Dori E. Rosenberg, Ph.D. - US grants

[unreadable] DESCRIPTION (provided by applicant): Among older Americans regular physical activity (PA) can decrease the risk of developing, and improve outcomes of existing, chronic disease. Yet, levels of PA decline substantially with advancing years making older adults largely inactive. Interventions to promote PA among older adults often focus on structured group exercise programs even though such programs are sometimes difficult to sustain and older adults may prefer doing activity independently. Walking is an activity often promoted for older individuals as it is easy, inexpensive, and can be performed almost anywhere on one's own. Theory grounded in individual and/or social perspectives has guided recent approaches to promoting walking in older adults and lacked environmental dimensions. It is increasingly important to address limitations of the physical environment faced by older adults including uneven sidewalks, unsafe streets, and lack of access to useful destinations. Individuals in assisted living facilities (ALFs) have rarely been the focus of physical activity research yet ALFs are home to increasing numbers of older adults who may be particularly prone to the constraints of their environments. Specialized approaches to increasing walking levels in residents of ALFs hold promise for improving physical functioning and health. The goal of the proposed study is to test a multilevel walking intervention focusing on individual, interpersonal, and environmental levels in assisted-living older adults. The study will be a randomized controlled field trial where residents living in 2-4 ALFs will partake in an intervention or comparison condition. Intervention components will include: pedometers for self-monitoring, feedback and motivation; individualized health counseling focusing on step goal setting; group meetings to encourage social support and problem solve barriers to walking; and tailored walking route maps designed to change participant perceptions of their site and neighborhood environments. Comparison group participants will receive weekly healthy aging seminars on topics other than physical activity. It is hypothesized that, compared to those randomized to the comparison condition, participants in the intervention group will have improved weekly step counts, physical functioning, and reports of depression and quality of life. Relevance: Adults over age 65 constitute a growing segment of the population and increasing numbers are moving to ALFs. Promoting walking in this population can contribute to health and quality of life outcomes yet little is known about how to accomplish this. This project will evaluate an innovative and sustainable intervention that is designed to enable seniors to overcome barriers to PA in their own neighborhood; if successful it may be generalizable to other ALFs. [unreadable] [unreadable] [unreadable] [unreadable]

Abstract Nearly 40% of adults over age 60 are obese. On average, these individuals spend over 10 hours a day sitting. This is a concern since emerging research shows higher sitting time is associated with worse cardiovascular and metabolic health. In fact, most obese older adults have comorbid cardiometabolic conditions. Interventions which can reduce sitting time in this high-risk population could improve health and lower health care costs. As such, more research is needed to develop interventions to effectively reduce sitting time among older obese adults. The proposed study will address this important goal and build on the promising results of our I-STAND randomized pilot study. This study found that a theory-based, multi-modal behavioral intervention which combined phone counseling and technology-based behavioral prompts was feasible, acceptable, and significantly reduced sitting time (-75 minutes/day in the intervention compared to control group, p < .01). Among those with elevated blood pressure at baseline, blood pressure also improved in two of our pilot studies. In short, we found that I-STAND warrants evaluation in a large randomized controlled trial. The current study will compare I-STAND to an attention-matched control intervention among participants over age 60, with obesity, and who sit more than 8 hours per day (N = 284). Both interventions include one in- person session and 9 follow-up phone calls. Experimental participants will also receive prompts for standing via wrist-worn technology and a home environment audit to identify modifications to improve standing time. All participants will be followed for 12 months. After 6 months, experimental participants will be re-randomized to receive either 5 additional booster calls or no further intervention, allowing us to assess the effects of the initial intervention and booster sessions. The primary outcomes will be reduction in sitting time as measured by a thigh-worn activPAL inclinometer and blood pressure. The secondary outcomes include changes in cardiometabolic risk factors (e.g. weight, lipids, fasting glucose). Mediators of significant treatment effects will also be explored. If effective, I-STAND could easily be implemented by health care systems to improve the health of older obese adults nationwide.

Physical activity (PA), sedentary behavior (SB), and sleep all impact cognitive and physical health in aging. Most research to date has focused on how time spent in each of these behaviors individually impacts health outcomes. However, interactions of PA, SB, and sleep likely account in part for the tremendous heterogeneity in aging-related health outcomes, and their optimal balance across the 24-hour day in supporting healthy aging is not known. This proposal capitalizes upon unique resources available through the Adult Changes in Thought (ACT) U19 Program to explore the inter-relatedness of PA, SB, sleep, and longitudinal trajectories of cognitive and physical health. The 24-hour activity cycle paradigm as a model for determining longitudinal inter- relatedness of PA, SB, and sleep on health outcomes is innovative, as is our proposed collection of device- based data to complement self-reported outcomes. This project proposes to use a number of innovative statistical approaches to analyze the complex relationships between the 24-hour activity cycle and trajectories of cognition and physical functioning. Scientific rigor is supported by objective monitoring of 24-hour behaviors and builds upon more than two decades of ACT data in a well-characterized clinical population. Measures of cognitive and physical function will include Cognitive Abilities Screening Instrument item response theory scores, specialized tests of executive functioning and verbal fluency, self-reported activities of daily living, gait speed, rising from a chair, and grip strength. For Aim 1, we will test bidirectional associations relating cognitive and physical function to the 24-hour activity cycle using device-assessed measures of PA and SB, and self- reported sleep. We hypothesize that (a) historically better cognitive and physical function will be independently associated with higher levels of PA, lower SB, and better sleep in ACT participants, and (b) more PA, less SB, and better sleep will be independently associated with better future maintenance of cognitive and physical function. For Aim 2, we hypothesize that (a) historically better cognitive and physical function will be independently associated with better device-assessed sleep quality and circadian rhythms in ACT participants, and (b) better device-assessed sleep quality and circadian rhythms will be independently associated with better future maintenance of cognitive and physical function. For both Aims, we will construct combined 24- hour activity cycle profiles (based on different balances of PA, SB, and sleep) and explore how profiles are associated with historical trajectories of and future changes in cognitive and physical function. Collaboration with other Cores will provide new data about how Life Course and Clinical Core variables influence associations, as well as new information about relationships between the 24-hour activity cycle and novel neuroimaging data. Ultimately, our results will provide much needed evidence to inform the development of guidelines and interventions to promote healthy aging in older adults, potentially including reducing risk for cognitive decline and late life dementia including Alzheimer?s disease.