C3EN #1

ClinicalTrials.gov link

Diseases or Conditions Being Studied
Heart disease, hypertension, stroke, diabetes, high cholesterol, arthritis

Communities of Focus
African American adults 40 years of age and older

Study Site
Cook, Lake, Dupage, Will, McHenry, Kane, or Kendall counties

Study Objectives
Testing the effectiveness of a church-based intervention to improve physical function (PF) in African Americans with PF limitations.

Intervention or Treatment
Individual participants in churches randomized to the intervention arm will participate in the Keep it Movin' multi-component PA education program, as well as be encouraged by their church and study interventionist to participate in the church-wide walking program.

Abstract

Persons with Multiple Chronic Conditions (MCCs) experience increased risk of disability, reduced quality of life, increased hospitalizations, and death. The burden of MCCs falls particularly hard on African Americans (AAs) who have a higher prevalence of multimorbidity than non-Hispanic whites and Hispanics, and have earlier declines in physical functioning and higher prevalence of disability. In our work in Chicago’s west side AA community, we have observed these adverse impacts of MCCs on physical functioning. For over a decade, Rush researchers and AA churches have collaborated through the Alive Faith Network (AFN) to work for health equity in the Chicago region. Recent health screenings with congregants and the community demonstrated high rates of lower extremity physical function limitations, with physical function limitations most common among those with chronic illness.

Since physical activity (PA) offers an effective approach to reducing morbidity and mortality among persons experiencing MCC-associated impairments, Church partners have called for the testing of PA interventions that might address this health challenge. Investigators will therefore test a multi-level PA program that community members named Keep It Movin’ (KIM). The KIM intervention builds on the evidence-based Lifestyle Interventions and Independence for Elders (LIFE) Study which showed that a structured PA program can reduce mobility disability among older adults with limitations of physical function. Findings from the LIFE intervention have not been previously tested in predominantly AA communities. Participants in the KIM pilot study reported significant barriers to engaging in recommended PA, including symptoms such as pain and dyspnea, fear of injury, and functional limitations. We have therefore adapted the LIFE intervention for implementation, adding functional education to help overcome barriers to starting and maintaining regular PA among persons with MCCs. We hypothesize that this augmented intervention, which enhances capability of church members through additional social support and education by knowledgeable rehabilitation specialists, will lead to both increased physical function and increased PA among AA adults with PF limitations due to MCCs.

The study will determine if, relative to matched participants from comparator churches, participants receiving the Keep it Movin’ intervention will have improved physical function at 6 months, as documented by mean SPPB scores at least 0.50 points higher. Secondary aims include testing the KIM intervention relative to an education comparator condition at 6 and 12 months on outcomes of Moderate or Vigorous PA, social support for PA, self-efficacy for PA, quality of life and self-reported physical functioning. We will use the RE-AIM framework to assess reach and factors driving successful adoption, implementation, and maintenance of the Keep it Moving intervention across churches.