The Engaged4Life Study: Enhancing the Health-Promoting Effects of Older Adults' Activity Portfolios

Study Overview
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Brief Summary
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This study designs and tests a multi-component intervention- Engaged4Life- designed to enhance physical activity (PA), cognitive activity (CA), social interaction (SI) and personal meaning (PM) in low-engaged community-dwelling older adults' everyday life activities through: 1) technology-assisted self-monitoring of PA, CA, SI, and PM activity engagement, 2) psycho-education + goal setting (via a 3-hour workshop), and 3) one-on-one peer mentoring (via phone 2X/week for 3 weeks) to support goal implementation. 15 adults age 65 or older will be randomized to receive all 3 intervention components and 15 to receive only the technology-assisted self-monitoring component.

Detailed Description
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The Social Model of Health Promotion posits that physical, cognitive, and social activity embedded within activities can help maintain or even restore cognitive and functional health in later life and stimulating activities that carry personal meaning or confer a sense of purpose may have stronger health-promoting effects than activities that are just stimulating. While the Experience Corps program-a community volunteering program for older adults designed to explicitly embed these characteristics-is an effective model for health-promotion, this program is not, as of yet, widely accessible. Further, formal volunteering is not always an activity that is attractive or accessible for older adults, and other interventions aimed at promoting social role involvement among older adults have shown only limited effectiveness in doing so. Thus, the current study explores whether it is possible to create an individually-tailored intervention that encourages older adults to 1) carefully examine their existing activity portfolios (technology-assisted self-monitoring), 2) empowers them with the knowledge and skills to make improvements upon their activity portfolios by enhancing/supplementing activities in ways that increase their overall levels of physical activity, cognitive activity, social interaction, and personal meaning (psycho-education + goal setting via a workshop), and 3) provides social support through peers in implementing their goals (one-on-one peer mentoring). Targeting a sample of community dwelling older adults who are at-risk for adverse cognitive and physical health outcomes due to their sedentary activity levels, we aim to influence positive changes in overall health and well-being in a way that is more practical, effective, and sustainable than prior interventions.

Official Title
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Enhancing the Health-Promoting Effects of Older Adults' Activity Portfolios: The Development, Feasibility and Initial Efficacy of an Ecologically Sensitive Intervention

Conditions
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Sedentary Lifestyle

Intervention / Treatment
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* Behavioral: Technology-assisted self-monitoring
* Behavioral: Workshop and Peer Mentoring


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age of 65 or older Low-to-moderate engagement levels as determined by a score of <10 on a modified version of the Health Enhancement Lifestyle Profile (HELP) (Hwang, 2010), where only the domains of exercise, social and productive activity, and leisure were included A resident of Waltham, MA Willing to be randomly assigned to study arm Available for relevant study dates Exclusion Criteria: Age of 64 or younger Living in an assisted living or nursing home facility Significant cognitive impairment (those with >2 errors on the six-item screener by Callahan, Unverzagt, Hui, Perkins, & Hendrie, 2002) Reports that a doctor has told them that it is unsafe to participate in physical activity

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Engaged4Life<br>Participants randomly assigned to this group receive: 1) technology-assisted self-monitoring of daily activity via a Fitbit Zip worn daily (for 8 weeks) and a daily tablet self-report survey (completed for a 7-day period at baseline and a second 7-day period 4-weeks later); and 2) a one-time, 3hr workshop and peer mentoring (via phone 2X/week for 3 weeks). The workshop includes psychoeducation on the relationship between active engagement and health and well-being and a goal setting activity focused on carefully assessing and then make improvements upon existing activity portfolios. Peer mentors provide support as participants implement their goals. | Behavioral: Technology-assisted self-monitoring<br>* Participants receive a Fitbit Zip, an iPad Mini tablet device, training on how to use the Fitbit and iPad, and are asked to complete brief surveys each night on their activity engagement that day (for two 7-day periods).<br>Behavioral: Workshop and Peer Mentoring<br>* Participants receive a 3-hour Engaged4Life Workshop (psychoeducation + goal setting) and one-on-one peer mentoring via phone 2X/week for 3 weeks.<br>|
| Active Comparator: Technology-assisted self-monitoring only<br>Participants randomly assigned to this group receive: 1) technology-assisted self-monitoring of daily activity via a Fitbit Zip worn daily (for 8 weeks) and a daily tablet self-report survey (completed for a 7-day period at baseline and a second 7-day period 4-weeks later). While it is expected that wearing the Fitbit and raising consciousness of activity engagement may initially result in behavior change, it is not expected to have a sustained impact on outcomes over time. | Behavioral: Technology-assisted self-monitoring<br>* Participants receive a Fitbit Zip, an iPad Mini tablet device, training on how to use the Fitbit and iPad, and are asked to complete brief surveys each night on their activity engagement that day (for two 7-day periods).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Physical Activity: Steps per day | Measured using the Fitbit Zip pedometer | worn daily for 8 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cognitive activity (CA)(assessed daily) | Cognitive activity (CA) assessed daily was measured as respondents' assessment of the number of cognitively stimulating activities they had participated in that day from a list of 13 activities plus one possible write-in other activity. | asked daily for 7 days at baseline and again for 7 days during week 4 | 
| Social interaction (SI) (assessed daily) | Social interaction (SI) questions focused on the quantity (the number of social interactions the respondent had that day, including in-person, by telephone, or by video, but NOT including email, text, or social media) and the quality (whether the participant had a problematic social interaction that day and the perceived stress of the problematic social interaction; and whether the participant had a positive social interaction that day and the perceived positivity of that social interaction) of daily social interactions. | asked daily for 7 days at baseline and again for 7 days during week 4 | 
| Personal meaning (PM) (assessed daily) | Respondents were asked 4 questions around whether they did anything that day that 1) benefited others, 2) left them feeling personally satisfied or accomplished, 3) felt significant in the broader scheme of things, or 4) was personally meaningful. Response options included 0 (not at all), 1 (to some extent), and 3 (to a great extent). Respondents were also asked a more global question: How much did you feel your life had purpose today? Th response scale ranged from 1 to 7 . | asked daily for 7 days at baseline and again for 7 days during week 4 |