Translation of Obesity and Cognitive Program by Lay Health Educators (Coaches)

Translation of Obesity and Cognitive Research in a Rural State Via Senior Centers

Obesity is a major public health problem among older adults, with 31% of non-institutionalized older persons (60 years+) in the US obese and projections indicating that this will rise to 40% by 2010. A second public health challenge on the horizon for the aging US population is the increasing number of individuals experiencing cognitive decline, dementia or Alzheimer 's disease. Recent clinical trials have demonstrated efficacy in reducing risks associated with both of these significant and increasingly pervasive health problems, which are more common among rural, low income and ethnic minority populations. The Diabetes Prevention Program (DPP) Lifestyle Intervention produced sustained weight losses in a large, diverse population of high-risk individuals and dramatically reduced rates of type 2 diabetes onset, particularly among older adults. SeniorWISE produced improvements in memory in community dwelling older persons. Transferring these exciting technologies to community settings where they can benefit older adults is a pressing public health need. Therefore, the current project seeks to transfer these two evidence-based interventions to older adults in a rural state using senior centers as the venue for dissemination and lay health educators to deliver the interventions. Senior centers are a particularly attractive context for translation of evidence-based health promotion technologies in predominantly rural states like Arkansas because they have a well-established infrastructure in communities and share a common goal of promoting healthy aging and reducing health care costs. The 3-year randomized, controlled trial will evaluate translation of the interventions by randomizing senior centers (N=16) across Arkansas to implement either (1) the DPP Lifestyle Weight Loss Program or (2) the SeniorWISE Cognitive Training Program. Older (age > 60) adults (N=288) nested within senior centers will receive the programs delivered in a group format by a trained lay health educator. Primary outcomes are changes in body weight and cognitive functioning at 12 months. The multi-level evaluation plan will characterize reach, effectiveness, adoption, implementation and maintenance of the interventions, with a cost effectiveness component.

Study Overview

• Status: Completed
• Conditions: Overweight; Memory Disorder
• Intervention / Treatment: Behavioral: lifestyle counseling; Behavioral: Cognitive Training

• Study Type: Interventional
• Enrollment (Actual): 16
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria for senior centers (unit of randomization):

• located in the state of Arkansas
• agree to be randomized
• able to identify two or three volunteers or staff members willing to be trained (including IRB certification) and deliver the programs within the senior center over the course of a year
• have adequate space for group meetings and for private data collection visits
• agreement that it would be likely that they could identify 18 interested and eligible (obese and not cognitively impaired) senior adults willing to attend the program over the course of 12 months

Exclusion Criteria:

• inability to identify and secure lay health educator from within their community
• concerns of inability to recruit the requisite 18 senior adult participants who met minimal inclusion criteria

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Lifestyle counseling; Diabetes Prevention Program Lifestyle Balance Intervention delivered by lay health educator	Behavioral: lifestyle counseling; 21 session group-based behavioral weight management program delivered in senior center over 12 months by lay health educators; Other Names: DPP Lifestyle Balance Program
Active Comparator: Cognitive Training; Adaptation of SeniorWise Memory Training program for delivery by lay health educator, matched in duration and contact to the other study arm	Behavioral: Cognitive Training; 21 session group-based cognitive training program delivered in senior center over 12 months by lay health educators

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
weight loss	weight change from baseline in kg and percent weight loss [1-(12-month weight/baseline weight)	4 and 12 month

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
cognitive function	change in memory (immediate and delayed) and attention	4 and 12 month

Collaborators and Investigators

• Sponsor: University of Arkansas
• Investigators: Principal Investigator: Delia S West, PhD, University of Arkansas

Publications and helpful links

General Publications

• West DS, Bursac Z, Cornell CE, Felix HC, Fausett JK, Krukowski RA, Lensing S, Love SJ, Prewitt TE, Beck C. Lay health educators translate a weight-loss intervention in senior centers: a randomized controlled trial. Am J Prev Med. 2011 Oct;41(4):385-91. doi: 10.1016/j.amepre.2011.06.041.

Study record dates

Study Major Dates

• Study Start: September 1, 2007
• Primary Completion (Actual): July 1, 2011
• Study Completion (Actual): July 1, 2011

Study Registration Dates

• First Submitted: June 17, 2011
• First Submitted That Met QC Criteria: June 17, 2011
• First Posted (Estimate): June 21, 2011

Study Record Updates

• Last Update Posted (Estimate): June 25, 2012
• Last Update Submitted That Met QC Criteria: June 21, 2012
• Last Verified: June 1, 2012

More Information

Terms related to this study

• Keywords: community-based; cognitive training; lifestyle intervention; memory training; behavioral weight control
• Additional Relevant MeSH Terms: Nervous System Diseases; Neurologic Manifestations; Neurobehavioral Manifestations; Body Weight; Overweight; Memory Disorders
• Other Study ID Numbers: 104877; R18DP001145 (U.S. NIH Grant/Contract)