Development of a Power Training Program to Improve Mobility in Older Veterans

About This Grant

Significance to VA: Aging in older adults can result in declines in physical function, mobility, and quality of life, leading to adverse health events including increased risk of falls, institutionalization, and mortality. Older Veterans are at an increased risk of age-related mobility declines due to greater medical complexity and high rates of mobility limitations compared to non-Veterans. Gerofit is a national clinical exercise program that aims to improve Veteran mobility and health through a tailored exercise program which emphasizes traditional strength training as part of the program. While the current program improves outcomes, the changes in mobility outcomes are clinically small and may not translate to changes in health outcomes like mortality or fall risk. Power training is an alternate type of resistance training that involves performing concentric muscle actions as fast and safely as possible, resulting in greater improvements in mobility outcomes in older adults compared to strength training. The current Gerofit program does not use power training, and introducing this type of training into the program may propel changes in mobility outcomes beyond the level necessary to improve key health outcomes like fall risk. Perspectives of Gerofit stakeholders are needed to develop a power training intervention to meet Veteran and Gerofit program needs to optimize implementation. Innovation and Impact: If successful, this study will develop the first co-designed power training intervention in older adults and establish its feasibility and acceptability for Gerofit Veterans. Introducing power training into Gerofit may propel mobility outcomes to the level necessary to produce meaningful health outcomes for older Veterans who are at risk of age-related mobility declines. Specific Aims: The overall purpose of this CDA-2 proposal is to co-design a power training intervention for Veterans engaged in Gerofit (Aim 1) and to evaluate the feasibility, acceptability, and candidate efficacy outcomes of a Gerofit power training program compared to standard of care Gerofit exercise prescription using a mixed methods approach (Aim 2) in preparation for a future efficacy trial. Methodology: Aim 1 focuses on co-designing the power training intervention by gathering feedback from Veteran and exercise providers involved in the Gerofit program through qualitative interviews. Next, local Gerofit Veteran and exercise providers will participate in the development and refinement of the power training intervention through rapid prototyping, an iterative process of testing out the program, providing feedback through focus groups, and refining the program prior to the next round of testing. The power training intervention developed in Aim 1 will be tested in Aim 2 by conducting a randomized feasibility pilot study. In Aim 2, the feasibility, acceptability, and preliminary outcomes of a power training program in older Veterans participating in Gerofit will be evaluated using an explanatory sequential mixed methods approach. Veterans will be randomized into power training and standard of care groups and will participate in exercise sessions within the Gerofit program. Clinical outcomes will be collected post training and will be compared between the two groups (power training and Gerofit standard of care). Quantitative feasibility and acceptability outcomes will be collected post training in the power training group which will guide the refinement of qualitative interview guides to gain a deeper understanding of the feasibility and acceptability of this intervention within Gerofit. Path to Translation/Implementation: Our study results, along with the comprehensive training and mentorship that I receive, will support my transition to becoming an independent VA clinician-scientist with the goal of preparing a Merit submission to establish safety and efficacy of power training to enhance older Veteran mobility and mitigate the age-related mobility decline. In addition, this power training program will serve as a framework that will be adapted to fit the context of additional Gerofit programs as well as other VA programs aimed at improving mobility in older Veterans.