Supporting Habit Formation to Attenuate Prefrailty in Elders: Pilot Study
Supporting Habit Formation to Attenuate Prefrailty in Elders: Pilot Study
The Supporting Habit Formation to Attenuate Prefrailty in Elders (SHAPE) Pilot Study is a
 randomized control study. The main objective of this pilot study is to determine the
 feasibility of using Habit Formation (HF) treatment to increase Physical Activity (PA)
 (reduction in daily in hours of sedentary time), and dietary among prefrail African
 Americans. We hypothesize: (1)The SHAPE study will demonstrate good feasibility with a high
 recruitment rate and successful administration all of the measures among the target
 population; (2) Treatment group participants will demonstrate greater increases in primary
 outcomes (physical activity level and dietary quality) and secondary outcomes (quality of
 life, depressive symptoms, prefrailty reduction, lower extremity strength and balance,
 physical activity level, waist circumference, and weight at intervention completion.
Frailty signifies a decline in physical, cognitive and/or psychosocial reserve that reduces
 an older adult's ability to respond to or recover from stressors (e.g., acute illness) and
 contributes to early morbidity and mortality. Nearly half of all older adults are prefrail,
 and prefrailty status increases the risk of becoming frail. Frailty is more prevalent among
 African Americans and occurs earlier in life when compared to European Americans. Older
 African Americans in the US, face significant challenges in adhering to frailty reduction
 treatment such as increasing physical activity (PA) and adopt a healthy diet. Those
 challenges include poverty, accelerated aging, higher levels of activities of daily living
 disability, and less access to safe opportunities for PA or healthy food. The situation is
 even worse for urban-dwelling older African Americans, who often reside in neighborhoods
 replete with physical and social stressors (e.g., derelict infrastructure or crime) that
 intersect with the vulnerabilities of aging, to further complicate their efforts to engage in
 frailty protective behaviors. Despite this, frailty interventions overwhelmingly exclude
 African Americans, thereby limiting generalizability to this high-risk group.

 Therefore, the rationale of this study is to test the feasibility of a novel habit formation
 (HF) intervention to facilitate frailty protective behaviors in prefrail African Americans
 ages 55 and older in a randomized control trial study. The HF intervention targets two main
 health behaviors: decrease sedentary time (ST) and improve dietary quality. The intervention
 consists of 12 treatment sessions over 12 weeks. In each session, an occupational therapist
 will deliver educational content, and use HF techniques and behavioral skills to facilitate
 frailty protective behaviors. Forty-eight prefrail African American adults will be randomized
 to the treatment or control group. The baseline evaluation will be conducted before
 randomization and the follow-up evaluation after the last treatment session. For the
 treatment group participants, we will further evaluation occupational activity
 performance/satisfaction and habit formation strength within treatment sessions.

 The main goal of this study is to determine the feasibility of HF intervention among prefrail
 African American adults. The main hypothesis is: the SHAPE study will demonstrate good
 feasibility with (1) high recruitment rate (recruit 48 participants over 6 months), (2)
 treatment group participants will show preliminary efficacy in primary outcomes such as
 reducing sedentary time (measured by the ActivPal device) and increasing dietary quality
 score (measured by Healthy Eating Index [HEI]) at intervention completion compared to
 controls. The secondary hypothesis is: treatment group participants will demonstrate
 preliminary efficacy in secondary outcomes such as increased quality of life (measured by the
 Cardiovascular Health Study frailty criteria), reduced depressive symptoms (Geriatric
 Depression Short form), prefrailty reduction (The Fried's Frailty Criteria Index), increased
 lower extremity strength and balance (Short Physical Performance Battery), increased physical
 activity level (The Community Healthy Activities Model Program for Seniors), reduced waist
 circumference and weight at intervention completion compare to controls.
Inclusion Criteria:

 -  English-speaking

 -  Community-dwelling

 -  Prefrail (evaluated by the Frailty scale)

 -  Self-identify as African Americans.

 Exclusion Criteria:

 -  Diagnosed psychiatric disorders,

 -  Moderate or severe cognitive impairment (using the Six Item Cognitive Impairment Test
 and operationalized as a score of ≥ 10),

 -  Using prescription drugs that could affect cognition and functioning (e.g.,
 neuroleptics), - - Individuals with typical daily pain ratings of ≥ 7/10 on a 10 point
 Likert scale of pain

 -  Planing to change residences during the study period

 -  Relying on a wheelchair for home or community mobility

 -  Actively receiving home care services, occupational, or physical therapy

 -  On dialysis or who have an end of stage disease (e.g., stage IV heart failure)

 -  Enrolling in a health promotion program focused on physical activity and diet

 -  Have a baseline healthy eating index score of ≥ 85/100 as their diet would already be
 very close to ideal (average score for U.S. population = 59)