MAT: MIND Foods and Aerobic Training in Black Adults With HTN

Study Details

Study Description

Brief Summary

The goal of this randomized controlled trial is to determine the impact of Mediterranean-Dash Intervention for Neurodegenerative Delay (MIND) diet and aerobic training on cognition in Black adults with high systolic blood pressure.

Researchers will compare Food Delivery and Cooking PLUS Aerobic Training (FoRKS+) versus Enhanced Usual Care (EUC) to evaluate the effects on cognition.

Participants will complete cognitive and cardiovascular assessments, 24-hr blood pressure monitoring, standard blood pressure measurements, weight, fingerstick for HbA1c point-of-care testing, and questionnaires.

Participants may also choose to participate in an optional blood draw for DNA Repair Capacity testing as a modifiable risk factor for aging-associated diseases.

Condition or Disease	Intervention/Treatment	Phase
Cognitive Decline Hypertension Diet Aerobic Exercise	Behavioral: Enhanced Usual Care (EUC) Behavioral: Food Delivery and Cooking PLUS Aerobic Training (FoRKS+)	N/A

Detailed Description

This randomized controlled trial will evaluate Mediterranean-Dash Intervention for Neurodegenerative Delay (MIND) diet and aerobic training (FoRKS+) versus enhanced usual care (EUC) in Black adults with systolic blood pressure of ≥140 mm Hg. This project seeks to evaluate the potential for high-polyphenol nutritious foods, hands-on training in food management skills, and aerobic exercise to impact cognition and risk factor reduction in persons with prevalent chronic disease.

Adults who give informed consent will complete a 24-hour ambulatory blood pressure measure to confirm blood pressure eligibility. Participants who meet criteria will complete a full baseline assessment, consisting of cognitive and cardiovascular assessments, blood pressure, weight, HbA1c testing, questionnaires, and optional blood draw.

Participants will be randomized to one of two arms:

Enhanced Usual Care (EUC), consisting of access to existing usual primary care services such as social determinants of health screenings, referrals to food pantries, and assistance enrolling in food assistance programs. They will be enrolled in a 5-week Hypertension Self-Management Education and Support (SMES) class, which is an existing CDC-endorsed program offered at Eskenazi to provide information and skills for managing hypertension (HTN).

Food Delivery and Cooking PLUS Aerobic Training (FoRKS+), consisting of the same services as EUC plus home-delivered MIND diet ingredient kits and virtual cooking classes for an additional 11 weeks with embedded lessons in kitchen organization, tool use, nutrition, budgeting, and shopping; PLUS aerobic training for an additional 12 weeks of moderate-intensity exercise.

Assessments will be completed at mid-intervention around Week 16, Week 28 as the primary endpoint, and around Week 52 for maintenance evaluation.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

128 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

Double (Investigator, Outcomes Assessor)

Primary Purpose:

Prevention

Official Title:

MIND Foods and Aerobic Training in Black Adults With HTN: An ADRD Prevention Pilot RCT

Anticipated Study Start Date :

Nov 28, 2023

Anticipated Primary Completion Date :

May 31, 2027

Anticipated Study Completion Date :

May 31, 2027

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: Enhanced Usual Care (EUC) Participants randomized to EUC will have access to existing usual primary care services. They will also be enrolled in Hypertension Self-Management Education and Support (SMES) class ("Hypertension group"), which is an existing CDC-endorsed program offered at Eskenazi Health to provide information and skills for managing hypertension (HTN). Classes are led by registered dietitians via Webex.	Behavioral: Enhanced Usual Care (EUC) Enhanced Usual Care (EUC) includes 5 weeks of hypertension classes.
Experimental: Food Delivery and Cooking PLUS Aerobic Training (FoRKS+) Participants randomized to FoRKS+ will attend weekly HTN SMES classes separately from EUC participants. SMES classes will include the EUC curriculum stated above and an introduction to the upcoming FoRKS+ intervention. Following HTN SMES completion, FoRKS+ continues with home-delivered Mediterranean-style ingredient kits, food management lessons, and hands-on cooking classes in one's own kitchen. Classes are led by registered dietitians via Webex. Classes are held twice per week thru Week 12, then only once per week through Week 16. Intervention continues with aerobic exercise led by health coaches via Webex. Classes start in Week 13 with one session per week, increasing to two sessions per week in Weeks 17-28.	Behavioral: Food Delivery and Cooking PLUS Aerobic Training (FoRKS+) Food Delivery and Cooking PLUS Aerobic Training (FoRKS+) includes 5 weeks of hypertension classes followed by 11 weeks of home-delivered Mediterranean-style ingredient kits and virtual cooking classes, and an additional 12 weeks of aerobic exercise.

Arm

Intervention/Treatment

Active Comparator: Enhanced Usual Care (EUC)

Participants randomized to EUC will have access to existing usual primary care services. They will also be enrolled in Hypertension Self-Management Education and Support (SMES) class ("Hypertension group"), which is an existing CDC-endorsed program offered at Eskenazi Health to provide information and skills for managing hypertension (HTN). Classes are led by registered dietitians via Webex.

Behavioral: Enhanced Usual Care (EUC)

Enhanced Usual Care (EUC) includes 5 weeks of hypertension classes.

Experimental: Food Delivery and Cooking PLUS Aerobic Training (FoRKS+)

Participants randomized to FoRKS+ will attend weekly HTN SMES classes separately from EUC participants. SMES classes will include the EUC curriculum stated above and an introduction to the upcoming FoRKS+ intervention. Following HTN SMES completion, FoRKS+ continues with home-delivered Mediterranean-style ingredient kits, food management lessons, and hands-on cooking classes in one's own kitchen. Classes are led by registered dietitians via Webex. Classes are held twice per week thru Week 12, then only once per week through Week 16. Intervention continues with aerobic exercise led by health coaches via Webex. Classes start in Week 13 with one session per week, increasing to two sessions per week in Weeks 17-28.

Behavioral: Food Delivery and Cooking PLUS Aerobic Training (FoRKS+)

Food Delivery and Cooking PLUS Aerobic Training (FoRKS+) includes 5 weeks of hypertension classes followed by 11 weeks of home-delivered Mediterranean-style ingredient kits and virtual cooking classes, and an additional 12 weeks of aerobic exercise.

Outcome Measures

Primary Outcome Measures

Cognitive function composite score as measured by individually-administered tests of psychomotor speed, complex sequencing, semantic fluency, interference and list learning and delayed recall at Week 28. [Week 28 post intervention start date]
The cognitive composite is derived from WAIS-IV Symbol Search & Coding, Trail Making Test Part B, Animals-Vegetables-Clothing Naming, Stroop Color-Word, and RBANS Update List Learning and List Recall. The composite will be formed by standardizing each test raw score to the sample baseline mean and standard deviation and then taking an average of the resultant z-scores. These measures will be combined into a single, overall cognitive composite score.
Cognitive function composite score as measured by individually-administered tests of psychomotor speed, complex sequencing, semantic fluency, interference and list learning and delayed recall at Week 52. [Week 52 post intervention start date]
The cognitive composite is derived from WAIS-IV Symbol Search & Coding, Trail Making Test Part B, Animals-Vegetables-Clothing Naming, Stroop Color-Word, and RBANS Update List Learning and List Recall. The composite will be formed by standardizing each test raw score to the sample baseline mean and standard deviation and then taking an average of the resultant z-scores. These measures will be combined into a single, overall cognitive composite score.

Secondary Outcome Measures

Average participant self-ratings of intervention acceptability. [From date of randomization until the date of the final training session or the end of the 28-week intervention, whichever came first.]
Average of individual Likert self-ratings of the interventions (where 1 = very unenjoyable, 2 = not enjoyable, 3 = neutral, 4 = enjoyable, and 5 = very enjoyable) throughout the 28-week intervention.
Participant adherence to treatment. [From date of randomization until the date of the final training session or the end of the 28-week intervention, whichever came first.]
Number of training sessions attended divided by the the total number of sessions available.
Participant adherence to outcome assessments. [End of follow-up at 52-weeks.]
Number of participants completing the outcome assessments divided by the total number randomized.
Number of participants with study-related adverse events (AE) by treatment arm. [From enrollment through end of follow-up at 52-weeks.]
Adverse event count for each study arm

Eligibility Criteria

Criteria

Ages Eligible for Study:

35 Years to 75 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Fluent in English
Marion County resident
35-75 years
Self-identified non-Hispanic and Black/African-American/biracial including African-American
Systolic BP of ≥140 in prior 12 months from a primary care visit
Ability to see and read street signs (self report)
Stable housing with independent access to kitchen, including functional stove or hotplate, oven, refrigerator, and freezer (self report)
Activity independence per functional activities questionnaire (FAQ; <3 responses of "Require Assistance" and 0 responses of "Dependent")
Normal cognition per six-item screener (SIS; score of ≥ 5)
Less than 20min on usual day of moderate or vigorous physical activity
Able to exercise safely per abbreviated Exercise Assessment for You (EASY) or primary care provider clearance
At Eligibility Visit: Mean systolic BP of ≥140 from 24-hour ABPM (from a minimum of 6 daytime readings and 2 nighttime readings)

Exclusion Criteria:

lives in nursing home
diagnosis of dementia or Alzheimer disease or mild cognitive impairment; Parkinson disease; brain tumor/infection/surgery (within the last 10 years with residual symptoms and/or functional loss/deficit, such as impaired learning, memory, or communication); cancer with short life expectancy, or current chemotherapy or radiation therapy; psychosis, schizophrenia, or bipolar disorder
ICD 10 code I11/hypertensive heart disease, ICD 10 code I12/hypertensive CKD, ICD 10 code I13/hypertensive heart disease and CKD, ICD 10 code I15, or ICD 10 code I16
current or past prescription of donepezil, memantine, rivastigmine, or galantamine
alcohol consumption ≥ 8 drinks per week for women, or ≥15 drinks per week for men
drug use/abuse (excluding marijuana) per EMR
moving out of area during study timeline
scheduling conflicts with intervention schedule
unwilling to use a touchscreen
unwilling to be on video conferencing
low communicative ability, functional status, or other disorders (examiner rated) that would interfere with interventions and assessments
unable to provide informed consent
participation in any lifestyle modification/weight loss program (e.g., Weight Watchers, etc.)