Supported Research

Academy Title:USING THE POWER OF THE INTERNET TO PROVIDE SOCIAL SUPPORT TO OLDER ADULTS ENGAGED IN A WELL-ROUNDED EXERCISE PROGRAM (WellREP)
USING THE POWER OF THE INTERNET TO PROVIDE SOCIAL SUPPORT TO OLDER ADULTS ENGAGED IN A WELL-ROUNDED EXERCISE PROGRAM (WellREP)

The aim of this project is to assess the efficacy of two models of presentation and support of a well-round physical exercise program (WellREP) for older Kansans: (1) a home-based, internet support driven program vs. (2) a class-based, internet support driven program. To date, research has shown that strictly home-based exercise programs are ineffective in promoting long term health behavior change and corresponding health outcomes. What most home-based programs lack are methods to encourage internal motivation and mechanisms to deliver external support to encourage older adults to start and maintain a physical activity program.

WellREP is a 16-week, 2 day/week physical activity intervention involving flexibility, strength, balance, and cardio-respiratory training. Grounded in the Theory of Reasoned Action and the Theory of Planned Behavior, the internet based support program WellREP-Online (WellREP-O) includes eight elements designed to support participants in their efforts to lead an active lifestyle: education, discussion board communication, step tracking logs and graphs to monitor progress, individualized goals, exercise (flexibility, strength and balance) routines and tracking, progression along a virtual US trail, walking competition, and motivational newsletters.

The questions of this pilot project necessitate four experimental groups: 1. Class-based WellREP-O; 2. Home- based WellREP-O; 3. Class-based WellREP-Control (no support); and 4. Home-based WellREP-Control (no support).

Objectives:
1.To determine if fostering internal- and providing external-motivation and support via the home-based WellREP-O, is more effective in improving fitness and activity levels than a home-based WellREP program without motivation and support.

2.To determine if fostering internal- and providing external-motivation and support via the class-based WellREP-O, is more effective in improving fitness and activity levels than a class-based WellREP program without motivation and support.

3.To assess whether either of the treatment methods, home- or class-based WellREP-O, are more effective in promoting behavior change than either a class-based program alone or a home-based program alone.

Protocol. D1. Design: Due to the missions of the community partners to provide physical activity programming for their communities and translational nature of this study, enrollment using a non-randomized design will be used and may result in unequal sample sizes. The limitation of this approach is the lack of randomization of subjects to the intervention groups. Thus, this study employs a quasi-experimental, nonequivalent control group design. This design is reported to be an acceptable alternative to an experimental design when randomization is not possible. ,

D2. Study Setting and Population: Approximately 80 females aged 55+ years will be recruited from local community centers, senior centers, retirement communities, other senior-based programs and media publications. Sample size was determined based on published , and unpublished functional fitness data. Training effects indicate a sample size of 12 subjects is required for a power of 0.80. Eighty participants will be recruited to allow equal participation (15) in the 4 intervention arms, while also accounting for attrition. Class-based WellREPs will be held at the Wichita Downtown Senior Center (Control) and Hesston Wellness Center (Online Intervention). Home-based participants will be recruited through senior-based programs and media publications.

D3. Screening: This study involves the elderly, a population viewed as vulnerable. To determine appropriateness of participation, older adults will be screened using the EASY (Exercise And Screening for You) tool. This tool was developed by an expert panel of interdisciplinary researchers and clinicians with experience establishing PA programs for older adults. The tool provides recommendations for safe and appropriate activities in light of known risk factors. If screening indicates the older adult should consult their healthcare provider, then physician consent will be required for program participation.

D4. Intervention:, WellREP is a 16-week, 2 day/week intervention including flexibility, strength, balance, and cardio-respiratory training. There will be 4 experimental groups: 1. Class-based WellREP-O; 2. Home- based WellREP-O; 3. Class-based WellREP-Control (no support); and 4. Home-based WellREP-Control (no support).

Class- and home-based WellREP-O Program Web Site: Class- and home-based WellREP-O participants (experimental groups 1 and 2) will have access to the program website. Grounded in the Theory of Reasoned Action and the Theory of Planned Behavior, the internet-based support program WellREP-O will be maintained and monitored by the PI and research assistant. The site will serve as a user-friendly interactive, secure, online method to motivate, educate, and track PA. The site will consist of eight major elements: educational material, discussion board communication, step tracking logs and graphs to monitor progress, individualized step goals, strength training routines and logs, walking progression along a virtual US trail, walking competition, and motivational newsletters. Participants will log into the site at least once per week to record steps, flexibility and strength training, and non-translatory PA (elliptical machine, gardening, etc). Non-translatory PA will be converted to steps, combined with pedometer step counts resulting in an overall activity index. Participants will receive immediate feedback regarding their activity index and view graphs and maps of their progress along a virtual US trail. Participants will form teams of 5 to “race” across the US. The site will provide newsletters to share information related to PA barriers, starting a walking program, strength training, strategies to accumulate PA, area walking routes, and the physical and mental benefits of daily PA.

Cardiovascular: WellRep-O participants will receive a pedometer to monitor and increase daily activity. Strategies to increase PA will be presented in newsletters. PA will be monitored by pedometers. Progression will be based on an individualized approach of goal-setting and self-monitoring. To achieve an individualized prescription, a 2-week baseline (steps/day) will be established as participants perform their normal daily activities while wearing a pedometer and recording non-translatory PA. Based on these values, the web site will calculate activity goals by increasing the activity index 10% with a subsequent 10% increase every 2 weeks until an overall activity goal (6,000-10,000) is achieved.

Flexibility: Participants will be asked to perform flexibility exercises 2 days/week. Photos, instructions, and tracking will be provided via the web site.

Strength Training: Photos, instructions, and tracking will be provided via the web site. Exercises will strengthen upper and lower body muscle groups (back, biceps, chest, triceps, hamstrings, and quadriceps) and will be performed for 3 sets of 12-15 repetitions. Participants will progress to higher resistance when they can easily complete 12-15 repetitions.

Balance: Photos, instructions, and tracking will be provided via the web site. Exercises will challenge the visual (e.g., open/close eyes), vestibular (e.g., move head), and somatosensory (e.g., stand on foam) systems. Exercises will first be performed while standing on the floor and then progress to standing on foam pads (Thera-Band® Stability Trainers). Information will be provided to recognize when and how to progress to more difficult exercises.

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