Promoting Physical Activity in a Spanish-Speaking Latina Population of Low Socioeconomic Status With Chronic Neurological Disorders: Proof-of-Concept Study

Abstract

Background: Physical activity (PA) is known to improve quality of life (QoL) as well as reduce mortality and disease progression in individuals with chronic neurological disorders. However, Latina women are less likely to participate in recommended levels of PA due to common socioeconomic barriers, including limited resources and access to exercise programs. Therefore, we developed a community-based intervention with activity monitoring and behavioral coaching to target these barriers and facilitate sustained participation in an exercise program promoting PA.

Objective: The aim of this study was to determine the feasibility and efficacy of a community-based intervention to promote PA through self-monitoring via a Fitbit and behavioral coaching among Latina participants with chronic neurological disorders.

Methods: We conducted a proof-of-concept study among 21 Spanish-speaking Latina participants recruited from the Los Angeles County and University of Southern California (LAC+USC) neurology clinic; participants enrolled in the 16-week intervention at The Wellness Center at The Historic General Hospital in Los Angeles. Demographic data were assessed at baseline. Feasibility was defined by participant attrition and Fitbit adherence. PA promotion was determined by examining change in time spent performing moderate-to-vigorous PA (MVPA) over the 16-week period. The effect of behavioral coaching was assessed by quantifying the difference in MVPA on days when coaching occurred versus on days without coaching. Change in psychometric measures (baseline vs postintervention) and medical center visits (16 weeks preintervention vs during the intervention) were also examined.

Results: Participants were of low socioeconomic status and acculturation. A total of 19 out of 21 (90%) participants completed the study (attrition 10%), with high Fitbit wear adherence (mean 90.31%, SD 10.12%). Time performing MVPA gradually increased by a mean of 0.16 (SD 0.23) minutes per day (P<.001), which was equivalent to an increase of approximately 18 minutes in MVPA over the course of the 16-week study period. Behavioral coaching enhanced intervention effectiveness as evidenced by a higher time spent on MVPA on days when coaching occurred via phone (37 min/day, P=.02) and in person (45.5 min/day, P=.01) relative to days without coaching (24 min/day). Participants improved their illness perception (effect size g=0.30) and self-rated QoL (effect size g=0.32). Additionally, a reduction in the number of medical center visits was observed (effect size r=0.44), and this reduction was associated with a positive change in step count during the study period (P.=04).

Conclusions: Self-monitoring with behavioral coaching is a feasible community-based intervention for PA promotion among Latina women of low socioeconomic status with chronic neurological conditions. PA is known to be important for brain health in neurological conditions but remains relatively unexplored in minority populations.

Trial registration: ClinicalTrials.gov NCT04820153; https://ichgcp.net/clinical-trials-registry/NCT04820153.

Keywords: clinical trial; community study; exercise; motivation; promotion; quality of life.

Conflict of interest statement

Conflicts of Interest: None declared.

©Alexander Garbin, Jesús Díaz, Vy Bui, Janina Morrison, Beth E Fisher, Carina Palacios, Ingrid Estrada-Darley, Danielle Haase, David Wing, Lilyana Amezcua, Michael W Jakowec, Charles Kaplan, Giselle Petzinger. Originally published in JMIR Formative Research (https://formative.jmir.org), 20.04.2022.

Figures

Figure 1

CONSORT (Consolidated Standards of Reporting Trials) flow diagram.

Figure 2

Moderate-to-vigorous physical activity (MVPA) throughout the 16-week intervention. Each dot represents a single week, with the color of the dot specifying the participant. Numbers beside the colored dots represent participant numbers. The box plots detail weekly medians (horizontal red lines) and quartile minutes performing MVPA for the group, while the black line illustrates the slope of MVPA over time for the group.

Figure 3

The effect of contact type on daily moderate-to-vigorous physical activity (MVPA) minutes. Each dot represents a single day, with the color of the dot specifying the participant. Numbers beside the colored dots represent participant numbers. The violin outline details the overall distribution of each contact type condition, while the box plots depict the medians and quartiles. The horizontal dashed line at 30 MVPA minutes illustrates the recommended number of MVPA minutes per day.

Figure 4

The association between change in medical center visits with rate of change in steps. A negative change in medical center visits indicates that a participant went to the medical center fewer times during the study period than during the period 16 weeks prior to study initiation. Numbers beside the colored dots represent participant numbers.