Tablet-Based Physical Activity Intervention for Frail and Pre-Frail Older Adults with Systemic Lupus Erythematosus
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PROJECT SUMMARY: Although adults with systemic lupus erythematosus (SLE) now live routinely to 50 years of age and beyond, their risk for adverse health outcomes is higher compared to older adults without SLE due to the effects of cumulative end-organ damage. While frailty is recognized as an important marker of vulnerability in SLE, limited research has focused on targeted strategies to improve clinically relevant outcomes in frail and pre-frail older adults with SLE, suggesting an important unmet need. In keeping with Stage 1 of the National Institutes of Health Stage Model for behavioral intervention development, the goal of this project is first to adapt and then to pilot test a social cognitive theory-based digital exercise intervention for aging adults with SLE (≥50 years of age) stratified by frailty status. The FITTLE Senior System (FSS) is an evidence-based digital exercise platform with team-driven social support features created to promote physical activity (PA) in sedentary older adults without comorbid conditions. In this study, the FSS digital software platform will be adapted, leveraging an established user-centered design approach, to meet the needs of the SLE population, resulting in FSS-SLE. My overarching hypothesis is that FSS-SLE will be feasible for and usable by both frail and pre-frail older adults with SLE. The specific project aims are to: Aim 1: Adapt FSS for frail and pre-frail adults ≥50 years of age with SLE. Semi-structured interviews will be conducted with rheumatologists and physical therapists, as well as frail and pre-frail aging adults with SLE to generate suggestions for adaptation of the FSS program and to incorporate key stakeholder perspectives in the refinement process. Aim 2: Conduct heuristic and usability analyses of the adapted FSS-SLE prototype, essential components of the user-centered design process, to identify any upfront functional problems (e.g., system glitches) with FSS- SLE prior to conducting a pilot randomized controlled trial (RCT). The heuristic analysis will be based on existing exercise guidelines for frail older adults and design guidelines for aging adults. The usability analysis will include frail and pre-frail adults ≥50 years of age with SLE. Aim 3: Conduct a pilot double blind RCT to assess feasibility, usability, acceptability, and preliminary efficacy of FSS-SLE in frail and pre-frail adults ≥50 years of age with SLE. Participants will be randomized to the intervention or a PA educational control arm. Feasibility will be evaluated by recruitment and retention based on findings from FSS. Usability and acceptability will be assessed through semi-structured interviews and validated instruments. Preliminary efficacy will be examined through change in exercise self-efficacy, a critical mediator of PA behavior, from baseline to 6, 12, and 24 weeks. This project will generate preliminary data to support a multicenter RCT of FSS-SLE targeting frail and pre-frail older adults with SLE to improve disability and health-related quality of life in this expanding target population.
