Testing Interventions for Mobility Through Exercise (TIME)

Sponsor
Milton S. Hershey Medical Center (Other)
Overall Status
Not yet recruiting
CT.gov ID
NCT05725564
Collaborator
(none)
620
4
42.1

Study Details

Study Description

Brief Summary

In this project, the team plans to test the impact of FAST, its brief home-based strength training program which includes performance goal setting, to a program for home (BAND TOGETHER) that is similar to one offered by Silver Sneakers, available online to millions of older adults, and includes strength, balance, and aerobic exercises. The team hypothesizes that the brief program (FAST) will improve leg function better than the standard program (BAND TOGETHER), by encouraging older adults to be more consistent with using it and to try harder when they do.

Condition or Disease Intervention/Treatment Phase
  • Behavioral: FAST (Functional Activity Strength Training)
  • Behavioral: Band Together
  • Behavioral: Behavioral Change Technique
N/A

Detailed Description

One in four older adults, the fastest growing demographic group in the US, reports serious difficulty walking or climbing stairs. Older adults note that these walking difficulties "deprives you of your identity" and "affects my day to day lifeā€¦ I can't do very much work on my own." Walking difficulties impair people's quality of life more than depression, anxiety, or pain. Walking difficulties also increase the chances of future disability, death, and healthcare costs. Though strength training improves walking ability, fewer than one in five older adults do strength training enough to benefit. What is unknown is how to create a strength training program that improves the ability of older adults to walk and do other things they need and want to do and that older adults are willing to do.

One approach to designing a strength training program that has not been tried before is to make them shorter. In 2020, the project team set out to design a short strength training program that older adults could do at home that would improve their physical function and that they would consistently do. The program was called FAST (Functional Activity Strength Training) and, to make it more effective, the team set specific goals for how many additional repetitions each person should be able to do over 12 weeks. These goals were then mentioned repeatedly, and feedback was provided about how well people made progress toward these goals.

In the first study of FAST (FAST-1), 24 healthy older adults performed 30 seconds of squats and push-ups each day but received no personal supervision. Over six months, they performed the exercises on 73 percent of days, which led to large increases in the number of push-ups and squats they were able to do. In the second study of FAST (FAST-2), the team randomly assigned 97 older adults who had trouble walking, and those assigned to do 30 seconds each of chair stands and steps onto a stepper each day improved their ability to stand up from a chair and stand on one leg more than those who did not do the exercises.

In this project, the team plans to test the impact of FAST, its brief home-based strength training program which includes performance goal setting, to a program for home (BAND TOGETHER) that is similar to one offered by Silver Sneakers, available online to millions of older adults, and includes strength, balance, and aerobic exercises. The team hypothesizes that the brief program (FAST) will improve leg function better than the standard program (BAND TOGETHER), by encouraging older adults to be more consistent with using it and to try harder when they do.

This study will enroll 520 primary care patients who are at least 65 years of age and randomly assign them to have access to 12 months of daily FAST or three-times weekly BAND TOGETHER. Each program will be delivered via the internet and each patient will receive about 30 minutes per month of personal support. The study will enroll patients who have trouble walking, have access to the internet, can provide informed consent, and receive permission from their doctor. The study is designed to see whether patients who have access to FAST, after 12 months, have better walking ability, balance, and leg strength and can do their normal daily activities more easily and fall less often than patients who have access to BAND TOGETHER.

To help us understand how best to perform the study, as well as how best to share the results, the study team assembled a group of stakeholders that includes patients, primary care providers, fitness center directors, and people who work for insurance, public health, and senior services organizations. The team will bring those stakeholders together each year and consult them regularly to help make difficult decisions as they arise-decisions that may impact each group of stakeholders differently. Two patient partners will work with investigators to supervise the group of stakeholders and organize their feedback, structured as a public comment period, to help the research team make decisions that take into account the perspectives of all of the key groups of stakeholders involved in improving the physical function of older adults.

Study Design

Study Type:
Interventional
Anticipated Enrollment :
620 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Masking:
Double (Investigator, Outcomes Assessor)
Primary Purpose:
Treatment
Official Title:
PCORI-HA-2021C3-25041 Comparative Effectiveness of Brief Strength and Balance Exercises and Standard Home-Based Group Exercise for Primary Care Patients With Mobility Disability
Anticipated Study Start Date :
Mar 1, 2023
Anticipated Primary Completion Date :
Sep 1, 2026
Anticipated Study Completion Date :
Sep 1, 2026

Arms and Interventions

Arm Intervention/Treatment
Experimental: FAST-BCT

FAST exercise intervention without behavior change techniques applied. Daily exercise intervention including functional resistance training and personalized coaching.

Behavioral: FAST (Functional Activity Strength Training)
Daily exercise intervention including functional resistance exercises and personalized coaching.

Experimental: FAST+BCT

FAST exercise intervention with behavior change techniques applied. Daily exercise intervention including functional resistance training and personalized coaching with added reminders, education, goal setting, self monitoring, and feedback to encourage adherence and effort.

Behavioral: FAST (Functional Activity Strength Training)
Daily exercise intervention including functional resistance exercises and personalized coaching.

Behavioral: Behavioral Change Technique
Reminders, education, goal-setting, self-monitoring, and feedback used to encourage participants to increase effort and adherence

Active Comparator: BT-BCT

Band Together exercise intervention without behavior change techniques applied. 3 times weekly group exercise intervention held over Zoom featuring strength and balance exercises for 45 minutes.

Behavioral: Band Together
3 times weekly group exercise over Zoom featuring strength and balance exercises for 45 minutes

Active Comparator: BT+BCT

Band Together exercise intervention with behavior change techniques applied. 3 times weekly group exercise intervention held over Zoom featuring strength and balance exercises for 45 minutes with added reminders, education, goal setting, self monitoring, and feedback to encourage adherence and effort.

Behavioral: Band Together
3 times weekly group exercise over Zoom featuring strength and balance exercises for 45 minutes

Behavioral: Behavioral Change Technique
Reminders, education, goal-setting, self-monitoring, and feedback used to encourage participants to increase effort and adherence

Outcome Measures

Primary Outcome Measures

  1. Physical Function [12 Months]

    Patient-Reported Outcomes Measurement Scale (PROMIS-29). The minimum and maximum values are unable to do and without any difficulty, and a higher score means a better outcome.

Secondary Outcome Measures

  1. Lower Extremity Performance [12 Months]

    Short Physical Performance Battery. The minimum value is a score of 0 points, the maximum value is a score of 16. A higher score means a better outcome.

  2. Dose Received [Through study completion, an average of 1 year]

    Sessions completed per week (percent)

  3. Effort (Rating of Perceived Exertion) [Monthly up to 12 months]

    Rating of Perceived Exertion. The minimum value is 0 (at rest) and the maximum value is 10 (maximal). This is a purely subjective measure here a higher or lower score doesn't necessarily lead to a better outcome, but for our exercise study we have a target RPE of 5 for exercise.

  4. Gait Speed (10 meter walk test) [12 Months]

    Gait Speed (10 meter walk test). Participants undergo two trials (comfortable speed and fast speed), and an average of the two trials is used as the gait speed in m/s.

  5. Muscle Strength [12 Months]

    Upper and lower extremity strength

  6. Walking Ability [12 Months]

    6 Minute Walk Distance

  7. Fatigue, Pain [12 Months]

    Patient Reported Outcomes Measurement Scale (PROMIS-29). The minimum value for the fatigue scales is "not at all", the maximum value is "very much". A lower score means a better outcome. The minimum values for the pain scales are "not at all" and 0, the maximum values "very much" and 10. A lower value means a better outcome.

  8. Falls [12 Months]

    Percent experiencing a fall-related injury

  9. Physical Activity [12 months]

    Accelerometry over 7 days

  10. Number of participants with a self-reported injury due to physical activities [Monthly up to 12 months]

    Injuries due to physical activities

  11. Program Satisfaction [Monthly up to 12 months]

    Net Promoter Score. The maximum value is 10 and the minimum value is 0. A higher value means a better outcome.

Other Outcome Measures

  1. Body Weight (kg) [12 Months]

    Body Weight (kg)

  2. Height (cm) [12 Months]

    Height (cm)

  3. Sociodemographics, self-reported medical history and tobacco use [Baseline]

    Age, gender, race and ethnicity, medical history, smoking status, and education

  4. Caregiving Status Questions (Receiving and Providing) [Monthly up to 12 months]

    Giving and receiving caregiving, paid or unpaid, for personal care needs, such as eating, bathing, dressing, or getting around inside the home.

Eligibility Criteria

Criteria

Ages Eligible for Study:
65 Years and Older
Sexes Eligible for Study:
All
Accepts Healthy Volunteers:
No
Inclusion Criteria:
  • Age greater than or equal to 65

  • Self reported difficulty or inability to walk 1/4/ mile

  • Access to the Internet

  • Covid vaccination

Exclusion Criteria:
  • Chest pain on the PAR-Q

  • Participating in another research project involving physical activity, falls or weight loss

  • Planning to move or have surgery in the next 12 months

  • Cognitive impairment

Contacts and Locations

Locations

No locations specified.

Sponsors and Collaborators

  • Milton S. Hershey Medical Center

Investigators

None specified.

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.
Responsible Party:
Christopher Sciamanna, MD, MPH, Principal Investigator, Milton S. Hershey Medical Center
ClinicalTrials.gov Identifier:
NCT05725564
Other Study ID Numbers:
  • HA-2021C3-25041
First Posted:
Feb 13, 2023
Last Update Posted:
Feb 13, 2023
Last Verified:
Feb 1, 2023
Studies a U.S. FDA-regulated Drug Product:
No
Studies a U.S. FDA-regulated Device Product:
No
Additional relevant MeSH terms:

Study Results

No Results Posted as of Feb 13, 2023