School of Nursing, Columbia University, New York, NY, United States.
Division of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, United States.
J Med Internet Res. 2024 Sep 5;26:e55079. doi: 10.2196/55079.
Exercise interventions often improve moderate to vigorous physical activity, but simultaneously increase sedentary time due to a compensatory resting response. A higher level of sedentary time is associated with a lower level of executive function, while increased moderate to vigorous physical activity is associated with improved global cognition and working memory among Latino adults. Latino adults are the fastest-growing minority group in the United States and are at high risk for cognitive decline, spend more time sedentary compared to non-Hispanic populations, and engage in low levels of physical activity. Interventions that are culturally appropriate for Latino adults to replace sedentary time with physical activity are critically needed.
This study aims to develop and test the feasibility and acceptability of an ecological momentary intervention (EMI; delivered in real time) that is individually designed to replace sedentary time with physical activity in Latino adults.
This pilot study randomized 39 (n=26, 67% female; mean age 61, SD 5.8 years) community-dwelling, Spanish-speaking Latino adults (1:1 allocation) to either a 6-week EMI program designed to replace sitting time with physical activity (20/39, 51%) or physical activity guidelines education (19/39, 49%). The program was conducted on the web and in Spanish. The intervention was individualized based on individual interview responses. The intervention included the use of a Fitbit activity monitor, weekly didactic phone meetings, interactive tools (SMS text messages), and coach-delivered feedback. Feasibility and acceptability were assessed via study satisfaction (Likert scales), motivation (ecological momentary assessment), retention, and compliance. Sedentary time and physical activity were assessed via 7-day actigraphy. Cognitive performance was assessed via the trail making test part A and B (part B=executive function) and via the National Institutes of Health Toolbox remote cognitive assessment. Statistical analysis included a linear model on change score from baseline, adjusting for age, sex, and education, emphasizing effect size.
Participant satisfaction with EMI was high (9.4/10), with a high degree of motivation to replace sitting time with physical activity (9.8/10). The intervention compliance rate was 79% with low difficulty using the Fitbit (1.7/10). Weekly step count increased in the intervention group by 5543 steps (group difference: d=0.54; P=.05) and sedentary time decreased by a mean 348 (SD 485) minutes (group difference: d=0.47; P=.24) compared to controls, with moderately strong effect sizes. The trail making test part B improved in the intervention group (mean -35.26, SD 60.35 seconds), compared to the control group (mean 7.19, SD 46 seconds; group difference: d=0.74; P=.01). No group differences were observed in other cognitive measures.
An individualized EMI designed for midlife and older Latino adults has the potential to replace sitting time with physical activity and improve executive functioning. The intervention was feasible and well received with a high degree of satisfaction.
ClinicalTrials.gov NCT04507464; https://tinyurl.com/44c4thk5.
运动干预措施通常可以提高中等至剧烈体力活动水平，但由于补偿性休息反应，同时也会增加久坐时间。久坐时间较长与执行功能较低有关，而中等至剧烈体力活动增加与拉丁裔成年人的整体认知和工作记忆改善有关。拉丁裔成年人是美国增长最快的少数族裔群体，他们认知能力下降的风险较高，与非西班牙裔人群相比，他们花更多的时间久坐，并且体力活动水平较低。对于拉丁裔成年人来说，需要有文化上合适的干预措施来用体力活动替代久坐时间。
本研究旨在开发和测试一种生态瞬时干预（EMI；实时提供）的可行性和可接受性，该干预措施针对拉丁裔成年人量身定制，旨在用体力活动替代久坐时间。
这项初步研究随机分配了 39 名（n=26，67%为女性；平均年龄 61 岁，标准差 5.8 岁）居住在社区、讲西班牙语的拉丁裔成年人（1:1 分配），分别接受 6 周的 EMI 计划（旨在用体力活动代替坐姿）或体力活动指南教育（n=19）。该计划在网络上以西班牙语进行。干预措施是根据个人访谈的回复个性化设计的。干预措施包括使用 Fitbit 活动监测器、每周的专题电话会议、互动工具（短信）和教练提供的反馈。通过研究满意度（李克特量表）、动机（生态瞬时评估）、保留率和依从性来评估可行性和可接受性。通过 7 天的活动记录仪评估久坐时间和体力活动。通过追踪测试 A 和 B 部分（B 部分=执行功能）和国家卫生研究院工具包远程认知评估来评估认知表现。统计分析包括线性模型，从基线变化得分，调整年龄、性别和教育，强调效应大小。
参与者对 EMI 的满意度很高（9.4/10），对用体力活动替代坐姿的动机很高（9.8/10）。干预的依从率为 79%，使用 Fitbit 的难度较低（1.7/10）。与对照组相比，干预组每周的步数增加了 5543 步（组间差异：d=0.54；P=.05），久坐时间减少了 348 分钟（平均 485 分钟）（组间差异：d=0.47；P=.24），具有中度强的效应大小。与对照组相比（平均 7.19，SD 46 秒），追踪测试 B 部分在干预组中有所改善（平均-35.26，SD 60.35 秒；组间差异：d=0.74；P=.01）。其他认知测量没有观察到组间差异。
针对中年和老年拉丁裔成年人设计的个性化 EMI 有可能用体力活动替代久坐时间，并改善执行功能。该干预措施具有可行性，并受到高度评价。
ClinicalTrials.gov NCT04507464；https://tinyurl.com/44c4thk5。
