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Brooks AK, Athawale A, Rush V, Yearout A, Ford S, Rejeski WJ, Strahley A, Fanning J. Successes and lessons learned from a mobile health behavior intervention to reduce pain and improve health in older adults with obesity and chronic pain: a qualitative study. FRONTIERS IN PAIN RESEARCH 2024; 5:1340400. [PMID: 38726351 PMCID: PMC11079154 DOI: 10.3389/fpain.2024.1340400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/07/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Chronic pain is a prevalent issue among older adults in the United States that impairs quality of life. Physical activity has emerged as a cost-effective and non-pharmacological treatment for chronic pain, offering benefits such as improved physical functioning, weight loss, and enhanced mood. However, promoting physical activity in older individuals with chronic pain is challenging, given the cyclical relationship between pain and sedentary behavior. The Mobile Intervention to Reduce Pain and Improve Health (MORPH) trial was designed as an innovative, mobile health (mHealth) supported intervention to address this issue by targeting daylong movement, weight loss, and mindfulness to manage pain in older adults with chronic multisite pain. The objective of this paper is to provide the result of a qualitative analysis conducted on post-intervention interviews with MORPH participants. Methods At the conclusion of the MORPH study, 14 participants were interviewed regarding their experience with the program. All interviews were conducted by phone before being transcribed and verified. A codebook of significant takeaways was created based on these accounts. Summaries were further synthesized into themes using the principles of thematic analysis. Results Three key themes of the MORPH intervention emerged from the qualitative interviews: MORPH technology (smart scales, Fitbit, MORPH Companion App) facilitated program adherence and accountability; MORPH intervention components (food tracking and mindfulness activities) facilitated program adherence and awareness, respectively; and, group meetings provided motivational support and accountability. Mobile health technologies, including a dedicated MORPH app, facilitated self-monitoring strategies, helped to break the cycle of old habits, and provided participants with immediate feedback on successes; however, technical issues required timely support to maintain engagement. Food tracking contributed to adherence and accountability for weight loss. Mindfulness activities increased participants' awareness of anxiety provoking thoughts and pain triggers. Finally, social support via group meetings and connection, played a crucial role in behavior change, but participants noted consistency in the delivery medium was essential to fostering genuine connections. Conclusion Overall, the study results highlight the key considerations related to program technology, intervention components, and the value of social support that can help to guide the development of future interventions similar to MORPH.
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Affiliation(s)
- Amber K. Brooks
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Abha Athawale
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Virginia Rush
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Abigail Yearout
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Sherri Ford
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - W. Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Ashley Strahley
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
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Fanning J, Brooks AK, Irby MB, N’Dah KW, Rejeski WJ. Associations Between Patterns of Daily Stepping Behavior, Health-Related Quality of Life, and Pain Symptoms Among Older Adults with Chronic Pain: A Secondary Analysis of Two Randomized Controlled Trials. Clin Interv Aging 2024; 19:459-470. [PMID: 38500497 PMCID: PMC10946442 DOI: 10.2147/cia.s453336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/09/2024] [Indexed: 03/20/2024] Open
Abstract
Purpose One's amount, intensity, and distribution of physical activity may have implications for whether it has positive or negative effects on pain and quality of life for older adults living with chronic pain. Thus, we investigated baseline patterns of stepping related to pain symptoms and health-related quality of life at baseline and over a 12-week follow-up period. Patients and Methods Participants were low-active older adults (69.54±6.74 years) with obesity and chronic pain who enrolled in one of two randomized controlled trials. Participants completed measures of pain intensity, interference, and health-related quality of life and wore an accelerometer for 7 days at baseline and week 12. Functional principal components analysis identified patterns of within-day stepping behavior at baseline, and linear regressions were used to investigate how these component scores related to pain and health-related quality of life at baseline and over 12 weeks. Results Two patterns were extracted; one describing more vs less stepping and the second capturing movement later vs earlier in the day. More baseline stepping was associated with better physical functioning (B=0.148, p<0.001) and energy (B=0.073, p=0.033), while a later start in the day was associated with worse social functioning (B=-0.193, p=0.031). More stepping at baseline predicted positive changes in physical functioning (B=0.094, p=0.019), emotional role limitations (B=0.132, p=0.049), energy (B=0.112, p<0.001), social functioning (B=0.086, p=0.043), pain (B=0.086, p=0.009), general health (B=0.081, p=0.003) and pain intensity (B=-0.039, p=0.003). A later start to the day was associated with worsening physical functioning (B=-0.229, p<0.001), physical (B=-0.282, p=0.047) and emotional role limitations (B=-0.254, p=0.048), general health (B=-0.108, p=0.041), and pain interference (B=0.055, p=0.043). Conclusion Findings suggest there is value in activity patterns as an indicator for additional behavioral intervention, as those who move little and/or delay daily movement are likely to experience subsequent decrements in quality of life and pain symptoms.
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Affiliation(s)
- Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Amber Keller Brooks
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Megan Bennett Irby
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Kindia Williams N’Dah
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
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Fanning J, Brooks AK, Robison JT, Irby MB, Ford S, N’Dah K, Rejeski WJ. Associations between patterns of physical activity, pain intensity, and interference among older adults with chronic pain: a secondary analysis of two randomized controlled trials. FRONTIERS IN AGING 2023; 4:1216942. [PMID: 37564194 PMCID: PMC10411520 DOI: 10.3389/fragi.2023.1216942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/10/2023] [Indexed: 08/12/2023]
Abstract
Background: Clinical management of chronic pain often includes recommendations to engage in physical activity (PA), though there are little data on the interplay between pain symptoms and key aspects of PA participation (e.g., intensity and bout duration) among older adults. Herein we investigate the longitudinal relationships between changes in PA behavior and changes in pain intensity and interference among low-active older adults with obesity and chronic pain. Methods: Participants (N = 41) were enrolled in two randomized pilot trials wherein they were assigned to an intervention focused on participation in frequent PA across the day, or to a low-contact control. Participants completed the 3-item PROMIS pain intensity scale and 8-item PROMIS pain interference scale before and after the interventions. Participants also wore an ActivPAL accelerometer for 7 days before and during the final week of the interventions. Results: A series of linear regression analyses demonstrated that increased time spent stepping at a high-light intensity in very short bouts was associated with increased pain intensity scores. By contrast, increased time spent stepping at a high-light intensity in bouts of 5-20 min was associated with reductions in pain intensity and interference scores. Increased time spent stepping at a moderate intensity overall was associated with reduced pain intensity scores, and time spent stepping at a moderate intensity for 10-20 min associated with reduced pain interference. Conclusion: These findings suggest older adults with chronic pain may benefit by moving at high-light or moderate intensities in brief bouts of at least 5 min in duration.
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Affiliation(s)
- Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Amber K. Brooks
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Justin T. Robison
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Megan B. Irby
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Sherri Ford
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Kindia N’Dah
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - W. Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
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Hughes JM, Brown RT, Fanning J, Raj M, Bisson ANS, Ghneim M, Kritchevsky SB. Achieving and sustaining behavior change for older adults: A Research Centers Collaborative Network workshop report. THE GERONTOLOGIST 2022; 63:gnac173. [PMID: 36473052 PMCID: PMC10474593 DOI: 10.1093/geront/gnac173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Indexed: 09/04/2023] Open
Abstract
Modifying unhealthy behaviors and/or environments may improve or maintain an older adult's health. However, achieving and sustaining behavior change is challenging and depends upon clinical, social, psychological, and political domains. In an effort to highlight the multidisciplinary nature of behavior change, the NIA Research Centers Collaborative Network (RCCN) held a two-day workshop, Achieving and sustaining behavior change for older adults. The workshop was informed by the socioecological model and designed to initiate dialogue around individual, community, and systems-level determinants of behavior change. This paper summarizes key topics presented during the workshop, discusses opportunities for future research, education, and training, and recommends how each of the six NIA research centers may pursue work in behavior change for older adults.
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Affiliation(s)
- Jaime M Hughes
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rebecca T Brown
- Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Minakshi Raj
- Department of Kinesiology and Community Health, University of Illinois, Champaign, Illinois, USA
| | - Alycia N S Bisson
- Department of Kinesiology and Community health, University of Illinois Urbana Champaign, Champaign, Illinois, USA
| | - Mira Ghneim
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stephen B Kritchevsky
- Sticht Center on Healthy Aging and Alzheimer’s Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Fanning J, Brooks AK, Ford S, Robison JT, Irby MB, Rejeski WJ. A remote group-mediated daylong physical activity intervention for older adults with chronic pain: Results of the MORPH-II randomized pilot trial. Front Digit Health 2022; 4:1040867. [PMID: 36405417 PMCID: PMC9666366 DOI: 10.3389/fdgth.2022.1040867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/14/2022] [Indexed: 01/24/2023] Open
Abstract
Chronic pain is a debilitating condition that affects many older adults who often have limited access to non-pharmacological pain management strategies. One potentially effective and novel lifestyle medicine for chronic pain involves increasing physical activity through frequent movement across the day, thereby also decreasing the presence of extended sedentary bouts. The MORPH-II pilot randomized controlled refinement trial iterated on the MORPH trial, which was a first-of-its-kind group-mediated daylong physical activity (DPA) intervention for older adults with chronic pain rooted in social cognitive and self-determination theories and supported by an mHealth toolset designed to foster social connection and awareness of physical activity patterns. MORPH-II was delivered fully remotely via videoconference software and supported by a technology kit comprising an iPad, activity monitor, and wireless weight scale. It was also implemented a refined coaching model designed to help participants better understand their own patterns of activity. A total of 44 participants were randomized to receive the 12-week group-mediated DPA intervention or to a low-contact control. Qualitative interviews suggest the program was well-received by participants and that participants developed an understanding of how patterns of physical activity related to their pain symptoms. Participants also highlighted several additional areas for refinement related to the coaching model and feedback provided within the mHealth app. Analyses of covariance, controlling for baseline values, revealed a small effect (η 2 = 0.01) on pain intensity favoring the intervention condition, though both groups improved during the study period. There was a large effect favoring the intervention condition on ActivPAL-assessed average daily steps (η 2 = 0.23) and postural shifts (η 2 = 0.24). Control participants spent less time in short sedentary bouts (η 2 = 0.09), and there was a small effect (η 2 = 0.02) indicating intervention participants spent less time in extended sedentary bouts. Finally, relative to control, intervention participants demonstrated a moderate improvement in autonomy satisfaction (η 2 = 0.05), relatedness frustration (η 2 = 0.05), and competence frustration (η 2 = 0.06), and a large magnitude improvement in competence satisfaction (η 2 = 0.22). These findings indicate that the MORPH-II intervention was feasible and acceptable, and may positively impact steps, postural breaks, and several key domains of basic psychological needs detailed in self-determination theory.
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Affiliation(s)
- Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, United States
| | - Amber K. Brooks
- Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Sherri Ford
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, United States
| | - Justin T. Robison
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, United States
| | - Megan B. Irby
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, United States
| | - W. Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, United States
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Fanning J, Rejeski WJ, Leng I, Barnett C, Lovato JF, Lyles MF, Nicklas BJ. Intervening on exercise and daylong movement for weight loss maintenance in older adults: A randomized, clinical trial. Obesity (Silver Spring) 2022; 30:85-95. [PMID: 34932885 PMCID: PMC8711609 DOI: 10.1002/oby.23318] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study aimed to determine the impact of dietary weight loss (WL) plus aerobic exercise (EX) and a "move more, more often" approach to activity promotion (SitLess; SL) on WL and maintenance. METHODS Low-active older adults (age 65-86 years) with obesity were randomized to WL+EX, WL+SL, or WL+EX+SL. Participants received a social-cognitive group-mediated behavioral WL program for 6 months, followed by a 12-month maintenance period. EX participants received guided walking exercise with the goal of walking 150 min/wk. SL attempted to achieve a step goal by moving frequently during the day. The primary outcome was body weight at 18 months, with secondary outcomes including weight regain from 6 to 18 months and objectively assessed physical activity and sedentary behavior at each time point. RESULTS All groups demonstrated significant WL over 6 months (p < 0.001), with no group differences. Groups that received SL improved total activity time (p ≤ 0.05), and those who received EX improved moderate-to-vigorous activity time (p = 0.003). Over the 12-month follow-up period, those who received WL+EX demonstrated greater weight regain (5.2 kg; 95% CI: 3.5-6.9) relative to WL+SL (2.4 kg; 95% CI: 0.8-4.0). CONCLUSIONS Pairing dietary WL with a recommendation to accumulate physical activity contributed to similar WL and less weight regain compared with traditional aerobic exercise.
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Affiliation(s)
- Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Iris Leng
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Cheyenne Barnett
- Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - James F Lovato
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Mary F Lyles
- Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Barbara J Nicklas
- Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
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