Title: HPCorporate Brand No Photo, Gold
1(No Transcript)
2Maintaining PA Among Older Adults 24mo Outcomes
of the Keep Active Minnesota RCT
- Brian C. Martinson, PhD, A. Lauren Crain, PhD,
Nancy E. Sherwood, PhD, Marcia Hayes, MPH, RD,
Nico P. Pronk, PhD, and Patrick J. OConnor,
MD, MPH - HealthPartners Research Foundation
- HealthPartners Health Behavior Group
- Supported by a grant from National Institute on
Aging (R01 AG023410 )
3Purpose
- Evaluate the efficacy at 6, 12 and 24-month
follow-up of a population-based intervention to
promote PA maintenance among currently active
older adults - a phone and mail-based physical activity
maintenance intervention - designed for use with adults age 50 to 70 years
who have increased their physical activity (PA)
within the past year
4Background
- Well known benefits of PA in older adults
- Yet, older adults are particularly sedentary
- Those just starting a PA routine have particular
difficulty sustaining it. - Flux over time in PA levels is common
5Background
- Issues of population reach
- Most PA promotion efforts focus on PA initiation
- Complementary strategies needed
- increase PA initiation among sedentary
- help active individuals maintain PA
6Specific Aim
- Did our phone- and mail-based intervention help
participants maintain their physical activity
level over two-years of follow-up relative to
usual care? - We present the primary outcomes at the 6, 12 and
24-month follow-up points
7Participants
- N1,049 health plan members ages 50-70
- Currently accumulating 30 mins of MVPA/d at
least 2 d/wk in average week - Current PA level increased within past 12 months
- Recruitment occurred from July 2004 through July
2005 - Randomized (11) to either the treatment
condition (KAM) or a usual care control group
(UC)
8Participants
- Health Plan administrative data used to
screen/recruit - Sufficiently healthy to participate in the
intervention - Exclusions
- Dx of CHD, CHF, or Charlson (comorbidity) score
gt3 in prior year - Selected heart rhythm disturbances or a cardiac
arrest in prior year
9Intervention
- Based primarily on Banduras Social Cognitive
Theory (SCT) and relapse prevention theory - Intervention self-management strategies
- cognitive
- behavioral and
- environmental
10Keep Active Minnesota Intervention Elements
- In-person orientation
- Workbook, PA logbook, pedometer
- 7 session phone course
- Monthly phone contact through 1st year
- Bi-monthly phone contact for 2nd year
- Motivational challenges
11Primary Outcome Measures
- Community Healthy Activities Model Program for
Seniors (CHAMPS) questionnaire (Stewart, King, et
al) to calculate primary outcomes - Revised by dropping 2 question items appearing
suspicious for over-reporting heavy work around
house, heavy gardening - Weekly kilocalorie expenditures at baseline, 6,
12 and 24 months from moderate or vigorous
intensity PA - Maintenance of PA at 6, 12 and 24 months relative
to baseline (maintenance) - Kcal/wk 80 of baseline and 1500
12Hypotheses/Analyses
- Hypothesis 1 KAM group will maintain a higher
absolute kcal expenditure from baseline to 6, 12
and 24 months, relative to a drop in kcal
expenditure among the UC control group. - Tested using general linear mixed model
regression - Moderate/vigorous kcal expenditure predicted from
time and treatment condition - Hypothesis 2 PA maintenance at 6, 12 and 24
months will be higher among intervention group
participants than among those in the usual care
group - Tested using generalized linear mixed regression
13Results
- At baseline - typical participant was
- 57 years old
- Female
- White
- Overweight (BMI 25 kg/m2)
- Working full time
- College educated
- Good functional health status
- Only observed group difference 3 fewer in KAM
group self-identified as White (plt.05)
14-KAM group maintains moderate PA and controls
decline (timetx p lt .001) -KAM
effect at each time point p lt .05
15-KAM group maintains moderate PA and controls
decline (timetx p lt .001) -KAM
effect at 6 24 months, p lt .05 -KAM effect at B
and 12 months, p lt .10
16-No significant time by KAM group effect (timetx
p .19) -KAM effect at 6 24
months, p lt .001 -KAM effect at 12 months, p lt
.05
17Discussion
- This relatively low intensity PA intervention for
50 to 70 year olds may be the first to focus
exclusively on PA maintenance - The Keep Active Minnesota intervention appears
successful in helping older adults maintain
health-promoting levels of physical activity - Preliminary SEM models suggest that KAM effect
may be mediated by incorporating physical
activity into the self-concept and self-efficacy
18Limitations
- Generalization to other populations should be
pursued with caution - We have examined and identified potential biases
across the recruitment process - Most notable differences were between responders
and non-responders - Differences were increasingly smaller as the
recruitment and enrollment proceeded - see our poster for more details
(Martinson, Crain, Sherwood, Hayes, Pronk,
OConnor, in press JPAH)
19Limitations
- Although this was a low-intensity intervention,
the costs of it are not negligible - Affordability should be considered for those
identified as potential payers - We have not yet conducted any cost-effectiveness
analyses
20Conclusions
- Helping the newly active to maintain PA and
fostering PA initiation among the sedentary
should be pursued as complementary strategies to
increase population activity levels - These promising results from KAM may be an
important contribution to overall efforts to
increase PA in the U.S. population
21Future Directions
- PASSPORT pilot
- KAM renewal re-submission
22PASSPORT pilot progress
- Recruitment has been completed as planned
- 63 adults ages 60-80 from HP membership,
- 43 assigned to intervention
- 20 to a materials only control
- Baseline measurements included
- actigraphy monitoring
- self-reported lifestyle survey
- venipuncture blood collection
- cognitive assessment battery
- anthropometric measures (height, weight, BP)
23PASSPORT pilot progress
- Intervention process data to date
- High call completion rate
- n32 subjects completed intervention
- N9 subjects in progress
- High satisfaction with the intervention
- Evaluation progress to date
- n26 completed 6 month follow-up visits
- Anticipate completion of all six-month
follow-ups by May 2009
24Thank you!
- Nancy Sherwood
- Nancy.E.Sherwood_at_HealthPartners.Com
- Lauren Crain
- Lauren.Crain_at_HealthPartners.Com
- Brian C. Martinson
- Brian.C.Martinson_at_HealthPartners.Com
25Discussion
- High fidelity to the intervention
- 93 of those randomized to intervention
participated in at least one intervention phone
call - 82 completed the seven session phone course
- 73 completed the monthly follow-up calls and
- 60 completed the sequence of bimonthly follow-up
calls - Client satisfaction with the intervention was
high at each follow up - Excellent retention - 94 response at 6 and 12
month follow ups and 92 at 24 month follow up
non-differential by treatment group - So differences observed unlikely due to
differential drop out, and - The intervention strategy may have wide appeal to
eligible adults
26PASSPORT pilot progress
- Recruitment has been completed as planned
- N63 adults ages 60-80 enrolled from HP
membership, - N43 assigned to intervention N20 to a
materials only control - Baseline measurements have also been completed
with excellent adherence to actigraphy monitoring
and self-reported lifestyle survey completion - Baseline clinic visits included venipuncture
blood collection, cognitive assessment battery
and anthropometric measures (height, weight, BP)
also completed successfully - Intervention is ongoing with good fidelity and is
being well received with high satisfaction
ratings. We have completed intervention delivery
with N32 subjects and are currently delivering
the intervention to N9 - High rate of course session completion
- Two subjects have quit the study
- 6mo follow-up visits completed with N26
- Anticipate completion of all six-month follow-ups
by May 2009
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28Limitations
- Generalization to other populations should be
pursued with caution - In prior analyses (in press see our poster
here), we examined potential biases across the
recruitment process - Those responding to an initial mailed screener
differed on demographic, behavioral, and SES
characteristics from those not responding - Eligible individuals were significantly younger,
more highly educated, and more likely to report
improved health in the prior year, compared to
ineligibles - Study enrollees had generally higher education
and income than eligible individuals who did not
enroll
(Martinson, Crain, Sherwood, Hayes, Pronk,
OConnor, in press JPAH)