Activation for Self-Care Needs in Older Adults with Chronic Kidney Disease: ACTIVE SENIORS with CKD.
Funded Grant
Overview
Affiliation
View All
Overview
description
Frailty, or having a decreased physiologic capacity to recover from a health-related stressor is common in and fatal to older Veterans. Frailty is even more prevalent among older adults with chronic kidney disease (CKD). Among older Veterans with CKD, physical activity frequency is the component of the frailty phenotype that significantly predicts mortality or dialysis initiation. However, existing interventions are only aimed to improve exercise capacity, do not apply behavior change theory to identify psychosocial mechanisms that explain infrequent physical activity, and do not improve muscle weakness despite its prevalence in CKD and associations with physical activity frequency in older adults. It also remains unknown how to identify those who would experience the greatest response such that interventions can be targeted. The ‘Capability, Opportunity, Motivation, Behavior’ (COM-B) theory of behavior change posits that a behavior occurs when an individual is ‘Capable’ of engaging in a behavior; sees the ‘Opportunity’ to engage in the environment; and feels the ‘Motivation’ to engage. My pilot data demonstrates that sedentary older adults reported low Patient Activation (the skill and confidence to engage in a behavior). Patient Activation and is a psychosocial factor that correspond to the ‘Motivation’ component of the COM-B theory. Thus, an intervention to maximally increase physical activity frequency and reduce frailty risk among older Veterans with CKD may need to be centered on improving Activation. The frequency of physical activity behaviors among older adults strongly depends on lower extremity muscle strength. Adults with CKD experience loss of muscle mass and exhibit poor lower extremity strength. Resistance training improves muscle strength by placing or force or pressure against muscle. Thus, an intervention to maximally increase physical activity frequency and reduce frailty risk among older Veterans with CKD may need to include resistance training. A maximally effective intervention requires that it be targeted to those would receive the greatest benefit. Senescence is a phenomenon of cell cycle arrest that is implicated in frailty pathogenesis. Biomarkers of senescence were recently shown to be predictive of treatment response after a physical activity intervention; therefore, biomarkers of senescence may be a novel way to identify older Veterans with CKD who would experience the greatest treatment response after a physical activity intervention. This proposal will 1) test whether Patient Activation associates with physical activity frequency among older Veterans with CKD; 2) explore whether other factors in COM-B theory associate with physical activity frequency; 3) develop and pilot test a novel physical activity intervention targeted to the mechanisms identified; and 4) explore if biomarkers of senescence predict intervention treatment response. The proposal is significant because it aims to reduce the adverse sequelae of frailty among Veterans with CKD, a group already vulnerable to adverse health outcomes. The proposal is innovative in its identification of novel mechanisms that impact frailty risk and its exploration of whether of biomarkers can predict intervention response. Completion of this proposal will impact the field, as it will lay the foundation for precise clinical practice guidelines for physical activity among older adults living with multimorbidity (guidelines which currently do not exist).
