TITLE: Feasibility, Acceptability, and Preliminary Impact of a mHealth Intervention on Cardiorespiratory Fitness in a Rural Hispanic Adult Population
Principal Investigator: Sheri Rowland PhD, RN
Co-Investigator: Athena Ramos PhD & Christine Eisenhauer PhD, RN
Roughly one third of all adults in the United States are now living with co-occurring cardiometabolic conditions; dyslipidemia, hypertension, obesity, and/or type II diabetes.1 Among Hispanic/Latino adults (HLA) specifically, the prevalence of metabolic syndrome is 34% in men and 36% in women.2 The HLA population is one of particular concern as they are 50% more likely to die from complications related to diabetes than non-Hispanic whites.3 A recent study found HLA to be at higher risk for cardiac dysfunction and heart failure compared to non-Hispanic whites.4 Other health compromising factors likely to be experienced in this population are low income levels, limited English language, and lack of health insurance coverage, particularly among rural-living HLA.5,6 The 2016 American Heart Association scientific statement on cardiovascular disease in HLA, specifically calls for prioritization of cardiovascular health and culturally relevant methods of engaging this population in prevention and disease management.7
It could be argued that the most powerful correlate for cardiometabolic condition prevention and/or management, is cardiorespiratory fitness.8–10 In fact, cardiorespiratory fitness assessment is now recommended at least annually for most adults to improve risk assessment and patient management by providing objective evaluation of cardiorespiratory efficiency.11 Other than asking patients about their physical activity behavior, there is no clear indication that health care providers in the United States are in fact using an objective measure of cardiorespiratory fitness to support interventions targeting cardiometabolic health.12 Therefore, this project proposes an intervention to target self-management of co-occurring cardiometabolic conditions in HLA by combining healthcare provider assessment of cardiorespiratory fitness with health behavior self-monitoring skill development using mHealth (mobile health) technology.
In this 12-week self-management mHealth intervention, participants will be randomized to either an intervention group (n = 27) or an enhanced usual care group (n = 27). The intervention will use knowledge of cardiometabolic health status (includes cardiorespiratory fitness step test), health promotion text messaging, and daily self-monitoring (calories, steps, weight) with MyFitnessPal (MFP) premium and a compatible smart scale. Evidence-based goals for the intervention group will be to weigh daily, work toward 10,000 steps/day, and maintain daily calorie intake according to recommendations based on age, gender, and physical activity level.13 The purpose of the study is to assess the feasibility, acceptability, and preliminary impact of a self- management mHealth intervention on indicators of cardiometabolic health and self-management capacity.
Specific aims of this two group (intervention and enhanced usual care), 12-week self-management mHealth intervention delivered to rural living HLA with at least two cardiometabolic conditions (dyslipidemia, hypertension, obesity, type II diabetes) are to:
Aim 1: To evaluate the feasibility (number of potential vs. recruited participants, intervention adherence, attrition, missing data) and usability (adapted Health-ITUES) of a self-management mHealth intervention.
Aim 2: Determine preliminary impact of the self-management mHealth intervention by comparing the intervention and enhanced usual care groups on: 1) cardiorespiratory fitness (primary outcome), 2) cardiometabolic health (fasting glucose and lipids, A1C, blood pressure, body mass index [BMI], waist circumference, physical activity behavior,), 3) self-management capacity (patient activation, self-efficacy, self- regulation), and 4) general health (quality of life, and global health) measured at 12 and 24 weeks.
Aim 3: Describe acceptability of the self-management mHealth intervention (MFP premium and smart scale) using structured interviews conducted at the end of the intervention (12 weeks) in a subsample of the intervention group (n = 10).
- Moore JX. Metabolic Syndrome Prevalence by Race/Ethnicity and Sex in the United States, National Health and Nutrition Examination Survey, 1988–2012. Prev Chronic Dis. 2017;14. doi:10.5888/pcd14.160287
- Heiss G, Snyder ML, Teng Y, et al. Prevalence of metabolic syndrome among Hispanics/Latinos of diverse background: the Hispanic Community Health Study/Study of Latinos. Diabetes Care. 2014;37(8):2391-2399.
- ¡A la Buena Salud! – To Good Health! Centers for Disease Control and Prevention. https://www.cdc.gov/vitalsigns/hispanic-health/index.html. Published May 5, 2015. Accessed August 5, 2018.
- Mehta H, Armstrong A, Swett K, et al. Burden of Systolic and Diastolic Left Ventricular Dysfunction among Hispanics in the United States: Insights from the Echocardiographic Study of Latinos (ECHO-SOL). Circ Heart Fail. 2016;9(4). doi:10.1161/CIRCHEARTFAILURE.115.002733
- James CV, Moonesinghe R, Wilson-Frederick SM, Hall JE, Penman-Aguilar A, Bouye K. Racial/ethnic health disparities among rural adults—United States, 2012–2015. MMWR Surveillance Summaries. 2017;66(23):1.
- Velasco-Mondragon E, Jimenez A, Palladino-Davis AG, Davis D, Escamilla-Cejudo JA. Hispanic health in the USA: a scoping review of the literature. Public Health Rev. 2016;37. doi:10.1186/s40985-016-0043-2
- Rodriguez CJ, Allison M, Daviglus ML, et al. Status of cardiovascular disease and stroke in Hispanics/Latinos in the United States. Circulation. 2014;130(7):593-625.
- Becofsky KM, Sui X, Lee D, Wilcox S, Zhang J, Blair SN. A prospective study of fitness, fatness, and depressive symptoms. American Journal of Epidemiology. 2015:kwu330.
- Kodama S, Saito K, Tanaka S, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. Jama. 2009;301(19):2024-2035.
- Barry VW, Baruth M, Beets MW, Durstine JL, Liu J, Blair SN. Fitness vs. fatness on all-cause mortality: a meta-analysis. Progress in Cardiovascular Diseases. 2014;56(4):382-390.
- Ross R, Blair SN, Arena R, et al. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign: a scientific statement from the American Heart Association. Circulation. 2016:CIR–0000000000000461.
- Barnes PM, Schoenborn CA. Trends in Adults Receiving a Recommendation for Exercise or Other Physical Activity from a Physician or Other Health Professional. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics;
- Services UD of H and H. Dietary Guidelines for Americans 2015-2020. Skyhorse Publishing Inc.;