Study protocol of “Worth the Walk”: a randomized controlled trial of a stroke risk reduction walking intervention among racial/ethnic minority older adults with hypertension in community senior centers

Abstract

BackgroundStroke disproportionately kills and disables ethnic minority seniors. Up to 30 % of ischemic strokes in the U.S. can be attributed to physical inactivity, yet most Americans, especially older racial/ethnic minorities, fail to participate in regular physical activity. We are conducting a randomized controlled trial (RCT) to test a culturally-tailored community-based walking intervention designed to reduce stroke risk by increasing physical activity among African American, Latino, Chinese, and Korean seniors with hypertension. We hypothesize that the intervention will yield meaningful changes in seniors’ walking levels and stroke risk with feasibility to sustain and scale up across the aging services network.Methods/DesignIn this randomized single-blind wait-list control study, high-risk ethnic minority seniors are enrolled at senior centers, complete baseline data collection, and are randomly assigned to receive the intervention “Worth the Walk” immediately (N = 120, intervention group) or in 90 days upon completion of follow-up data collection (N = 120, control group). Trained case managers employed by the senior centers implement hour-long intervention sessions twice weekly for four consecutive weeks to the intervention group. Research staff blinded to participants’ group assignment collect outcome data from both intervention and wait-list control participants 1 and 3-months after baseline data collection. Primary outcome measures are mean steps/day over 7 days, stroke knowledge, and self-efficacy for reducing stroke risk. Secondary and exploratory outcome measures include selected biological markers of health, healthcare seeking, and health-related quality of life. Outcomes will be compared between the two groups using standard analytic methods for randomized trials. We will conduct a formal process evaluation to assess barriers and facilitators to successful integration of Worth the Walk into the aging services network and to calculate estimated costs to sustain and scale up the intervention. Data collection is scheduled to be completed in December 2016.DiscussionIf this RCT demonstrates superior improvements in physical activity and stroke knowledge in the intervention group compared to the control group and is found to be sustainable and scalable, Worth the Walk could serve as a primary stroke prevention model for racial/ethnic communities across the nation.Trial registrationClinicalTrials.gov NCT02181062; registered on June 30, 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-015-0346-9) contains supplementary material, which is available to authorized users.

Behavioral self-management strategies for practice and exercise should be included in neurologic rehabilitation trials and care

“…Individualized counseling combined with tailored exercise programs after stroke can improve long-term physical activity participation and functional exercise capacity. 19 Such personal counseling and goal setting, however, have usually been absent in mobility and upper extremity rehabilitation trials in home settings, unless a therapist or nurse visited 20,2122 When additional elements of behavioral training were included, the results have been informative. For example, in a large trial of repeated verbal instruction and encouragement about how to exercise, to try to get participants who could walk within 90 days after stroke to be more physically active, the results were no better than in the usual care control group.…”

Relationship Between Negative Mood and Health Behaviors in an Immigrant and Refugee Population

“…Interventions targeting health behaviors with U.S. ethnic minorities have demonstrated increased physical activity levels [10], reduced weight and body mass index (BMI) [10], reduced consumption of saturated fats and sugar-sweetened beverages [10], and improvements in measures of mental health and emotional well-being [11]. Continued development of new interventions for high-risk minority groups [12, 13] encourages the expansion of research on interventions tailored to immigrant populations. Promising results show that culturally-relevant interventions to promote change in nutrition and physical activity behaviors yield successful outcomes for increased knowledge of illness risk, increased knowledge of national guidelines, and behavior change for children [14] and adults [15].…”

What makes community‐based physical activity programs for culturally and linguistically diverse older adults effective? A systematic review

“…20 Designing a culturally meaningful milieu is evident in numerous intervention studies with CALD or indigenous populations that did not meet all of the inclusion criteria for this integrative review. 10,[21][22][23][24][25][26] The included articles reported bespoke intervention programs 13,14,18 and modified versions of existing community programs 5,16,17,19 as culturally suitable for enrolling CALD older adults. Similarly, examples of robust bespoke 10 and modified mainstream 27 physical activity programs for indigenous populations have been reported in the literature.…”