JMIR Publications

ABSTRACT

Background:

Exercise interventions often improve moderate-vigorous physical activity, (MVPA) but simultaneously increase sedentary time due to a compensatory resting response. A higher level of sedentary time is associated with a lower level of executive function while increased MVPA is associated with improved global cognition and working memory among mid-life and older Latinos. Latinos are the fastest growing minority group in the USA, and are at high risk for cognitive decline, spend more time sedentary, compared to non-Hispanic populations, and engage in low levels of physical activity. Interventions that are culturally appropriate for mid-life and older Latinos to replace sedentary time with physical activity are critically needed.

Objective:

To develop and test an Ecological Momentary Intervention (EMI) that is culturally and individually designed to replace sedentary time with physical activity in mid-life and older Latinos.

Methods:

This study randomized mid-life and older Spanish-speaking Latinos to either a 6-week EMI program designed to replace sitting time with physical activity, or to a group that received education on physical activity guidelines. The program was conducted virtually and in Spanish. The intervention was individualized based on individual interview responses to ensure that it was culturally appropriate. The intervention included use of a Fitbit activity monitor and mobile app, weekly didactic phone meetings, interactive tools (e.g., text messages/app reminders), and coach-delivered feedback. Sedentary time and physical activity were assessed via 7-day actigraphy worn on the hip. Cognitive performance was assessed via the trail making test part A and B (executive function), and via the NIH Toolbox remote cognitive assessment. Statistical analysis included linear model on change score from baseline, adjusting for age, sex, and education.

Results:

A total of 39 mid-life and older Spanish-speaking Latinos were randomized (26 female, mean age 61.0 (5.8)). The intervention group had a 79% compliance rate to the intervention. Trail making test part B time to completion and number of errors improved over time in the intervention group (-35.26 + 60.35 seconds and -1.98 + 2.19 respectively), compared to the control group (7.19 + 46 seconds and 0.37 +2.24 respectively, d=.74, p=.006). Weekly step count increased in the intervention group by 5,543 steps (d=.54, p=.052) and sedentary time decreased by 348 +485 minutes (d=.47, p=.24), compared to control. Percent of time spent performing moderately-high intensity activity increased in the intervention group, compared to the control group (d=.67, p=.015). Participant satisfaction was high and a high degree of motivation to replace sitting time with physical activity was reported.

Conclusions:

An individualized ecological momentary intervention designed for mid-life and older Latinos was successful in replacing sitting time with physical activity and improved executive functioning. The intervention was feasible and well received with a high degree of satisfaction. Clinical Trial: (ClinicalTrials.gov NCT04507464; https://www.clinicaltrials.gov/study/NCT04507464)