Dr. Lee is a geriatrician whose career goal is to become an independent academic researcher to investigate and implement interventions to improve the independence and quality of life of older adults, particularly those with chronic diseases. Dr. Lee has previous research experience involving epidemiology research but lacks experience with clinical trials, which are critical skill for her to achieve her career goal. The proposed Career Development Award (CDA) provides a valuable opportunity for Dr. Lee to acquire the research skills she need. Under the guidance of an experienced mentorship team consists of experts from different disciplines of clinical research, Dr. Lee will conduct a clinical trial involving middle-aged and older veterans with diabetes. Through the proposed CDA project, Dr. Lee will develop specialized expertise to address challenges in conducting a randomized-controlled trial involving older veterans with diabetes, to obtain objective measurement of physical activity (PA), to investigate the relationship between PA, contextual environment, and social participation - an individual's functioning involving the environment, and to develop a tailored lifestyle intervention based on ecologically measured PA patterns to improve PA and social participation through integration of an individual's contextual environment. At the end of the CDA, Dr. Lee is expected to have acquired new research skills, established pilot data for a future large scale intervention, and completed an application for independent funding such as VA Merit Review award or NIH R01. With the proposed CDA, Dr. Lee will test the preliminary efficacy of a brief tailored lifestyle modification PA intervention among veterans 60 years of age and older with diabetes. The intervention is guided by well- established health behavior theory (i.e., self-regulation) and the conceptual framework from the World Health Organization, with several innovations not previously investigated in this veteran population. The intervention: 1) is tailored based on individual's unique daily PA patterns performed within his/her environment as opposed to the total amount of PA performed in a day or a recall of activities over some time period; 2) uses an accelerometer-assisted, field-based method to address veterans' physical and social environment which has been tested in veterans with osteoarthritis and has been shown to be feasible; 3) is delivered by a trained occupational therapist in a brief counseling session, which can be easily translated into real clinical settings; and 4) addresses social participation, a patient-centered outcome that is associated with quality of life and is likely to be more meaningful for individuals than glucose control, but has received limited attention outside of rehabilitation research. The overall research goal of this CDA is to refine and test the efficacy o a new lifestyle modification PA intervention (AIM 2) that could be feasibly delivered at the VA. The intervention will be tailored based on the relationship of PA, environment, and social participation determined from a 7-day home monitoring period using an accelerometer (AIM 1), and will be further refined for a future larger trial and dissemination based on study participants feedback (AIM 3). The proposed PA intervention is developed with a high potential for sustainability and dissemination throughout the VA as the tailoring can potentially be modified to be delivered through Telehealth, and the actual physical activity will be done at individual's home environment.
Improving the care of veterans with diabetes is a top priority for the Veterans Health Administration. Diabetes is prevalent among veterans, particularly among older veterans; 16% of the veterans receiving VA care have diabetes and more are at high risk for developing diabetes. Increasing physical activity (PA) can reduce the risk for diabetes associated complications, including mortality, but majority of diabetic individuals are not physically active. There is no dedicated VA program aimed to improve the PA of veterans with diabetes. Increasing social participation, or individual's functioning involving his/her environment, may improve the individual's quality of life, but this important outcome is currently not the goal of ay diabetes programs at the VA either. The proposed lifestyle intervention specifically targeting veterans with diabetes will help meet the needs of the VHA and supplement the MOVE! Weight Management Program.