommendation Refractory Research Risk Risk Factors Social support Specific qualifier value Testing Walking antiretroviral therapy brief advice cardiovascular disorder risk chronic pain clinical risk comorbidity design efficacy evaluation efficacy validation exercise intervention experience experimental study fitbit frailty healthspan human old age (65+)improved lifestyle factors multidisciplinary multiphase optimization strategy physical conditioning primary outcome programs recruit secondary outcome social theories therapy development

项目摘要

Increasing numbers of persons living with HIV (PLWH) are living to older ages. Older PLWH are at increased risk for a wide spectrum of co-morbid conditions such as cardiovascular disease, frailty phenotype, and mental health disorders. Practical primary care-based interventions are needed for older PLWH that target lifestyle factors to reduce complications of aging and improve healthspan. Most PLWH engage in less physical activity (PA) than is recommended by public health guidelines. Thus, increasing PA can lead to numerous mental and physical health benefits among PLWH. Current studies in PLWH typically focus on the impact of supervised exercise. However, there are many barriers to this type of PA. Lifestyle physical activity (LPA) programs that focus on integrating PA, especially walking, into everyday life, may be more successful in producing a sustained increase in PA. The long-term goal of this research is to develop an effective and efficient primary care intervention that increases LPA among older PLWH. We leverage the Multiphase Optimization STrategy (MOST) as a framework for developing, optimizing, and evaluating a multicomponent behavioral intervention. MOST is comprised of three phases. First, in the preparation phase, an empirical and theory-driven conceptual model is developed that identifies differentiable intervention components and specifies optimization criteria (i.e., goal of intervention development). We have completed this phase. Second, in the optimization phase, the impact of each intervention component on the desired outcome is empirically examined. The goal is to determine which components to include in a final intervention package that is optimized for efficacy and efficiency. The proposed study reflects the second phase, or an optimization trial. Finally, in the evaluation phase, the optimized intervention package is evaluated for efficacy in a traditional RCT; this will be the next step in this line of research following the currently proposed project. In this project, we will test the impact of three separable intervention components on steps per day after 4 months of intervention. We will recruit 208 PLWH of age ≥50 year classified as low-active. All participants receive component ‘0’: brief advice to exercise and a Fitbit activity tracker. We then test 3 additional components in a factorial design: 1) PA Coaching— focused on goal-setting and self-monitoring; 2) Cognitive-Behavioral intervention for PA (CB-PA)—focused on identifying values and addressing internal barriers to PA such as pain, depression, or fatigue; 3) Social Support for PA (SS-PA)—a component which leverages the social functionality of the Fitbit app, promoting social support and friendly competition. The primary outcome will be steps per day during Month 4. The observed main and interaction effects for the 3 candidate components will guide selection of components to be included in an optimized intervention that will be tested in a future RCT. We will also examine potential mediators for each intervention component, as well as secondary outcomes including perceived physical health, mental health, cardiovascular disease risk, and the frailty phenotype.

越来越多的艾滋病毒（PLWH）人数越来越大。较旧的PLWH正在增加有多种合并症的风险，例如心血管疾病，脆弱的表型和精神健康障碍。较旧的PLWH需要实用的基于初级保健的干预措施，以实现生活方式减少衰老并改善健康状况的因素。大多数PLWH从事较少的体育锻炼（PA）比公共卫生指南的建议。那就增加了PA会导致许多心理和 PLWH中的身体健康益处。 PLWH的当前研究通常集中于监督的影响锻炼。但是，这种类型的PA有很多障碍。生活方式体育锻炼（LPA）计划专注于将PA，尤其是步行融入日常生活中，可能更成功地生产 PA持续增加。这项研究的长期目标是开发有效而有效的初级护理干预措施增加了LPA的旧PLWH。我们利用多相优化策略（大多数）作为开发，优化和评估多组分行为干预的框架。大多数由三个阶段组成。首先，在准备阶段，是经验和理论驱动的概念开发了识别可区分干预组件并指定优化标准的模型（即干预开发目标）。我们已经完成了这个阶段。第二，在优化阶段，迫切需要检查每个干预部分对所预期结果的影响。目标是确定在最终干预套件中包括哪些组件，以优化效率和效率。拟议的研究反映了第二阶段或优化试验。最后，在评估中阶段，评估了优化的干预软件包，以在传统的RCT中提高效率；这将是下一个在当前提出的项目之后介入这一研究。在这个项目中，我们将测试干预4个月后，每天每天的步骤三个单独的干预组件。我们将招募208 年龄≥50岁的PLWH被归类为低活动。所有参与者都会收到组件“ 0”：简短的锻炼建议和Fitbit活动跟踪器。然后，我们在阶乘设计中测试3个其他组件：1）PA教练 - 专注于目标设定和自我监控； 2）PA（CB-PA）的认知行为干预 - 专注于识别值并解决PA的内部障碍，例如疼痛，抑郁或疲劳； 3）社会支持对于PA（SS-PA） - 利用Fitbit应用程序的社会功能的组成部分，促进社会支持和友好的比赛。主要结果将是第4个月期间每天的步骤。三个候选组件的主要和交互作用将指导选择要包含的组件在一项优化的干预措施中，该干预措施将在未来的RCT中进行测试。我们还将检查潜在的调解人的每个干预组成部分以及次要结果，包括感知到的身体健康，心理健康，心血管疾病风险和脆弱的表型。