Physical inactivity is a public health priority for older Latinos with mild cognitive impairment (MCI). MCI, considered the pre-dementia stage of Alzheimer?s disease (AD), increases the risk of developing AD and related dementias (ADRD). A recent review suggests that physical activity enhances cognition indirectly by improving health behaviors such as sleep and by reducing chronic conditions such as cardiovascular disease that affect neurocognitive function. Older Latinos, the fastest growing ethnic minority group in the United States., experience a disproportionate burden of cognitive disease, including MCI, and ADRD, due in large part to higher rates of inactivity and sleep-wake disturbances that are associated with obesity, metabolic syndrome, diabetes, and cardiovascular risk. Latinos are often identified as one of the most sedentary of the older racial/ethnic groups and experience significant multi-level barriers to physical activity ? including cost, environmental/neighborhood and safety concerns [especially if ?engaging (i.e., walking) alone?], and lack of social networks. Yet, the majority of physical activity interventions have not been designed for older Latinos with MCI. Our proposed intervention study, ?Tiempo Juntos para la Salud? (Time Together for Health) is guided by a socio-ecological framework that includes multilevel strategies: empowerment education for behavior change and individual motivation, building a social support network, and promoting cultural and community resources for safe walking. We will use a randomized controlled trial design to assess the impact of Tiempo Juntos on the primary outcome of moderate-intensity physical activity; theoretically grounded mediators; and secondary outcomes of cognitive function, CV health, and sleep at 3, 6, and 12 months among 216 Spanish language-dominant Latinos aged 55 and older with MCI [Montreal Cognitive Assessment (MoCA) score ? 23 to 26 for Latino populations]. Participants randomized to Tiempo Juntos will receive a 1-hour, group walking intervention, designed by and tailored to older Latinos, delivered twice weekly for 3 months by a trained community health worker (CHW), and followed by bi-weekly, mobile health (mHealth) booster sessions in Months 4-6. Participants randomized to Attention Control will receive Spanish health education adapted from the National Institute on Aging online resources for older adults and including topics recommended by community focus groups in preliminary research. Findings from this study will lay the essential groundwork for a Stage IV, pragmatic trial of Tiempo Juntos in senior community settings serving Latinos throughout the United States.
This 4-year R01 proposal will address National Institute on Aging strategic goals by testing a multilevel intervention, ?Tiempo Juntos para la Salud,? (Time Together for Health) designed to promote moderate- intensity physical activity; theoretically grounded mediators; and secondary outcomes of cardiovascular health, sleep and cognitive function at 3 months, 6 months, and 12 months among 216 Spanish language-dominant Latinos aged 55 and older with MCI [Montreal Cognitive Assessment (MoCA) score ? 23 to 26 for Latino populations]. This study is timely given the increasing rates of Alzheimer?s disease and related dementias (ADRD) among Latinos.
