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Research Protocol Adaptations During the COVID-19 Pandemic: A Process Evaluation

Mariana Wingood, Amy M. Linsky, Rebekah Harris, Patricia Bamonti, Jennifer Moye, and Jonathan F. Bean

In general, COVID-19-related adaptations that transitioned in-person assessments and interventions to a virtual format were not routinely evaluated. We aimed to conduct a process evaluation to examine the impact of COVID-19-related adaptations on a behavior change intervention designed to increase exercise adherence among Veterans with mobility difficulty. We used secondary data from a nonrandomized study to complete a process evaluation examining the intervention’s reach, recruitment, fidelity, dose delivered by physical therapists, and the dose received by the 14 participating Veterans. The physical therapist delivered 95% (133/140) of the study’s 10 sessions. Sessions with the lowest delivery dose included Sessions 1 and 10 (86%; n = 12/14). The elements with the lowest dose received included using an exercise journal and developing a postintervention plan (86%; n = 12/14). Our COVID-19 adaptations allowed us to provide our intervention to the majority (67%) of eligible participants without a negative impact on fidelity, dose delivered, or dose received.

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Evaluation of Electronic and Pen-and-Paper Formats of the Inventory of Physical Activity Barriers: A Randomized Crossover Study

Mariana Wingood, Salene Jones, Nancy M. Gell, Jennifer S. Brach, and Denise M. Peters

Background: The Inventory of Physical Activity Barriers (IPAB) assesses physical activity participation barriers. Development, refinement, and psychometric evaluation of the IPAB occurred via an electronic format. However, various circumstances may require using a pen-and-paper format. As instrument formats are not always interchangeable, the authors aimed to establish whether 2 different formats (electronic and pen and paper) can be used interchangeably for the IPAB. Methods: This randomized crossover study included 66 community-dwelling adults aged 50 years and older (mean age = 73 [SD = 7.6]). Half the sample completed the electronic format of the IPAB first and the pen-and-paper format second, and the other half completed them in reverse order. Tests of equivalence and a Bland–Altman plot were performed. Results: The intraclass correlation coefficient between formats was .94, and kappa was .68. The mean difference between the 2 administration forms of the IPAB was 0.002 (P = .96). Both administration formats had high internal consistency (Cronbach alpha = .92 and .93) and illustrated construct validity (P ≤ .001 for both administration formats). Conclusion: Pen-and-paper and electronic formats of the IPAB are equivalent and, thus, can be used interchangeably among non-Hispanic whites who are highly educated. The format should be used consistently if completing preintervention and postintervention evaluations or comparing scores.

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Associations of Cognitively Active Versus Passive Sedentary Behaviors and Cognition in Older Adults

Mariana Wingood, Nancy M. Gell, Dori E. Rosenberg, Gregory J. Stoddard, and Erin D. Bouldin

Background: Cognitively stimulating sedentary behavior (SB) may positively impact cognition. This study aimed to (1) describe participation across types of SB among older adults with and without cognitive impairment and (2) examine how baseline SB participation impacts cognition, longitudinally. Methods: We used National Health and Aging Trends Study data from rounds 6 to 11 for cross-sectional and longitudinal analyses. Participants were 2244 community-dwelling older adults who were selected for the SB module in round 6. The SBs were categorized as active (eg, hobbies) and passive (eg, television). Participants were also categorized as having intact or impaired orientation, memory, and executive function based on tests of orientation, recall, and the clock-drawing test. We calculated descriptive statistics characterizing SB by cognitive status. Aim 2 involved competing risks proportional hazard models of participants with intact cognition (n = 1574) to identify associations between baseline SB and changes in cognition, moves to institutional care, and death over 6 years. Results: Participants (40% ≥ 80 years, 55% female, 77% White non-Hispanic) averaged 8.75 (SD = 4.42) hours of daily SB, including 4.05 (SD = 2.32) hours of passive SB and 4.75 (SD = 3.13) hours of active SB. Active SB >3 hours per day was associated with a lower risk of impaired orientation (subdistribution hazard models = 0.60; P = .048) and memory (subdistribution hazard models = 0.62; P = .02). Baseline participation in passive SB did not impact the risk of having a change in cognition during rounds 7 to 11. Conclusion: Cognitive decline was lower among older adults who participated in more active SB. Thus, type of SB should be considered in examining the impact on cognition.

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Community-Dwelling Older Adults and Physical Activity Recommendations: Patterns of Aerobic, Strengthening, and Balance Activities

Mariana Wingood, Levi Bonnell, Andrea Z. LaCroix, Dori Rosenberg, Rod Walker, John Bellettiere, Mikael Anne Greenwood-Hickman, David Wing, and Nancy Gell

Though it is known that most older adults do not meet the recommended physical activity (PA) guidelines, little is known regarding their participation in balance activities or the full guidelines. Therefore, we sought to describe PA patterns among 1,352 community-dwelling older adult participants of the Adult Changes in Thought study, a longitudinal cohort study exploring dementia-related risk factors. We used a modified version of the Community Healthy Activities Model Program for Seniors questionnaire to explore PA performed and classify participants as meeting or not meeting the full guidelines or any component of the guidelines. Logistic regression was used to identify factors associated with meeting PA guidelines. Despite performing 10 hr of weekly PA, only 11% of participants met the full guidelines. Older age, greater body mass index, needing assistance with instrumental daily activities, and heart disease were associated with decreased odds of meeting PA guidelines. These results can guide interventions that address PA among older adults.