Boston Roybal Center for Active Lifestyle Interventions

Maiya Geddes, McGill University

An Intergenerational Behavioral Intervention to Enhance Physical Activity in Older Adults at Risk for Alzheimer’s Disease

Mentor: Art Kramer

Abstract:

This research will significantly advance our understanding of the individual differences and brain processes that underlie successful physical activity engagement in older adults who are at risk of Alzheimer’s disease. This new knowledge will lead to brain based and personalized strategies to reduce the risk of Alzheimer’s disease progression. Physical inactivity is the most important modifiable risk factor for Alzheimer’s disease (AD) in North America. Despite this, most older adults are inactive. This NIH Stage I randomized controlled trial will test the efficacy of a technology-based intergenerational intervention to enhance physical activity in at-risk older adults. We will recruit 60 older adults (30 intervention, 30 control) from the PREVENT-AD longitudinal cohort at McGill, on which PI (Geddes) is already a formal collaborator. This cohort includes 356 cognitively normal older adults with a first-degree family history of AD who were followed since 2011 with serial cognitive, brain, genetic, and fluid biomarkers. A multimodal AD risk score, based on already acquired data will be used as strata for randomization. Older participants (> 60 years) in the intervention group will be paired with younger study partners (14 – 30 years), and receive positive daily messages over six weeks that combine intergenerational social engagement (growing a virtual garden using an in-house developed technology platform) and prosocial goals (microdonations to charity after reaching exercise goals). The primary outcome is change in physical activity compared to baseline measured using a wrist-worn accelerometer. Secondary outcomes include loneliness, self-efficacy, cognition, sleep, and mood. We apply the NIH Science of Behavior Change Framework to assess candidate target mechanisms (social engagement, generativity, reward sensitivity). We leverage already acquired longitudinal neuroimaging data to characterize the brain fingerprint of intervention responders using rigorous machine-learning methods. This will further the development of individualized strategies for AD prevention. 

Timothy P. Morris, Northeastern University

Mechanistic Correlates of Planning, Reminders and Micro-Incentives to Increase Physical Activity After Traumatic Brain Injury in Older Adults

Mentor: Art Kramer

Traumatic brain injury can leave older adults particularly susceptible to a sedentary lifestyle, which can lead to many co-morbid health complications, including early mortality. Developing efficacious, sustainable and
non-pharmacological lifestyle interventions to promote physical activity will therefore have a large public health impact. The neurobiological and behavioral sequelae of traumatic brain injury (TBI) places older adults at high risk for sedentary behaviors. But very little research is tailored towards promoting sustainable long-term lifestyle interventions for this population. Therefore, we aim to test the effect of planning, reminders, and micro-incentives intervention on physical activity participation in older adults (65-80 years) with a history of mild or moderate TBI. Individual differences in recovery trajectories means this intervention may have a greater benefit in some compared to others and identifying the moderating mechanism of this effect will optimize clinical interventions. 60 sedentary older adults aged 65-80 who have suffered a mild or moderate TBI between 2 and 10 years prior, will be randomized into one of two 12-week conditions, consisting of a planning, reminders, and micro-incentives intervention to promote 5 days of walking per week or a control condition that receive educational advice about the health benefits of walking only. Both groups will receive an activity tracker and be instructed to wear it daily for 12 weeks. We hypothesize that those randomized into the intervention group will increase their physical activity participation more so than those in the control group over, and that baseline structural and functional metrics of brain regions and circuits that subserve reward processing, self-monitoring, and problem-solving abilities will moderate the effect of the intervention. The study design falls under stage 0 and stage 1 of the NIH stage model of intervention development, testing both basic mechanisms and preliminary efficacy of an intervention.

Franchino Porciuncula, Boston University

Amplifying physical activity through music using autonomous walking entrainment in Parkinson disease

Mentor: Terry Ellis

Abstract: Parkinson disease (PD) is the fastest growing source of disability among neurological disorders globally. Diminished levels of physical activity are highly prevalent in PD and often lead to the onset of disability. Regular, habitual exercise is a critical, evidenced-based component of the long-term PD management. However, PD-specific motor (e.g. slowness in movement, reduced movement output, gait variability) and non- motor (e.g. depression, apathy) problems collectively hinder engagement in physical activity. In this pilot study, we propose to use a breakthrough digital therapeutic that employs music-adaptive rhythmic auditory stimulation (RAS) to target PD-specific problems and promote moderate intensity walking activity. Using music as a substrate for cue delivery, this digital therapeutic leverages gait benefits that are associated with RAS along with enjoyment of music listening, thus making it a viable and engaging modality that is capable of increasing engagement in regular walking exercises. We hypothesize that music-adaptive RAS administered as a user-managed, community-based gait training program (“Amped-PD") has the potential to prompt regular physical activity through a series of behavioral change processes (e.g., habit formation) that develop enhanced self-efficacy and self-regulation. Specific Aims: (SA.1) To determine if Amped-PD (Experimental Intervention) is more effective than a standard-of-care walking program (Active Control Intervention) in improving physical activity (moderate intensity walking) in individuals with mild to moderate PD. (SA.2) To describe relationships between self-efficacy, habit formation and physical activity. Research Strategy: We will conduct a randomized controlled trial enrolling 44 individuals with mild-to-moderate PD (22 per intervention). The experimental intervention, Amped-PD, is a 6-week, user-managed community-based walking program that utilizes a novel digital therapeutic to provide music-adaptive RAS to progressively increase walking intensities based on user’s step frequency and gait quality. The control intervention is a similarly structured free-walking program without RAS. Outcome assessments at pre-training, post-training, and follow-up will include measures of (1) real-world walking intensities using validated wearable sensors, and (2) habit formation and self-efficacy to explore mechanisms of behavioral change. Preliminary data generated in this study will be critical for future funding of sufficiently powered studies on dose-response effects and mechanisms underlying behavioral change toward increased physical activity in PD.

Courtney Millar, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School

Dietary intervention targeting inflaming, depressive symptoms, and engagement in physical activity in sedentary, older adults.

Mentor: Lewis Lipsit

Abstract: Older adults spend the majority of their day engaging in sedentary behavior, which increases risk of mortality by 22%. Depressive symptoms have been identified as a critical barrier to overcoming sedentary behavior, specifically in older adults. Given that inflammation is involved in the development of depressive symptoms, interventions targeting inflammatory pathways offer a promising approach to reduce depressive symptoms. As such, targeting inflammation-related depressive symptoms may subsequently reduce sedentary behavior and increase physical activity in older adults. Dietary components such as fiber and anthocyanins (a compound found in berries) possess strong anti-inflammatory properties, and may be particularly useful at targeting inflammatory pathways related to depressive symptoms and sedentary behavior. However, interventions targeting such a pathway between inflammation, depressive symptoms, and sedentary behavior are scarce. This proposal aims to determine the feasibility and preliminary efficacy of a dietary intervention to target inflammatory pathways related to depressive symptoms and sedentary behavior. We propose a single-site, randomized, parallel pilot study in 24 sedentary, older adults with depressive symptoms. Participants will be randomized to consume either 100 mg of anthocyanins and 8 g of fiber mixed in 8 fluid ounces of water or to consume 8 fluid ounces of coconut water (control) each day for a total of 12 weeks. We hypothesize this study will be feasible, and that consuming anthocyanins (100 mg/day) and fiber (8 g/day) tends to reduce serum inflammatory markers (interleukin-6 and C-reactive protein), reduce depressive symptoms (via Center for Epidemiological Studies Depression scale), and increase engagement in physical activity (via average daily step count monitored by accelerometer) after 12 weeks compared to control (~8 fluid ounces of coconut water/day). Identification of a dietary intervention to target the inflammatory pathways may offer a novel and feasible approach to ameliorate depressive symptoms and also increase the engagement of physical activity in older adults, which would help avoid the plethora of health consequences associated with depressive symptoms and sedentary behavior.

Jeff Huffman, Massachusetts General Hospital

A Randomized Pilot Trial of a Multicomponent Interactive Text Message Intervention to Promote Physical Activity in Midlife Adults

Mentor: Margie Lachman

Abstract: Physical activity in midlife (age 50-64) plays a strong and independent role in preventing heart disease, but fewer than 20% of midlife adults complete recommended levels of physical activity. Multiple factors in midlif, including increased time pressure and numerous sources of stress, can serve as major barriers to the initiation and maintenance of physical activity. In addition, many midlife adults experience low overall psychological well-being, which is prospectively associated with reduced physical activity. Unfortunately, existing programs to promote activity are often time-intensive, do not leverage scalable mobile technologies like text messaging, do not target psychological well-being, and are not adapted to the specific needs and challenges of midlife. Our team has developed an individualized, multicomponent, text message-based physical activity intervention that combines: (1) positive psychology activities that systematically target psychological well-being, (2) practical and specific goal-setting techniques to facilitate regular physical activity completion, and (3) the use of skill building and resources to address midlife-specific stressors (e.g., time pressure, occupational stress) that impede participation in activity. The 12-week program utilizes weekly two-way, algorithm-driven, personalized text message sessions to develop relevant skills and promote activity, along with three short phone check-ins from study trainers to provide additional support. We have developed and refined this new intervention via qualitative research and a proof-of-concept trial (NIH Stage 1A) in midlife adults, with promising initial results.

As a next step, we propose an NIH Stage IB randomized pilot trial of this intervention (The Midlife Activity, Stress reduction, Time Efficiency, Resilience, and Youthfulness [MASTERY] program) utilizing individualized text messaging with adjunctive phone check-ins. We will compare the MASTERY intervention to an attention-matched control condition (focused on physical activity goal-setting, with one-way texts and phone check-ins) among 80 inactive midlife adults without heart disease. We will gauge feasibility, compare between-group differences in physical activity and other key outcomes at 12 weeks, and explore mechanisms of the intervention’s effects via mediation analyses. This work is consistent with the Boston Roybal Center’s focus on using multifaceted interventions, developed via the NIH Stage Model, to improve the well-being and activity of at-risk populations (e.g., inactive persons) to promote healthy aging.

Xin Lin, Brandeis University

Social Exergame Intervention to Promote Physical Activity, Social Support, and Well-Being in Family Caregivers

Mentor: Margie Lachman

Abstract: Family caregivers often experience a high level of stress, social isolation, sedentary lifestyle, and poor mental and physical health. There is a need for sustainable, scalable, and enjoyable programs to support social, physical, and emotional well-being among family caregivers. The current project seeks to promote a healthy lifestyle by investigating whether Go&Grow, a social exergame (i.e., a digital game in which play involved real-world physical activity and virtual social contact), can increase physical activity, social support and well-being in family caregivers. Go&Grow allows participants to grow flowers virtually as they increase their physical activity Participants can also have virtual social contact to share gardens and stories with other participants. Limitations of past exergame studies include small sample sizes and lack of comparison groups in testing their effectiveness and the underlying mechanisms. The current project addresses these limitations with a randomized trial (N=66) to compare the effectiveness of the treatment (full social exergame version of Go&Grow) with a control version of the exergame that does not include the social components. The study goals are (1) to examine whether the treatment group will increase in physical activity, social support, and well-being more than the control condition, and (2) to test whether social support and physical activity are significant as mechanisms in the relationship between condition (social exergame vs nonsocial exergame) and well-being.

Mirjam Stieger, Brandeis University

Testing Self-Control as a Behavior Change Mechanism to Increase Physical Activity

Mentor: Margie Lachman

Abstract: It is widely known that being physically active is beneficial for one’s health and well-being, yet only a small percentage of adults engage in the recommended amounts of physical activity. Research has shown that health- damaging behaviors such as a sedentary lifestyle can be attributed in part to a lack of self-control. There is some evidence that self-control strategies can be improved with targeted interventions. The overall aim of the proposed study is to test self-control as a behavior change mechanism for physical activity and to investigate whether a smartphone-based self-control intervention can increase physical activity among sedentary middle-aged and older adults.

To test the effect of this self-control intervention, we will randomize participants into two conditions: The self- treatment group and the control group. Both groups will track their daily physical activity using a Fitbit step counter over eight weeks. Additionally, the self-control intervention group will receive a 7-week smartphone-based self-control intervention to learn strategies how to potentiate desirable impulses or weaken undesirable ones. It is expected that the self-control treatment group will show greater increases in physical activity and that changes will last longer compared to the control group. Self-control is expected to mediate the relationship between condition and physical activity. It is predicted that the self-control treatment group will show greater changes in self-control compared to the control group and that people who increase more in self-control also increase more in their physical activity.

We will use two versions of the MINDHIKE smartphone application to communicate with all participants. The self-control treatment group will receive a version delivering a self-control intervention. The control group will receive a minimal version without the interventional components. Both groups will be matched in terms of contact frequency. Results from this study will provide information about the efficacy of a smartphone-based self-control intervention to support physical activity in middle-aged and older adults. If this intervention is effective, this digital approach would represent a low-threshold and cost-effective approach to increasing physical activity. Such an intervention could be delivered to a large number of people to improve their health outcomes in the long run.

Publications:

• Stieger, M., Allemand, M., & Lachman, M. E.  (2021).  Targeting self-control as a behavior change mechanism to increase physical activity: Study protocol of a randomized controlled trial. Contemporary Clinical Trials, 100. https://doi.org/10.1016/j.cct.2020.106236
• Stieger, M., Robinson, S.A., Bisson, A., & Lachman, M.E. (2020).  The relationship of personality and behavior change in a physical activity intervention. Personality and Individual Differences, 166. Advance online publication. https://doi.org/10.1016/j.paid.2020.110224

Dinesh John, Northeastern University

An Integrated Two-Way Communication and Near-Real-Time Sensing System to Detect and Modify Daily Inactivity among Adults > 60 y

Mentor: Carmen Sceppa, Arthur Kramer

Abstract: Substantial amount of evidence on the benefits of physical activity among adults >60 y comes from studies that have used the supervised exercise training model. Drawbacks of the model include a low frequency of trainer contact and a limited ability to change behavior outside weekly sessions. Strategies to motivate adults >60 y to move more and sit less outside weekly sessions are necessary to maximize health benefits. Current technologies aimed at modifying behavior rarely incorporate meaningful two-way communication. The applicants have integrated wearable sensing technology with the smartphone to develop a behavior-aware, virtual “Companion” that uses a “human-in-the-loop” approach to gain knowledge of ongoing or recent behavior, the situational contexts of behavior and past discourse, and knowledge about the adult to allow a novel adaptive behavioral intervention. The long-term goal is to develop hybrid artificial intelligence (AI) systems for adaptive behavioral interventions to attenuate the progression of chronic disease in adults >60 y.

The objective of this application is to test if Companion improves and sustains overall daily free-living physical activity and sedentary behavior in adults >60y. The central hypothesis is that Companion will improve overall daily free-living physical activity and sedentary behavior in adults >60 y and thereby improve their health. This hypothesis will be tested via two aims: (i) Determine if Companion improves and sustains free-living physical activity and sedentary behaviors in adults >60 y; (ii) Explore if supplementing a supervised exercise program with Companion further improves cardiometabolic health, physical fitness and function, body composition, and cognitive function. In this RCT, both treatment and control groups will engage in a 16-week supervised exercise program and will then be followed-up after 24 weeks. Only the treatment group will receive Companion. Primary outcomes are daily total and bouts of moderate-to-vigorous physical activity and sedentary time.

Companion is innovative because the computer automates sensor-based behavior monitoring and interpretation, but real people problem-solve through discourse understanding to create meaningful human rapport. This work is significant because it will help develop a new two-way communication-based intervention paradigm and will inform the incremental automation of two-way communication AI systems to elevate scalability.

Publications:

• Castaneda-Sceppa C, Cloutier G, Isaacowitz D, John D. (under review). Exercise-induced relationships between physical performance, activity and affect in community-dwelling frail older adults.

Brad Manor and Amy Lo, Marcus Institute for Aging Research

Modulating brain activity to improve goal-directed physical activity in older adults

Mentor: Lewis Lipsitz

Abstract: The majority of older adults are aware of the compelling evidence that regular exercise is critical to the maintenance of health into old age. The majority of older adults, however, do not meet daily exercise recommendations. This lack of engagement in "goal-directed"’ physical activity stems from interrelated factors including lack of motivation, depressed mood, and cognitive impairments that diminish one’s ability to regulate behavior over time. Intriguingly, each of these factors have been linked to the function of brain networks that include the left dorsolateral prefrontal cortex (dlPFC). Transcranial direct current stimulation (tDCS) is a noninvasive and safe means of modulating the excitability of specific brain regions and their connected neural networks. tDCS designed to facilitate the excitability of the left dlPFC has been shown to improve motivation, mood, and multiple aspects of cognitive function in healthy adults. We thus hypothesize that tDCS also holds promise to increase goal-directed physical activity in older adults.

In this pilot study, we will conduct a small yet well-controlled randomized trial to established the feasibility and preliminary effects of a 10-session tDCS intervention targeting the left dlPFC on physical activity, over a two-month period following the setting of a personalized physical activity goal, in physically-inactive older adults without overt illness or disease. This work is expected to provide proof-of-concept that tDCS may be used to increase regular engagement in goal-directed physical activity. It will also stimulate future grant activity by providing insights into optimal methods for recruitment, retention, and protocol compliance, as well as estimates of intra- and inter-subject variance in study outcomes over time within this vulnerable population.

Publications:

• Guo, Z., Bao, D., Manor, B., & Zhou, J. (2020). The Effects of Transcranial Direct Current Stimulation (tDCS) on Balance Control in Older Adults: A Systematic Review and Meta-Analysis. Front Aging Neurosci, 12, 275. https://doi.org/10.3389/fnagi.2020.00275, PMCID: PMC7516302
• Lipsitz, L.A., Macklin, E.A., Travison, T.G., Manor, B., Gagnon, P., Tsai, T., Aizpurúa, I. I., Lo, O., & Wayne, P. M. (2020). A Cluster Randomized Trial of Tai Chi vs Health Education in Subsidized Housing: the Mi-Wish Study. J Am Geriatr Soc, 67(9), 1812-1819. https://doi.org/ 10.1111/jgs.15986, PMCID: PMC6732029
• Lo, O.Y., Conboy, L.A., Rukhadze, A., Georgetti, C., Gagnon, M.M., Manor, B., Wayne, P.M. (2020). In the Eyes of Those Who Were Randomized: Perceptions of Disadvantaged Older Adults in a Tai Chi Trial. The Gerontologist, 60(4), 672-682. doi.org/10.1093/geront/gny165
• Wayne, P.., Gagnon, M.M., Macklin, E.A., Travison, T.G., Manor, B., Lachman, M., Thomas, C.P., & Lipsitz,  L.A. (2017). The Mind Body-Wellness in Supportive Housing (Mi-WiSH) study: Design and rationale of a cluster randomized controlled trial of Tai Chi in senior housing. Contemporary Clinical Trials, 60, 96-104. doi: 10.1016/j.cct.2017.07.005, PMCID: PMC5639896

Maiya Geddes, Charles Hillman and Susan Whitfield-Gabrieli, Northeastern University

Changing and understanding motivation to increase physical activity among sedentary
older adults

Mentor: Arthur Kramer

AbstractThis study focuses on examining the efficacy of factors that have shown promise in motivating sedentary older adults to become more physically active as well as to investigate changes in patterns of activation of the neural networks, as indexed by MRI and fMRI, that support these factors and changes in physical activity. Our primary aim is to assess, in a six week pilot randomized controlled trial with healthy but sedentary older adults, the efficacy of self-affirmation + positive messaging versus a control group that receives positive messaging only on changes in physical activity. We will also examine whether any differential physical activity >engendered in the two groups is maintained at 6 months post-intervention.

A secondary exploratory aim will examine the extent to which individual differences in motivation, conscientiousness, growth mindset and several other factors (see the description of our study below) moderate the effects of our intervention on physical activity change, for our self-affirmation + positive messaging versus a control group that receives positive messaging only, over the course of the intervention and at 6 months post-intervention. Another exploratory aim will examine the extent to which our intervention influences patterns of activation and connectivity in self-referential brain networks including medial prefrontal cortex and ventral striatum that have been related to self-affirmation of health messages (Falk et al, 2015; Gutchess et al., 2007), as well as other networks associated with aging and physical activity (e.g. resting state executive control, default and salience networks), and whether activation and connectivity within and between these networks is associated with physical activity change both following the intervention and 6 months post-intervention.

We believe that our intervention will provide valuable novel information about the efficacy of promising factors to enhance physical activity, and in turn cognitive and brain health, in sedentary older adults as well as the functional brain changes and individual differences that support these potential changes in physical activity.

Publications:

• Ai M, Morris TP, Ordway C, Quinoñez E, D’Agostino F, de la Colina A, Whitfield-Gabrieli S, Hillman CH, Pindus DM, Kramer AF, Geddes MR (2021). The daily activity study of health (DASH): A pilot randomized controlled trial to enhance motivation and physical activity in sedentary older adults (Accepted).
• Geddes, M. R., O'Connell, M. E., Fisk, J. D., Gauthier, S., Camicioli, R., & Ismail, Z. (2020). Remote cognitive and behavioral assessment: Report of the Alzheimer Society of Canada Task Force on dementia care best practices for COVID-19. Alzheimers Dement (Amst), 12(1), e12111. doi: 10.1002/dad2.12111, PMCID: PMC7507991.

Yujun Liu, Brandeis University

A Group-Based Walking Study Using WeChat to Enhance Physical Activity Among Older Adults: The Role of Social Engagement

Mentor: Margie Lachman

Abstract: The aim of this study was to explore social engagement and social comparisons as mechanisms to increase physical activity among older adults.Participants (N=60, mean age=65.7) were randomly assigned to one of two conditions. Participants in the treatment condition used the application to track their daily walking steps and interact via text messages with their group members for 4 weeks. Participants in the control group used the application only to track their own walking steps. Outcome variables included mean weekly steps, exercise self-efficacy, and social engagement. The results revealed that participants in the experimental condition significantly increased their mean weekly steps and social engagement from the pretest to the posttest whereas the control group did not. These effects were maintained at the one-month follow up. The study expands our understanding of the motivational role of social engagement and social comparison in increasing PA among older adults.

Publications: 

• Liu, Y., & Lachman, M.E. (2019). A Group-Based Walking Study Using WeChat to Enhance Physical Activity Among Older Adults: The Role of Social Engagement. Research on Aging, 3(Suppl 1), S142. doi: 10.1093/geroni/igz038.512, PMCID: PMC6845435

Carina Katigbak, Boston College

Together, We Move: A Multi-Component Intervention to Increase Physical Activity for Ethnic Minority Older Adults

Mentor: James Lubben

Abstract: The benefits of physical activity (PA) for healthy aging are well known; however < 16% of U.S. older adults meet the federal recommendations for moderate to vigorous PA (MVPA). Asian Americans (AA) are a fast-growing segment of the older adult U.S. population and are likely to have limited English proficiency, lower-incomes, and low PA levels. Older AA adults are under represented in clinical trials and as a result, evidence-based PA programs remain inaccessible. Similarly, while the number of PA interventions for older adults incorporating technology to promote and sustain behavior change is increasing, the applicability and efficacy of these approaches for AA is poorly understood. Thus, there is a critical need to develop and test innovative PA interventions for this at-risk group.

The primary objective of this study is to evaluate if a culturally and linguistically adapted community-based walking program enhanced with a cognitive behavioral intervention delivered via WeChat – a widely used Chinese social networking application - (enhanced walking) improves physical activity compared with walking only. Secondary objectives are to identify participant experiences in engaging in this platform to improve PA, and gain insights into the scalability of the intervention for future pivotal trials. The proposed research is a randomized, controlled trial that will recruit 50 community-dwelling Chinese older adults. The primary outcomes are PA (measured by FitBit step counts over time, and proportion meeting federal recommendations for moderate physical activity (MPA)). Secondary outcomes include patient-reported outcomes, and patient-reported experience measures. We aim to evaluate the acceptability of this enhanced program, and determine the feasibility of WeChat as a platform for increasing PA. The primary outcome will be analyzed using mixed effects ANOVA, and latent growth curve modeling. Secondary outcomes will be analyzed using linear regression. Semi-structured interviews will be conducted with participants upon program completion to identify contextual factors influencing application use, and thematic analysis will be used to examine relationships between these key factors.

Results from this study will provide information about the applicability of mobile technology in supporting PA improvement among older Chinese, and valuable insight on contextual factors influencing application effectiveness, which will inform the potential for adoption and scale.

Anica Pless Kaiser, Boston University School of Medicine, National Center for PTSD

A Randomized Pilot Trial of Tai Chi Compared to Wellness Education for Older Veterans

Mentor: Lewis Lipsitz

Abstract: Exercise and other healthy lifestyle behaviors are critically important for those at risk of developing physical health problems, such as older veterans. In addition, trauma exposure has been associated with increased risk for poor health and for engaging in health risk behaviors (Lee & Park, 2017), and older veterans have a higher likelihood of exposure to trauma over the course of their lives. Consequently, trauma-exposed older veterans are particularly susceptible to health problems. In addition, older adults commonly experience pain and decreased mobility, which can lead to increased trauma-related thoughts, memories, and possible distress (Davison et al., 2016). Therefore, older veterans who have been exposed to trauma may be good candidates for interventions that promote physical fitness and well-being. Tai Chi, an ancient Chinese mind-body exercise practice, has been shown to effectively reduce pain and improve quality of life in participants with a variety of chronic health conditions. It has also been demonstrated to help with balance, hypertension, cognitive performance, and stress reduction. The primary aim of this study is to examine the feasibility, utility, and acceptability of a Tai Chi intervention for sedentary, older (>60 years) trauma-exposed veterans, compared with a wellness education attention control condition. Examination of changes in physical fitness, PTSD symptoms, and well-being, as well as other outcomes, will be conducted. This study will provide three 12-week, 24-session Tai Chi intervention groups and three 12-week, 24-session wellness education groups for older, sedentary, trauma-exposed veterans. Baseline and post-treatment assessments will be conducted, with the primary outcomes of improvement in physical fitness and well-being. Satisfaction with the interventions will also be examined. Data from this pilot study will be used to inform the development of a larger randomized trial comparing Tai Chi to an active control condition with this population.

Jane Ebert, Brandeis University

Using a Habit Formation Intervention to Increase Sustainable Walking Activity in Midlife and Working Adults

Mentor: Margie Lachman

Abstract: While people commonly understand that regular physical exercise conveys many health benefits, only 20% of U.S. adults take regular exercise and they have difficulty maintaining new healthy behaviors. In the current research, we use a planning intervention to help establish and maintain a daily step regimen in working midlife adults. We will ask participants to form implementation intentions (by planning when, where, and how to act on a daily walking goal) in conjunction with a habit formation intervention to increase the chances that they will maintain this new regimen. To encourage habit formation, participants in a habit-friendly experiment condition will make plans, each week for 4 weeks, for daily walking in consistent contexts that recur from day to day. We expect that they will take more steps daily more consistently than those participants in a no schedule control group who will not plan a walking schedule, and to maintain this activity for longer than those participants in a habit-unfriendly control group who will plan a walking schedule in inconsistent contexts that vary from day to day. To test these predictions, daily steps and consistency in reaching daily goals will be obtained and compared across groups before and after the intervention period and at a one month follow-up assessment. We will also measure habit formation, and outcome variables such as well-being. Finally, we will examine the moderating role of participants’ home and work schedule routine characteristics (level of routine and busyness) on these intervention effects, predicting stronger effects of the habit formation intervention for individuals with greater existing routine and weaker effects for those with more busyness.

Publications: 

• Robinson, S.A., Bisson, A.N., Hughes, M.L., Ebert, J., & Lachman, M.E. (2019). Time for change: Using implementation intentions to promote physical activity in a randomised pilot trial. Psychology & Health, 34(2), 232–254. doi.org/10.1080/08870446.2018.1539487, PMCID: PMC6440859

Dae Kim, Hebrew SeniorLife

Home-Based Exercise Program for Recovery After Transcatheter Aortic Valve Replacement: A Pilot Randomized Controlled Trial

Mentor: Lewis Lipsitz

Abstract: With the increasing number of transcatheter aortic valve replacement (TAVR) performed in multi-morbid frail older adults with aortic stenosis, high-quality evidence is needed to improve the postoperative care of high-risk patients after TAVR. Under the current model of care, TAVR patients continue to experience functional decline and worsening disability despite improved cardiac function. Currently, there is no established rehabilitation program targeting both frailty and endurance in older adults treated with TAVR. This proposed research is a pilot randomized controlled trial of home-based exercise with cognitive behavioral interventions, home-based exercise alone, vs. attention control educational intervention to improve functional status and disability over 8 weeks in 60 patients (20 per group) who are discharged home after TAVR from Beth Israel Deaconess Medical Center. The home-based exercise program will consist of individualized exercise guided by a physical therapist targeting balance, flexibility, strength, and endurance. Cognitive behavioral interventions will target beliefs and attitude about exercise. The main hypothesis is that home-based exercise program with cognitive behavioral intervention is more effective than home-based exercise alone; home-based exercise program with and without cognitive behavioral intervention is more effective than attention control educational intervention in preventing decline in physical function and disability after TAVR. The primary outcome is the Late Life Function Disability Instrument, a patient-reported measure of physical function and disability. Secondary outcomes are the Short Physical Performance Battery, 2-minute walking distance, and handgrip strength. Self efficacy and outcome expectation about exercise, adherence, and adverse events will be measured. The research team will leverage expertise and resources within the Boston Roybal Center and the Boston Older American Independence Center to achieve the following aims: 1) to determine the effect of a home-based rehabilitation program with or without cognitive behavioral interventions vs. educational on physical function and disability; 2) to determine the effect of cognitive behavioral intervention on adherence and the change in physical function and disability among the participants in the exercise program. It is anticipated that the research team will be able to assess the feasibility of conducting a large RCT. Once confirmed, this proposed study can change the standard of care in TAVR patients.

Publications:  

• Hosler, Q.P., Maltagliati, A.J., Shi, S.M., Afilalo, J., Popma, J.J., Khabbas, K.R., Laham, R.J., Guibone, K., & Kim, D.H. (2019). A Practical Two-Stage Frailty Assessment for Older Adults Undergoing Aortic Valve Replacement. J Am Geriatr Soc, 67(10), 2031-2037. https://doi.org/10.1111/jgs.16036, PMCID: PMC6800747
• Jang, I.Y., Jung, H.W., Park, H., Lee, C.K., Yu, S.S., Lee, Y.S., & Kim, D.H. (2018). A multicomponent frailty intervention for socioeconomically vulnerable older adults: A designed-delay study. Clinical Interventions in Aging, 13, 1799-1814. doi: 10.2147/CIA.S177018, PMCID: PMC6156114
• Jang, I.Y., Lee, E., Lee, H., Park, H., Kim, S., Kim, K., Jung, H., & Kim, D.H. (2020). Characteristics of sarcopenia by European consensuses and a phenotype score. J Cachexia Sarcopenia Muscle, 11(2), 497-504. https://doi.org/10.1002/jcsm.12507, PMCID: PMC7113507
• Kapadia, M., Shi, S.M., Afilalo, J., Popma, J.J., Laham, R.J., Guibone, K., Kim, D.H. (2020). Cognition, Frailty, and Functional Outcomes of Transcatheter Aortic Valve Replacement. Am J Med, 133(10), 1219- 1222. doi: 10.1016/j.amjmed.2020.01.041, PMCID: PMC7501150.
• Kim, D. (2018). Incorporating quality of life prediction in shared decision-making about transcatheter aortic valve replacement: Current state and future directions. Circulation: Cardiovascular Quality and Outcomes, 11. doi: 10.1161/CIRCOUTCOMES.118.005097, PMCID: PMC6208138
• Kim, D.H., Afilalo, J., Shi, S.M., Popma, J.J., Khabbaz, K.R., Laham, R.J., Grodstein, F., Guibone, K., Lux, E., & Lipsitz, L.A. (2019). Evaluation of Changes in Functional Status in the Year After Aortic Valve Replacement. JAMA Intern Med, 179(3), 383-391. https://doi.org/ 10.1001/jamainternmed.2018.6738, PMCID: PMC6439710
• Kim, D.H., Mahesri, M., Bateman, B.T., Huybrechts, K.F., Inouye, S.K., Marcantonio, E.R., Herzig, S.J., Ely, E.W., Pisani, M. A., Levin, R., & Avorn, J. (2018). Longitudinal Trends and Variation in Antipsychotic Use in Older Patients After Cardiac Surgery. J Am Geriatr Soc, 66(8), 1491-1498. https://doi.org/10.1111/jgs.15418, PMCID: PMC6217828
• Lee, K. C., Streid, J., Sturgeon, D., Lipsitz, S., Weissman, J.S., Rosenthal, R.A., Kim, D.H., Mitchell, S.L., & Cooper, Z. (2020) The Impact of Frailty on Long-Term Patient-Oriented Outcomes after Emergency General Surgery: A Retrospective Cohort Study. J Am Geriatr Soc, 68(5), 1037-1043. doi: 10.1111/jgs.16334, PMCID: PMC7234900.
• Orkaby, A.R., Rich, M.., Sun, R., Lux, E., Wei, L., & Kim, D.H. (2018). Pravastatin for Primary Prevention in Older Adults: Restricted Mean Survival Time Analysis. J Am Geriatr Soc, 66(10), 1987-1991. https://doi.org/10.1111/jgs.15509, PMCID: PMC6181782
• Park, H., Jang, I.Y., Lee, H.Y., Jung, H.W., Lee, E., & Kim, D.H. (2019). Screening Value of Social Frailty and Its Association with Physical Frailty and Disability in Community-Dwelling Older Koreans: Aging Study of PyeongChang Rural Area. Int J Environ Res Public Health, 16(16), 2809. https://doi.org/10.3390/ijerph16162809, PMCID: PMC6720732
• Shi, S.M., Afilalo, J., Lipsitz, L.A., Popma, J.J., Khabbaz, K.R., Laham, R.J., & Kim, D. H. (2018). Frailty phenotype and deficit accumulation frailty index in predicting recovery after transcatheter and surgical aortic valve replacement. Journal of Gerontology, Series A: Biological Sciences and Medical Sciences, 74(8), 1249-1256. doi: 10.1093/gerona/gly196, PMCID: PMC6625585
• Shi, S. M., Sung, M., Afilalo, J., Lipsitz, L.A., Kim, C.A., Popma, J.J., Khabbaz, K.R., Laham, R.J., Guibone, K., Lee, J., Marcantonio, E.R., & Kim, D.H. (2019). Delirium Incidence and Functional Outcomes after Transcatheter and Surgical Aortic Valve Replacement. J Am Geriatr Soc, 67(7), 1393-1401. https://doi.org/10.1111/jgs.15867, PMCID: PMC6612597

Karen Quigley, Northeastern University & Edith Nourse Rogers Memorial VA Hospital

Mobile Intervention to Improve Functional Health and Community Engagement of Post-9/11 Veterans with Chronic Insomnia: Does Enhancing Physical Activity Help?

Mentor: Carmen Sceppa

Abstract: Veterans of the most recent wars in Afghanistan and Iraq (collectively, post 9/11 Veterans) have notable sleep problems including both chronic insomnia and, as we recently demonstrated in a small pilot study, higher than expected rates of obstructive sleep apnea (OSA; 47%). In those using a mobile app (with self-management guidance) to provide evidence-based cognitive behavioral therapy for insomnia (CBTI) and an objective sleep monitor for 6 weeks, we saw pre- to post-intervention improvements in subjective sleep (Insomnia Severity Index or ISI) and functional outcomes in those who completed the intervention. The surprisingly high occurrence of OSA in these relatively young (relative to those at greatest risk for apnea), and mostly normal weight veterans led us to consider the possibility that a shift to a more sedentary lifestyle in these formerly physically fit individuals, may be increasing the likelihood of both insomnia and OSA. Because increasing physical activity (PA) has been shown to reduce insomnia and OSA, we posit that increasing PA in these veterans with chronic insomnia could provide a useful adjunctive intervention to both reduce insomnia and perhaps even the incidence of OSA in this sample of veterans. Here, we plan to compare two groups of veterans with insomnia: (1) one that completes a 6 week self-management-guided use of the mobile CBTI app (CBTI alone) and (2) one that completes a 6 week combined self-management-guided use of the mobile CBTI app in addition to a PA intervention (CBTI + PA). We hypothesize that the group receiving the adjunctive 6- week PA intervention will have better subjective and objective sleep, higher step counts, and better functional health and social and community integration than those receiving CBTI alone. This pilot work will provide evidence to guide the design of a future randomized controlled trial including power estimates for the sleep, physical activity, functional health, and social and community engagement outcomes.

Publications:

• Robinson, S.A., Reilly, E., Petrakis, B.A., Wiener, R., Castañeda-Sceppa, C. & Quigley, K.S. (2021). Daily physical activity and sleep in veterans: The role of insomnia severity. Journal of Behavioral Medicine. 30. doi: 10.1007/s10865-021-00260-8.
• Reilly, E.D., Robinson, S.A., Petrakis, B.A., Gardner, M.M., Wiener, R.S., Castañeda-Sceppa, C., & Quigley, K.S. (2021). Mobile intervention to improve sleep and functional health of veterans with insomnia: A randomized controlled trial. JMIR. 5(12):e29573. doi: 10.2196/29573.

Margie Lachman, Brandeis University

Increasing Physical Activity Among Sedentary Older Adults: What, When, Where, and With Whom

Abstract: The goal of this project is to increase physical activity (i.e., walking) in sedentary older adults by providing the environmental and behavioral resources to incorporate additional steps into their daily lives. We will use a behavioral approach that fosters a sense of control and facilitates planning by focusing on the what, when, where, and with whom using a smartphone app. During the app development phase, we showed the app wireframe sketches to 9 older adults to get their feedback, and modifications were made accordingly. The app is currently being developed using the Apple Research Kit. In the next phase, participants will be 30 sedentary adults over the age of 60 who own a smart phone. They will be randomly assigned to one of the three conditions using different components of the app. The control group will just have the accelerometer program to count and record steps. One experimental condition will have the schedule and map components, and the second experimental group will have the schedule, map, and social components. The two experimental conditions are expected to increase their steps to a greater extent than the control group. We predict that those in the experimental condition with all components (that is including the social component) will show the greatest increases in their step counts over the course of the 3-month study. We also expect the experimental group will show larger increases in psychological well-being, health quality of life, and social engagement than the control group. The app will also record mood and energy level several times a day. It is expected that on days in which adults are walking they will have more positive affect and greater energy than on inactive days. On average, those who are in the experimental conditions are expected to have a better mood than the control group each week during the intervention and at the 3-month posttest. After the 3-month program is completed the posttest will be administered. Analyses will compare the experimental and control groups to test for differences in walking behavior change. We will examine the effects of the walking program on psychological well-being, sense of control, and social integration and support.

Publications:

• Bisson, A.N., Sorrentino, V., Lachman, M.E. (2021). Walking and daily affect among sedentary older adults measured using the StepMATE app: Pilot randomized controlled trial. JMIR Mhealth Uhealth. 9(12). 10.2196/27208
• Infurna, F. J., Gerstorf, D., & Lachman, M. E. (2020). Midlife in the 2020s: Opportunities and challenges. Am Psychol, 75(4), 470-485. doi: 10.1037/amp0000591, PMCID: PMC7347230.
• Lachman, M. E., Lipsitz, L., Lubben, J., Castaneda-Sceppa, C., & Jette, A. (2018). When adults don’t exercise: Behavioral strategies to increase physical activity in sedentary middle-aged and older adults. Innovation in Aging, 2. doi: 10.1093/geroni/igy007, PMCID: PMC6037047
• Lin, X. Y., Saksono, H., Stowell, E., Lachman, M. E., Castaneda-Sceppa, C., & Parker A. G. (2020). Go&Grow: An Evaluation of a Pervasive Social Exergame for Caregivers of Loved Ones with Dementia. Proc ACM Hum Comput Interact, 4, CSCW 2. doi: 10.1145/3415222, PMCID: PMC7605491.
• Liu, Y., & Lachman, M. E. (2020). A Group-Based Walking Study to Enhance Physical Activity Among Older Adults: The Role of Social Engagement. Res Aging. Doi: 10.1177/0164027520963613, PMCID: PMC8021609.
• Lo, O.Y., Conboy, L.A., Rukhadze, A., Georgetti, C., Gagnon, M. M., Manor, B., Lachman, M. E., Lipsitz, L. A., & Wayne, P. M. (2020). In the Eyes of Those Who Were Randomized: Perceptions of Disadvantaged Older Adults in a Tai Chi Trial. Gerontologist, 60(4), 672-682. doi: 10.1093/geront/gny165, PMCID: PMC7228436.
• Matz-Costa, C., Howard, E. P., Castaneda-Sceppa, C., Iriarte, A. D., & Lachman, M. E. (2019). Peer-Based Strategies to Support Physical Activity Interventions for Older Adults: A Typology, Conceptual Framework, and Practice Guidelines. Gerontologist, 59(6), 1007-1016.  https://doi.org/10.1093/geront/gny092, PMCID: PMC6858827
• Matz-Costa, C., Lubben, J., Lachman, M. E., Lee, H., & Choi, Y. J. (2018). A Pilot Randomized Trial of an Intervention to Enhance the Health-Promoting Effects of Older Adults' Activity Portfolios: The Engaged4Life Program. J Gerontol Soc Work, 61(8), 792-816. https://doi.org/10.1080/01634372.2018.1542371, PMCID: PMC6353638
• Robinson, S. A., Bisson, A. N., Hughes, M. L., Ebert, J., & Lachman, M. E. (2019). Time for Change: Using Implementation Intentions to Promote Physical Activity in a Randomised Pilot Trial. Psychol Health, 34(2), 232-254. https://doi.org/10.1080/08870446.2018.1539487, PMCID: PMC6440859
• Robinson, S. A., & Lachman, M. E. (2018). Daily Control Beliefs and Cognition: The Mediating Role of Physical Activity. J Gerontol B Psychol Sci Soc Sci, 75(4), 772-782. https://doi.org/10.1093/geronb/gby081, PMCID: PMC7328023
• Robinson, S. A., & Lachman, M. E. (2017). Perceived Control and Aging: A Mini Review and Directions for Future Research. Gerontology, 63(5), 435-442. https://doi.org/10.1159/000468540, PMCID: PMC5561527
• Robinson, S. A., & Lachman, M. E. (2018). Perceived Control and Cognition in Adulthood: The Mediating Role of Physical Activity. Psychol Aging, 33(5), 769-781. https://doi.org/10.1037/pag0000273, PMCID: PMC6104634
• Robinson, S., & Lachman, M. E. Perceived control and behavior change: A personalized approach. In: Infurna F, Reich J, editors. Perceived Control: Theory, Research, and Practice in the First 50 Years New York: Oxford University Press; 2016. Chapter 9; p.201-227.
• Stieger, M., Allemand, M., & Lachman, M. E. (2021). Targeting self-control as a behavior change mechanism to increase physical activity: Study protocol of a randomized controlled trial. Contemp Clin Trials, 100, 106236. doi: 10.1016/j.cct.2020.106236, PMCID: PMC7887092.
• Stieger, M., Robinson, S. A., Bisson, A. N., & Lachman, M. E. (2020) The Relationship of Personality and Behavior Change in a Physical Activity Intervention: The Role of Conscientiousness and Healthy Neuroticism. Pers Individ Dif, 166. doi: 10.1016/j.paid.2020.110224, PMCID: PMC7434063.
• Sullivan, A. N., & Lachman, M. E. (2017). Behavior change with fitness technology in sedentary adults: A review of the evidence for increasing physical activity. Frontiers in Public Health, 4. doi: 10.3389/fpubh.2016.00289, PMCID: PMC5225122
• Sullivan-Bisson, A. N., Robinson, S. A., & Lachman, M. E. (2019). Walk to a Better Night of Sleep: Testing the Relationship Between Physical Activity and Sleep. Sleep Health, 5(5), 487-494. https://doi.org/10.1016/j.sleh.2019.06.003, PMCID: PMC6801055
• Wayne, P. M., Gagnon, M. M., Macklin, E. A., Travison, T. G., Manor, B., Lachman, M. E., Thomas, C. P., & Lipsitz, L. A. (2017). The Mind Body-Wellness in Supportive Housing (Mi-WiSH) Study: Design and Rationale of a Cluster Randomized Controlled Trial of Tai Chi in Senior Housing. Contemp Clin Trials, 60, 96-104. https://doi.org/10.1016/j.cct.2017.07.005, PMCID: PMC5639896

Lewis Lipsitz, Hebrew SeniorLife/Harvard Medical School

Factors Influencing Adherence to a Tai Chi Exercise Intervention Among Senior Housing Residents Participating in a Clinical Trial

Abstract: Sedentary older adults with disadvantaged economic or education background are challenging to enroll in exercise intervention programs. Moreover, once recruited, it requires concerted effort to maximize their participation and retention in the program. The NIA-funded Mi-WISH study provides either Tai Chi or Health and Wellness Education interventions to older residents living in subsidized housing facilities. The goal of this Roybal Pilot Project is to determine factors influencing subject recruitment and retention. To date, 79 participants from 8 sites entered the intervention. The adherence rate for Tai Chi and Health and Wellness Education groups are 66.6±13.6% and 77.7±10.4%, respectively. By the end of the study, 67 participants remained and 12 participants withdrew from the program. We have completed 14 focus groups and recorded reasons for 12 withdrawals: six were unwilling or unable to continue in the study, four moved out of the housing site or a nursing home, one death, and one lost to follow up. The analysis from the focus groups is in progress.

Publications: 

• Gordon, S. E., Dufour, A. B., Monti, S. M., Mattison, M. L. P., Catic, A. G., Thomas, C. P., & Lipsitz, L. A. (2016). Impact of a Videoconference Educational Intervention on Physical Restraint and Antipsychotic Use in Nursing Homes: Results From the ECHO-AGE Pilot Study. J Am Med Dir Assoc, 17(6), 553-556. https://doi.org/10.1016/j.jamda.2016.03.002, PMCID: PMC5331906
• Kim, D. H., Afilalo, J., Shi, S. M., Popma, J. J., Khabbaz, K. R., Laham, R. J., Grodstein, F., Guibone, K., Lux, E., & Lipsitz, L. A. (2019). Evaluation of Changes in Functional Status in the Year After Aortic Valve Replacement. JAMA Intern Med, 179(3), 383-391. https://doi.org/ 10.1001/jamainternmed.2018.6738, PMCID: PMC6439710
• Lachman, M. E., Lipsitz, L., Lubben, J., Castaneda-Sceppa, C., & Jette, A. (2018). When adults don’t exercise: Behavioral strategies to increase physical activity in sedentary middle-aged and older adults. Innovation in Aging, 2. doi: 10.1093/geroni/igy007, PMCID: PMC6037047
• Lee, K. C., Streid, J., Sturgeon, D., Lipsitz, S., Weissman, J. S., Rosenthal, R. A., Kim, D. H., Mitchell, S. L., Cooper, Z. (2020). The Impact of Frailty on Long-Term Patient-Oriented Outcomes after Emergency General Surgery: A Retrospective Cohort Study. J Am Geriatr Soc, 68(5), 1037-1043. doi: 10.1111/jgs.16334, PMCID: PMC7234900.
• Lipsitz, L. A., Macklin, E. A., Travison, T. G., Manor, B., Gagnon, P., Tsai, T., Aizpurúa, I. I., Lo, O., & Wayne, P. M. (2020). A Cluster Randomized Trial of Tai Chi vs Health Education in Subsidized Housing: the Mi-Wish Study. J Am Geriatr Soc, 67(9), 1812-1819. https://doi.org/ 10.1111/jgs.15986, PMCID: PMC6732029
• Lo, O.Y., Conboy, L. A., Rukhadze, A., Georgetti, C., Gagnon, M. M., Manor, B., … & Wayne, P. M. (2020). In the eyes of those who were randomized: Perceptions of disadvantaged older adults in a Tai Chi trial. The Gerontologist, 60(4), 672-682. https://doi.org/10.1093/geront/gny165
• Perloff, J., Thomas, C. P., Macklin, E., Gagnon, P., Tsai, T., Isaza, I., Wayne, P. M., & Lipsitz, L. (2021). The Impact of Tai Chi Exercise on Health Care Utilization and Imputed Cost in Residents of Low-Income Senior Housing. Glob Adv Health Med, 10. https://doi.org/ 10.1177/2164956120985479, PMCID: PMC7841657
• Shi, S. M., Sung, M., Afilalo, J., Lipsitz, L. A., Kim, C. A., Popma, J. J., Khabbaz, K. R., Laham, R. J., Guibone, K., Lee, J., Marcantonio, E. R., & Kim, D. H. (2019). Delirium Incidence and Functional Outcomes after Transcatheter and Surgical Aortic Valve Replacement. J Am Geriatr Soc, 67(7), 1393-1401. https://doi.org/10.1111/jgs.15867, PMCID: PMC6612597
• Shi, S. M., Afilalo, J., Lipsitz, L. A., Popma, J. J., Khabbaz, K. R., Laham, R. J., … & Kim, D. H. (2018). Frailty phenotype and deficit accumulation frailty index in predicting recovery after transcatheter and surgical aortic valve replacement. Journal of Gerontology, Series A: Biological Sciences and Medical Sciences, 74(8), 1249-1256. doi: 10.1093/gerona/gly196, PMCID: PMC6625585
• Wayne, P. M., Gagnon, M. M., Macklin, E. A., Travison, T. G., Manor, B., Lachman, M., … & Lipsitz,  L. A. (2017). The Mind Body-Wellness in Supportive Housing (Mi-WiSH) study: Design and rationale of a cluster randomized controlled trial of Tai Chi in senior housing. Contemporary Clinical Trials, 60, 96-104. doi: 10.1016/j.cct.2017.07.005, PMCID:PMC5639896

Lisa Quintiliani, Boston University

A Process Evaluation of an Innovative Approach to Promote Proficiency in Nurse-Led Motivational Interviewing for Behavior Change Among Older Adults

Mentor: Alan Jette

Abstract: Motivational interviewing is an effective psychologically-based health behavior change counseling method, yet it is difficult to maintain proficiency in delivering motivational interviewing as skills tend to wane over time. This may be particularly true among clinicians who face multiple barriers to delivering motivational interviewing, including lack of time and confidence. Therefore, the objective of the proposed Roybal pilot project is to conduct a process evaluation of an innovative approach to improve proficiency in motivational interviewing skills performed by nurse falls care managers in a large multi-center trial that aims to promote physical activity for falls reduction among older adults. We will use multiple sources of data to meet our objective: both objective and self-reported ratings from the nurse falls care managers, feedback from participants, and feedback regarding the feasibility of our approach from multiple stakeholders (clinicians and health care administrators). Currently, we have interviewed 5 stakeholders; we have finished baseline data collection and will commence follow up data collection in 1-2 months. We will then conduct the participant interviews. This process evaluation will provide key information about the effectiveness and feasibility of our approach to promoting proficiency in motivational interviewing, not only in the current trial, but also in future studies. If deemed feasible and effective, this approach to promoting proficiency in motivational interviewing could be widely applied to trials focusing on behaviors, such as physical activity or healthy eating for an array of chronic conditions, including diabetes, frailty, and cardiovascular disease among older adults.

Publications: 

• Colón-Semenza, C., Latham, N. K., Quintiliani, L. M., & Ellis, T. D. (2018). Peer Coaching Through mHealth Targeting Physical Activity in People With Parkinson Disease: Feasibility Study. JMIR Mhealth Uhealth, 6(2), e42. https://doi.org/10.2196/mhealth.8074, PMCID: PMC5832905

Presentations:

• Quintiliani, L. Educational Conference Series at the Geriatrics Section at Boston Medical Center on April 20, 2018
• Quintiliani, L. (2017, July). A Process Evaluation of an Innovative Approach to Promote Proficiency in NurseLed Motivational Interviewing for Behavior Change Among Older Adults. Educational Conference Series at the Geriatrics Section at Boston Medical Center, Boston, MA.

Andrea Parker, Northeastern University

Roybal Center Administrative Supplement: Development of an Exergame for Caregivers of Family Members with Alzheimer's Disease

Mentor: Margie Lachman

Abstract: The number of caregivers providing informal care for family members with Alzheimer’s Disease (AD) is rising dramatically. Caregivers of AD patients have relatively high levels of stress and depression and limited physical activity and social engagement. There is a vital need for supportive programs and novel interventions to help informal caregivers of family members with AD to take care of their own health and well-being. Technology-driven programs can offer engaging, sustainable, and scalable opportunities to give caregivers critically-needed supports for health and well being. We will conduct a pilot study using cognitive behavioral methods to develop an innovative social exergame to increase physical and social activity among AD caregivers. Leveraging wearable activity monitors, physical activity data collected throughout the day and in varied settings will serve as input to the game experience. Caregivers will assess the suitability of alternative prototypes with an array of features including (1) instructional exercise modules, (2) feedback from activity data, (3) digital rewards for physical activity that can be used to create virtual community gardens and artwork galleries, and (4) opportunities to connect virtually with other caregivers to share and comment on their creative products. Aim one is to develop and build the exergame, with the AD caregivers providing extensive input into the features. Twenty AD caregivers will participate in the design and development phase. The second aim is to evaluate enjoyment of the exergame and its feasibility to increase moderate and vigorous physical activity, virtual social contact, exercise self-efficacy, and well-being. A new group of 20 caregivers will test the program on a computer, tablet, or smart phone for four weeks. The findings will be used to develop larger-scale intervention studies to test the efficacy of the exergame in the future. Tailoring an exergame for caregivers of AD has the potential to increase physical activity and to improve overall health and well-being in this vulnerable population, which in turn can benefit the Alzheimer’s patients for whom they provide care.

Publications:

• Lin, X. Y., Saksono, H., Stowell, E., Lachman, M. E., Castaneda-Sceppa, C., & Parker, A. G. (2020). Go&Grow: An Evaluation of a Pervasive Social Exergame for Caregivers of Loved Ones with Dementia. Proc ACM Hum Comput Interact, 4, CSCW 2. doi: 10.1145/3415222, PMCID: PMC7605491.
• Stowell, E., Zhang, Y., Castaneda Sceppa, C., Lachman, M., Parker, A. G. (2019). Caring for Alzheimer's disease caregivers: A qualitative study investigating opportunities for exergame innovation. Proceedings of the ACM on Human-Computer Interaction, 130. https://doi.org/10.1145/3359232

Presentations:

• Proceedings of the 2019 CHI Conference on Human Factors in Computing Systems. New York, NY: ACM.

Nathaniel Rickles, Northeastern University

A Community Pharmacy Exercise and Health Promotion Program (CPEHPP): Stepping Up to Improve Medication Adherence in Older Adults

Mentor: Carmen Sceppa

Objectives: 1. To measure the impact of CPEHPP among older adults on primary outcomes such as number of steps, medication use, and attitudes toward exercise and health. 2. To evaluate the feasibility and acceptability of CPEHPP among older adults.

Methods: Three Boston community pharmacies began, in January 2016, a 1-year randomized, prospective controlled study engaging older adults in a 3-month CPEHPP. Participants are recruited through flyers and/or profile review. Those eligible are 65 years or older; ≥1 of medications for hypertension, diabetes, and/or hyperlipidemia; understand and read English; self-report not exercising at least 150 minutes per week; and indicate having no dementia. All participants have one face to-face meeting with the pharmacist to review the value of exercise, receive an activity tracker for daily step monitoring, and obtain 3 monthly logs to record daily steps. Those randomized to the CPEHPP receive a discussion of exercise goals, barriers, motivators, preferences and reinforcement on medication adherence. CPEHPP participants receive follow-up phone calls weekly during month 1, and biweekly calls during months 2 and 3 for further exercise support. All study pharmacists are trained in exercise and health promotion counseling. Descriptive and bivariate analysis will involve comparing several self-reported measures (collected through surveys) related to exercise and medication self-efficacy, health status, daily steps, and attitudes of medication use. End of study assessments will also evaluate pharmacist and patient self-report of program effectiveness.

Results: To date, 16 females and 7 males (mean 69.1 years, SD 4.6) have been enrolled with 76% being African American and five have completed the program. On average, baseline participants have mostly positive attitudes towards exercise but a third lack confidence in exercise. Initial trends suggest improved step counts associated with CPEHPP.

Presentations:

• A Community Pharmacy Exercise and Health Promotion Program (CPEHPP): Stepping Up to Improve Medication Adherence in Older Adults, Poster to be presented at the American Pharmacist Association meeting, March 2017.
• Rickles NM, Sceppa C, Fitzpatrick D, Cloutier G, Ho A, Moutinho M, Patel S. Pilot study: a community pharmacy exercise and health promotion program. Presented at the Annual Meeting of the American Pharmacists Association (San Francisco, CA) in March 2017.

Stephanie Robinson, Brandeis University

Planning the Next Steps: Using an Implementation Intention Approach to Increase Daily Walking

Mentor: Margie Lachman

Abstract: A perceived lack of time to exercise is a common barrier, especially among working middle-aged adults with numerous demands. Although scheduling out time to exercise can help, many cannot find the time or place to exercise. Using step-counters is a popular approach to enhancing exercise, however it is not clear if this approach by itself is effective in changing behavior. The present study tested the efficacy of a 5-week intervention to increase walking by incorporating additional steps into daily schedules with customized maps of easily accessible walking routes and comparing it to a control group who was given a step counter without any additional instructions. Multilevel analyses revealed significant condition (intervention vs. non-intervention) X time (Weeks 1 – 5) intervention on steps, F(4,1814)=8.57, p<.001. The non-intervention condition showed no increase across the five weeks, while the intervention condition increased their steps by 29.97%. General sense of control, self-efficacy, and cognition do not seem to be influenced by the intervention. However, there was a significant interaction between conditions in pre- and posttest exercise self-efficacy related to time constraints, p=.027. Contrasts revealed that the intervention group significantly increased their time-relevant exercise self-efficacy (p=.005) whereas the control condition showed no significant change (p=.881). These promising results suggest that this low-cost motivational and informational intervention is a feasible method to enhance walking and increase exercise self-efficacy.

Publications:

• Stieger, M., Robinson, S.A., Bisson, A., & Lachman, M.E. (2020).  The relationship of personality and behavior change in a physical activity intervention. Personality and Individual Differences, 166. Advance online publication. https://doi.org/10.1016/j.paid.2020.110224
• Sullivan-Bisson, A. N., Robinson, S. A., & Lachman, M. E. (2019). Walk to a better night of sleep: Testing the relationship between physical activity and sleep. Sleep Health: Journal of the National Sleep Foundation, 5(5), 487-494. doi.org/10.1016/j.sleh.2019.06.003, PMCID: PMC6801055
• Robinson, S. A., Bisson, A. N., Hughes, M. L., Ebert, J., & Lachman, M. E. (2020). Time for change: Using implementation intentions to promote physical activity in a randomised pilot trial. Psychology & Health, 34(2), 232-254. doi: 10.1080/08870446.2018.1539487, PMCID: PMC6440859
• Robinson, S. A. & Lachman, M. E. (2018). Daily control beliefs and cognition: The mediating role of physical activity. Journals of Gerontology, Series B: Psychological Sciences, 75(4), 772-782. https://doi.org10.1093/geronb/gby081, PMCID: PMC7328023
• Robinson, S. A., & Lachman, M. E. (2018b). Perceived control and cognition in adulthood: The mediating role of physical activity. Psychology and Aging, 33(5), 769-781. doi: 10.1037/pag0000273, PMCID: PMC6104634
• Robinson, S. A., Lachman, M. E. (2017). Perceived control and aging: A mini review and directions for future research. Gerontology, 63(5), 435-442. doi: 10.1159/000468540, PMCID: PMC5561527
• Robinson, S. A. & Lachman, M. E. (2016). Perceived control and behavior change: A personalized approach. In F. Infurna & J. Reich (Eds.), Perceived control: Theory, research, and practice in the first 50 years (pp. 201-227). New York, NY: Oxford University Press.

Presentations:

• Hughes, M. L., Lachman, M. E., & Robinson, S. A. Taking Steps to Feel Younger. In J. Bellingtier (Chair). Accepted for Symposium Presentation at the 126th Annual APA Convention, San Francisco, CA.
• Robinson, S. A. & Lachman, M. E. (2017, July 16-20). Conscientiousness and Daily Physical Activity: Perceived Control as a Mediator. In J. Drewelies (Chair). The Importance of Control Beliefs for Successful and Healthy Aging. Accepted for Symposium Presentation at 21st IAGG World Congress of Gerontology and Geriatrics, San Francisco, CA.
• Sullivan, A. N., Robinson, S. A., & Lachman, M. E. (2017, May 25 – 28). Walk to a better night of sleep: Examining the relationship between activity and sleep. Accepted for presentation at the annual meetings of the Association for Psychological Science (APS), Boston, MA.
• Robinson, S. A., Sullivan, A., Hughes, M., Ebert, J. & Lachman, M. E. (2016, November 16-20). Planning the Next Steps: A Feasibility Study to Enhance Walking in Middle-aged Adults. In M. E. Lachman (Chair), Strategies to Increase Physical Activity: Boston Roybal Center for Active Lifestyle Interventions. Symposium conducted at The Gerontological Society of America's Annual Scientific Meeting, New Orleans, LA.

Jutta Wolf, Brandeis University

Increasing Physical Activity in Middle-Aged and Older Adults – A Stress Framework

Mentor: Margie Lachman

Abstract: Middle and older age is associated with elevated risk for negative health outcomes, giving rise to health behavior change intentions. Given the health implications, unsuccessful attempts to implement health behavior change may induce stress, which may negatively affect future attempts. The current study aimed to reduce stress in order to facilitate implementation of physical activity change by providing individually tailored and comprehensive informational support (‘scaffolding’). A total of 104 sedentary middle-aged and older adults were enrolled in a 12-week Fitbit-assisted walking intervention with a comprehensive baseline assessment during week 1 and week 12, as well as 10 weeks of daily diary reports. For weeks 2-11, bi-weekly 15% increases in goal steps were developed based on an individual’s average week 1 step count. First, we assessed daily walking behavior and exercise motivations. As expected, with increasing age, women walked less. Physical appearance, weight management and health pressures were identified as motivators for physical activity (PA) across all ages, however, only appearance concerns motivated actual behavior (daily steps), while perceiving health pressures was linked to self-reported behavior. Interestingly, at no age were health promotion and ill-health avoidance associated with Fitbit-measured or self-reported PA. Lastly, having weight management being a strong motivator for exercising predicted higher depressive symptoms independently of physical activity. Next, we assessed changes over the course of the intervention. Most importantly, participants successfully increased their daily steps by 43%. Furthermore, as intended, perceived stress levels significantly decreased, while depressive symptom severity significantly improved. These changes were accompanied by significant increases in exercise self-efficacy levels, which were closely tied to increases in steps from pre to post intervention. Interestingly, although physical ability itself only improved at a trend-level, participants reported significant increases in physical function satisfaction. Of note, all these effects were comparable across the two informational support levels. In contrast, assessing subjective social status revealed that only participants in the high informational support condition reported improvements in perceived status, with higher status ratings post-intervention predicting lower post-intervention depressive symptom severity. Taken together, the current findings are highly encouraging and in support of the study’s general framework.

Presentations:

• Elling, Goodman, Sabik, Wolf. Self-objectification is linked to physical activity and physical activity change in sedentary middle to older-aged women. Poster presentation at the American Psychosomatic Society, March 2018, Louisville, KY.
• Elling, Goodman, Geiger, Vaynberg, Sabik, Wolf. Positive opinions of one’s body functions, but not body image, are linked to physical activity in middle to older-aged women. Poster presentation at the International Society of Psychoneuroendocrinology, September 2017, Zurich, Switzerland.
• Goodman, Geiger, Elling, Wolf. Associations between physical activity motivations and physical activity in middle to older aged women after a 12-week walking intervention. Poster presentation at the International Society of Psychoneuroendocrinology, September 2017, Zurich, Switzerland.
• Maxfield, J., Elling, C., Goodman, W., Geiger, A., Wolf, J. Dispositional mindfulness buffers against sleep decrements in older age. Paper presentation at the Eastern Psychological Association, April 2017, Boston MA
• Elling, C., Goodman, W., Geiger, A., Vaynberg, I., Loaiza, Sabik, Wolf, J. Positive opinion of one’s body functions and perceptions of more positive appearance judgments by others are linked to physical activity in middle-aged women. Poster presented at the American Psychosomatic Society, March 2017, Seville, Spain.
• Geiger, A. Goodman, W., Elling, C., Kaye, Kriegsman, R., Wolf, J. Increases in subjective social status during a 12-week walking intervention predict health improvements in middle- aged and older women. Poster presented at the American Psychosomatic Society, March 2017, Seville, Spain.
• Goodman, W., Geiger, A., Elling, C., Corvil, R., Bernstein, Wolf, J. Appearance concerns but not health promotion motivates Fitbit-assessed physical activity behavior in middle-aged and older women. Paper presentation at the American Psychosomatic Society, March 2017, Seville, Spain.
• Vaynberg, I., Geiger, A., Elling, C., Goodman, W., Sherman, Wolf, J. A 12-week Fitbit-assisted walking intervention improves body function satisfaction in older women and decreases physical limitations in middle-aged women. Poster presented at the American Psychosomatic Society, March 2017, Seville, Spain.

Christina Matz-Costa, Boston College

Enhancing the Health-Promoting Effects of Older Adults’ Activity Portfolios: The Development, Feasibility and Initial Efficacy of a Real-Time, Ecologically Sensitive Intervention

Mentor: James Lubben

Abstract: Engaged4Life is an innovative multi-component intervention designed to help community dwelling older adults, who are at-risk for adverse cognitive and physical health outcomes due to their sedentary activity levels, to enhance existing or explore new activities that are personally meaningful and that also provide opportunities for physical activity. 15 adults age 65 or older were randomized to receive and 15 to not receive the Engaged4Life intervention, consisting of a 3-hour workshop and individualized peer mentoring via phone (2X/week for 3 weeks). Outcomes were measured using FITBIT® Zips worn daily and daily surveys assessed using iPad® Minis. Linear mixed effects models revealed that daily steps increased from the baseline to T1 (4- week follow-up) and from baseline to T2 (8-week follow-up) for the intervention group (n=12), but decreased for the control (n=13). Also, time spent/day in sedentary activities and daily fatigue levels decreased for the intervention group compared to the control group. Qualitative interviews with study participants, peer mentors, and staff at the partner organizations supported the feasibility and acceptability of the intervention. These findings indicate that the intervention shows initial promise in facilitating active lifestyles through personally meaningful activity engagement. The individualized approach focused on increasing activities that also support cognitive activity, social interaction, and personal meaning may enhance the likelihood that this intervention will have an impact on more distal outcomes like cognitive and functional health in later life and will support longterm adherence to the more active lifestyle. These hypotheses will be explored in future studies.

Publications:

• Matz-Costa, C., Howard, E., Sceppa, C., Diaz-Valdes Iriarte, A., & Lachman, M. (2018). Peer-based strategies to support physical activity interventions for older adults: A typology, conceptual framework, and practice guidelines. The Gerontologist. Advance online publication. doi: 10.1093/geront/gny092, PMCID in process
• Matz-Costa, C., Lubben, J., Lachman, M., Lee, H. N., & Choi, Y. J. (2018). A pilot randomized trial of an intervention to enhance the health-promoting effects of older adults' activity portfolios: The Engaged4Life Program. Journal of Gerontological Social Work, 61, 792-816. doi: 10.1080/01634372.2018.1542371, PMCID: PMC6353638

Presentations:

• Matz-Costa, C., Howard, E., Sceppa, C., & Lachman, M. (2017, June). Peer-based strategies to support physical activity interventions for older adults: Lessons learned from the Boston Roybal Center. An invited presentation at the Boston Roybal Center for Active Lifestyle Interventions (RALI) Center Annual Meeting, Brandeis University, Waltham, MA: National Institute on Aging.
• Matz-Costa, C. Presentation on improving activity in older adults. Boston College School of Social Work (2017, January 25). Faculty publication spotlight: Boston College School of Social Work Blog. Retrieved from: https://bcsocialworkblog.com/2017/01/25/faculty-publication-spotlight-Christina-Matz-Costa-on-improving activity-in-older-adults/
• Matz-Costa, C., Lee, H.L, Choi, Y.J., Foss, S., & Lubben, J. (2017, January). Findings from a randomized controlled trial of an ecologically-sensitive intervention to enhance the health-promoting effects of older adults' activity portfolios. Paper presented in C. Matz-Costa (chair), Engagement in paid and unpaid work in later life: From conceptualization to intervention and the role of social work. Symposium presented at the 2017 Society for Social Work Research’s (SSWR) Annual Conference, New Orleans, LA.
• Matz-Costa, C., Lee, H.L, Choi, Y.J., Foss, S., & Lubben, J. (2016, November). Engaged4Life: An ecologically sensitive intervention to enhance the health-promoting effects of older adults’ activity portfolios.
• Matz-Costa, C. (2016, May 19). The results of the Engaged4Life Study: A research partnership between Boston College and the Waltham Council on Aging. Open to the Waltham Community. Waltham, MA.

Elizabeth Howard, Hebrew Senior Life/Harvard Medical School

Promoting Optimal Wellness among EldeRs through Vitalize 360 (Power V-360)

Mentor: Lewis Lipsitz

Abstract: This pilot project expanded COLLAGE/Vitalize 360, comprehensive assessment and wellness coaching program into low-income housing. Initially implemented in a continuing care retirement community (CCRC), one year follow-up analyses, compared to a no coaching control group, demonstrated improved mood state (p=0.035), improved quality of life (p= 0.032) and decreased loneliness and social isolation. For Vitalize 360 low-income sample, there was a 10% increase in average physical activity level after one year but 6 months later, physical activity level decreased to near baseline level. Comparison group not receiving any wellness coaching had consistently lower physical activity levels that remained stable over time. Contrary to CCRC results, other analyses revealed outcomes of mood, health status and quality of life remained unchanged over time. Future exploration of factors impacting disparate outcomes will be pursued to revise the model so as to improve physical activity level and related health outcomes across all older adult populations.

Publications:

• Matz-Costa, C., Howard, E., Sceppa, C., Diaz-Valdes Iriarte, A., & Lachman, M. (2019). Peer-based strategies to support physical activity interventions for older adults: A typology, conceptual framework, and practice guidelines. The Gerontologist, 59(6), 1007-1016. doi: 10.1093/geront/gny092, PMCID: PMC6858827
• Howard, E. P., & Louvar, K. E. (2017). Examining life goals of community-dwelling, low-income older adults. Research in Gerontological Nursing 10, 205-214. doi: 10.3928/19404921-20170831-02, PMCID: PMC5890925
• Howard, E. P., Schreiber, R., Morris, J. N., Russotto, A., & Flashner-Fineman, S. (2016). COLLAGE 360: A model of person-centered care to promote health among older adults. Journal of Ageing Research and Healthcare, 1. doi: 10.14302/issn.2474-7785.jarh-16-1123, PMCID: PMC5627496

Presentations:

• Matz-Costa, C., Howard, E., Sceppa, C., & Lachman, M. (2017, June). Peer-based strategies to support physical activity interventions for older adults: Lessons learned from the Boston Roybal Center. An invited presentation at the Boston Roybal Center for Active Lifestyle Interventions (RALI) Center Annual Meeting, Brandeis University, Waltham, MA: National Institute on Aging.
• Howard, E. Lipsitz, L., Schreiber, R. Power-V 360 – Promoting Optimal Wellness among Elders through Vitalize 360. Gerontological Society of America’a 69th Scientific Annual Meeting, New Orleans, LA (November 2016) (symposium presentation)
• Howard, E. Power-V 360 – Promoting Optimal Wellness among Elders through Vitalize 360. 2016 World InterRAI Conference, Toronto, Ontario, Canada (April 2016) (podium presentation)

Holly Jimison, Northeastern University

Remote Health Coaching Technology to Address Depression Risk Factors in Older Adult Populations with Health Disparities

Mentor: Carmen Sceppa

Project Goals: The goal of our research was to determine how best to develop a novel and scalable approach to interactive video exercise and coaching in support of depression prevention and management, with a focus on low-income older adults living independently at home. We built upon our existing software platform for semi-automated remote health coaching to explore new options for tailoring our interfaces, messaging, and protocols to low-income minority populations. Our specific aim for this pilot project was to obtain guidance from low-income older adults regarding preferred technologies and interfaces for home-based exercise. Our method for addressing this aim was to conduct a set of focus groups with low-income minority older adults in Boston Housing Authority (BHA) residences to obtain suggestions for implementing health behavior change interventions and how best to use sensor and communications technology to make the interfaces, messages, and protocols most compelling and meaningful. With the recommendations from the focus groups, our ultimate goal was to develop design specifications and use these to update our interactive exercise systems to prepare for a follow-on clinical trial of interactive physical exercise and health coaching technologies as a component of depression prevention and management in low-income older adults at risk for poor health outcomes.

Study Design: We used a funnel design for the focus groups, starting with general open-ended discussions followed by reactions to stimulus materials, including existing and newly created intervention protocols, displays, and messages. We also asked focus group participants about their preferences and guidance on what would be important aspects to include in the interactive video materials. Using standard qualitative methodologies, we identified and described themes and patterns in preferences and recommendations. Participants reported preferences for protocols and interface designs for in-home exercise systems. We obtained feedback on preferences for instructor’s ethnicity, avatar types (if used), music, and exercise protocols. Participants were recruited from two Boston Housing Authority public housing facilities, Holgate and Bellflower. We intentionally selected locations with a high proportion of African American residents. We recruited a total of 28 participants across the two locations (10 in Holgate, 18 in Bellflower). Focus groups were held in December 2015 in communal spaces within each housing facility. Each group met for approximately one hour. Participants were provided beverages and snacks as well as a $25 grocery gift card.

Results: Main findings — At both sites, there was a strong preference for video using upbeat gospel, soul or Latin music. Other aspects of the technologies presented resulted in mixed or inconclusive results. Examples include exercising alone vs. with others, acknowledgment vs. anonymity, cultural matching of instructor, and avatar representation. Discussion among participants raised several critical barriers that must be addressed in order to utilize many of the technologies presented.

Secondary findings — Many of our focus group findings were not directly related to our initial research question, but still very informative in preparing for follow-on studies in low-income minority settings. For example, even though BHA residences are considered senior facilities, many residents are less than 65 years old but there due to health frailty. Secondly, we found that requiring the signing of a consent form to participate in a focus group made several people very suspicious about what they were signing. Although, we explained the content of the form a few people asked to participate but refused to sign and we could not use their comments in our analysis.

Thirdly, we found that $25 was too great an incentive for this group. In later discussions with the 9 staff, we determined that it would be better to have the amount go to a group activity or a common area improvement. Fourth, most if not all BHA residences do not have widely available Internet access; a few have a computer room with Internet access, but some have no connectivity at all, let alone access to a wireless network that would facilitate sensor-based interventions. If we were to plan for and incur the cost of installing residence-wide Wi-Fi, we would still need to address the need for training, as participants were often intimidated by unfamiliar technologies.

Publications:

• Jimison, H. B., Hagler, S., Kurillo, G., Bajcsy, R., & Pavel, M. (2015). Remote health coaching for interactive exercise with older adults in a home environment. Engineering in Medicine and Biology Society (EMBC), 2015 37th Annual International Conference of the IEEE, 5485-5488. doi: 10.1109/EMBC.2015.7319633, PMCID: PMC4809522
• Ofli, F., Kurillo, G., Obdržálek, S., Bajcsy, R., Jimison, H., & Pavel, M. (2015). Design and evaluation of an interactive exercise coaching system for older adults: Lessons learned. IEEE Journal of Biomedical Health and Informatics, 20, 201–212. doi: 10.1109/JBHI.2015.2391671, PMCID: PMC4835340
• Pavel, M., Jimison, H. B., Korhonen, I., Gordon, C. M., & Saranummi, N. (2015). Behavioral informatics and computational modeling in support of proactive health management and care. IEEE Transactions on Biomedical Engineering, 62, 2763–2775. doi: 10.1109/TBME.2015.2484286, PMCID: PMC4809752

Nancy Latham, Boston University

A Web-Based Training Module for Peer-Coaches to Promote Exercise Adherence in People with Neurological Conditions

Mentor: Alan Jette

Introduction: The vast majority of individuals with Parkinson disease (PD) are sedentary. Long-term engagement in exercise and physical activity increases quality of life and may mitigate the progression of the disability. There is a critical need for a safe, feasible, and effective method to assist those with PD to engage in active lifestyles. Training peers to be coaches may be a viable approach to help people with PD to engage in exercise successfully over the long-term. The purpose of this study was to develop and evaluate the safety, feasibility and acceptability of a peer mentoring training and walking program in people with PD. We also examined individual level changes in walking activity, self-efficacy and disability.

Methods: A peer coaching training program and a peer mentored walking program was developed and tested in 10 individuals with PD. We matched 5 physically active persons with PD (peer coaches) with a sedentary person with PD (peer mentee) resulting in 5 peer pairs. Using both web-based and in-person delivery methods, we trained the peer coaches in basic knowledge of PD, exercise, active listening and motivational interviewing. Peer coaches and mentees wore FitBit Zip activity trackers and participated in daily walking over 8 weeks. Peer pairs interacted via the FitBit application and weekly telephone calls over the 8-week study period.

Results: There were no adverse events over the course of the study. All participants would recommend this program to others with PD. All peer coaches were “satisfied” or “very satisfied” with the training program and all participants were “satisfied” or “very satisfied” with the peer mentored walking program. Four of the 5 pairs completed the 8 weekly phone conversations; the remaining pair completed 6/8 weekly phone conversations. Increases in average steps/day exceeding the clinically important difference occurred in 4/5 mentees. Conclusions: Peer coaching is safe, feasible and acceptable for persons with PD. Peer coaching may be an effective method to increase physical activity in PD. Larger, controlled trials are necessary to examine effectiveness of this approach.

Publications:

• Colón-Semenza, C., Latham, N. K., Quintiliani, L. M., Ellis, T. D. (2018). Peer coaching through mHealth targeting physical activity in people with Parkinson Disease: Feasibility study. JMIR Mhealth Uhealth, 6. doi: 10.2196/mhealth.8074, PMCID: PMC5832905

Presentations:

• Latham, Nancy. Extending the Benefits of Physiotherapy in Community Settings. Australian Physiotherapy Association Annual Conference, Sydney Australia October 19, 2017.
• C. Colón-Semenza, N. Latham, L. Quintiliani, N. Sullivan, T. Ellis. Feasibility of Peer Coaching to Increase Physical Activity in People with Parkinson Disease. American Physical Therapy Association, Combined Sections Meeting, San Antonio, TX; February 2017.
• C. Colón-Semenza, N. Latham, L. Quintiliani, N. Sullivan, T. Ellis, A. Jette. Development of a Training Program for Peer Exercise Coaches for People with Parkinson Disease. Gerontological Society of America, New Orleans, LA; November 2016 11
• C. Colón-Semenza, N. Latham, L. Quintiliani, N. Sullivan, T. Ellis. Feasibility of Peer Coaching to Increase Physical Activity in People with Parkinson Disease. World Parkinson Congress, Portland, OR; September 2016.
• C. Colón-Semenza and N. Latham. Behavior Change for People with Parkinson Disease: Increasing Physical Activity for Lasting Self-Management. Physical Therapy Faculty Program at the Parkinson Disease Foundation, Boston, MA; August 2016.
• T. Ellis, American Physical Therapy Association Combined Sections Meeting; Evidence-Based Rehabilitation in Persons with Parkinson Disease: 2-day preconference; Anaheim, CA; February 2016
• N. Latham, T. Ellis, T. DeAngelis, K. Hendron The Use of Mobile Health and Virtual Coach Technology for People with Neurological Conditions. American Congress of Rehabilitation Medicine, Dallas TX, October 2015.

Carmen Sceppa, Northeastern University

Does Exercise-Induced Improvement in Emotion Regulation Enhance Daily Physical Activity and Well-Being in Frail Sedentary Older Adults?

Mentor: Terry Fulmer

Abstract: We examined whether improved physical function from engaging in a resistance+balance training (RBT) program favorably influences emotional regulation and free-living physical activity (FLPA) in community dwelling frail older adults. Twelve frail women and 8 men (72.9±6.8 y; gait speed: 0.67±0.14 m/sec) were randomized to RBT 2x/wk (n=13) or attention-control (n=7). Physical function, emotion regulation, and 7-dayFLPA measured with activPALs were assessed before and after 12 weeks. Exercise improved gait speed (∆45.8%, p=0.001), balance (∆65.2%, p=0.008), chair stand (∆24.8%, p=0.025), and the Short Physical Performance Battery scores (∆37.5%, p=0.0001), with no increases in FLPA or emotion regulation. Across all participants, positive mood at baseline was significantly correlated with a positive change in gait speed (r=.56, p=.03). These preliminary findings suggest some novel links between mood and improved health behaviors in frail older adults. Future work must explore the links between function and both mood and emotion regulation strategies in this at-risk population.

Publications:

• Castaneda-Sceppa, C., Cloutier, G.J., Isaacowitz, D.M., & John, D. (under review). Exercise-induced relationships between physical performance, activity and affect in community-dwelling frail older adults.
• Lachman, M.E., Lipsitz, L., Lubben, J., Castaneda-Sceppa, C., & Jette, A. (2018). When adults don’t exercise: Behavioral strategies to increase physical activity in sedentary middle-aged and older adults. Innovation in Aging, 2. doi: 10.1093/geroni/igy007, PMCID: PMC6037047
• Lin, X.., Saksono, H., Stowell, E., Lachman, M.E., Castaneda-Sceppa, C., & Parker A.G. (2020). Go&Grow: An Evaluation of a Pervasive Social Exergame for Caregivers of Loved Ones with Dementia. Proc ACM Hum Comput Interact, 4, CSCW 2. doi: 10.1145/3415222, PMCID: PMC7605491.
• Matz-Costa, C., Howard, E., Sceppa, C., Diaz-Valdes Iriarte, A., & Lachman, M. (2019). Peer-based strategies to support physical activity interventions for older adults: A typology, conceptual framework, and practice guidelines. The Gerontologist, 59(6), 1007-1016. Advance online publication. doi: 10.1093/geront/gny092, PMCID: PMC6858827

Presentations:

• Matz-Costa, C., Howard, E., Sceppa, C., & Lachman, M. (2017, June). Peer-based strategies to support physical activity interventions for older adults: Lessons learned from the Boston Roybal Center. An invited presentation at the Boston Roybal Center for Active Lifestyle Interventions (RALI) Center Annual Meeting, Brandeis University, Waltham, MA: National Institute on Aging.
• Castaneda-Sceppa, C., Cloutier, G., Sands, M., Karliyil, K., Strode, S., Isaacowitz, D., & John, D. Effects of improved physical function on emotion regulation strategies and daily physical activity.
• Results were shared with community partners: East Boston Neighborhood Health Center Elder Service Plan and the Irish Parish Center in Dorchester, MA.
• Project presented at the Beth Israel Deaconess Medical Center Division of Gerontology Grand Rounds, Boston, MA (Feb. 7, 2017).