Recipient Organization
SOUTH DAKOTA STATE UNIVERSITY
PO BOX 2275A
BROOKINGS,SD 57007
Performing Department
(N/A)
Non Technical Summary
Preserving and/or improving lean mass and function among older women is crucial to health and independence. Sarcopenia is the age-related loss of muscle mass and affects up to one-third of women and can lead to reduced functionality and increased likelihood of disability. The goal of this project is to improve physical function to allow independence and increased health span in this population. Through this proposal, seven states: South Dakota, Iowa, Rhode Island, West Virginia, Arkansas, New York, and Washington, DC, will develop, implement, and evaluate an Extension-delivered, community-based, virtual sarcopenia risk reduction program (StrengthenHER) over a five-year period. This intervention is aimed at lowering sarcopenia risk or severity among a diverse sample of women ages 50 to 70 years. The anticipated key outcomes are that StrengthenHER participants will experience a reduction in sarcopenia risk as measured by the SARC-F survey and increased dietary protein intake through whole foods as measured by the Diet History Questionnaire (DHQ) III. Other expected outcomes include improved: nutritional status, dietary intake, quality of life, socialization, and physical activity. Success in achieving these outcomes will be determined through validated web-based questionnaires.
Animal Health Component
70%
Research Effort Categories
Basic
(N/A)
Applied
70%
Developmental
30%
Goals / Objectives
The long-term goal of StrengthenHer is to promote the independence and well-being of community-residing older women (ages 50-75 years) through an integrative, community-based exercise and nutrition intervention. The overall objective of this application is to design, implement, and evaluate a theory-based, Extension-delivered, community-based exercise and nutrition program capable of reducing sarcopenia risk among women ages 50-75 years. This work is important as it reduces the barrier of access to qualified experts in exercise and nutrition and encourages the consumption of food sources of protein rather than supplementation while delivering quality programming that is sustainable well beyond the timeline of the project.The expected outcome for this proposed project is that participants will experience a reduction in and/or maintained score on the SARC-F (Strength, Ambulation, rising from a chair, stair climbing and history of falling) and improved dietary protein intake. The hypothesis is evoking positive physical activity and dietary intake changes will lead to increased time spent being physically active and improve dietary protein consumption, thus reducing sarcopenia risk. Reducing risk will be done by: (a) designing a program that is viewed as relevant and useful for the target audience, thereby enhancing enrollment and retention, and (b) providing an integrated exercise and nutrition program targeting behaviors that promote lean body mass maintenance and growth. We will test our central hypothesis, accomplish the overall objective of this application, and progress towards our long-term goal while promoting independence and well-being of community-residing older adults through StrengthenHer. The primary outcomes from this study are to evaluate:The change in SARC-F score in participants who complete the StrengthenHer intervention.The change in protein consumption of participants following completion of the StrengthenHer intervention.The change in participants' physical activity levels following completion of the StrengthenHer intervention.The feasibility and acceptability of a completely virtual intervention aimed at preventing or limiting the severity of sarcopenia.
Project Methods
Objective 1: To develop a comprehensive 16-week virtual sarcopenia-risk reduction intervention for community-residing women ages 50 to 75 years. (SMT Steps 2-3; Year 1) [EXTENSION & RESEARCH]We will create a virtual 16-week comprehensive virtual sarcopenia risk reduction program that is both implementable and easy to evaluate at the community level via Extension. StrengthenHer will be created using Social Marketing Theory (SMT) to ensure it is relevant and appropriate for women ages 50-75 years. SMT is a cyclic process comprised of six steps: (1) planning and strategy, (2) selecting channels and materials, (3) developing materials and pretesting, (4) implementing the program, (5) assessing effectiveness, and (6) using feedback to revise the program to generate audience-tailored interventions.StrengthenHer will be comprised of eight asynchronous PA videos and live virtual PA and nutrition education (8 weeks) and follow-up messaging (8 weeks). Each StrengthenHer PA session (3 weekly for 8 weeks, n=24 total) will last 50-minutes including warm-up and cool-down to ensure participants are meeting the 150 minutes of weekly moderate PA recommendation. The weekly live zoom PA and nutrition education sessions will focus on sarcopenia-risk reduction lifestyle strategies through a 10-15-minute PA education lesson and a 40-to-45-minute nutrition lesson. Zoom is the selected platform based on the preliminary work of Dr. Francis that revealed Zoom had high program satisfaction and reported lifestyle changes with minimal technology challenges. This 8-week direct intervention will be followed by an 8-week indirect follow-up messaging intervention.Exercise Intervention (Thrice weekly; Weeks 2 through 9) While considerable research supports exercise and nutrition interventions to lower sarcopenia risk, there is a lack of consensus on duration, method, and nutrition intervention. Sarcopenia interventions have ranged from 8 weeks to 9 months, with the majority lasting 12 weeks. Exercise duration ranged from two to five times weekly; most were three times. All exercise programs included some form of RT and were tested on those ages 65 and older. Based on this evidence, we will develop a video-based periodized RT program three days weekly on non-consecutive days following National Strength and Conditioning Association and American College of Sports Medicine guidelines. Weeks 2 and 3 will consist of primarily body weight and elastic band exercises and a few unilateral and multi-joint lower resistance exercises. Weeks 4 and 5 will incorporate progressively greater resistance exercises and exercises that are multi-joint. Weeks 7 through 10 will incorporate more complex multi-joint movements.PA & Nutrition Education (Once weekly; Weeks 2-9): In addition to the asynchronous exercise videos, each week participants will receive 10-15 minutes of PA education prior to the 45-minute nutrition education intervention as to the benefits of PA to reinforce why they are being encouraged to be active. The PA lessons will be developed by SD and RI while the ISU team will create the nutrition education intervention. The nutrition curriculum will focus on low-cost, easy-to-chew, and easy-to-prepare protein meals and snacks that are appealing for a diverse audience and will include a complete script, user guide for easier consistent delivery through various community agencies (e.g., Extension), and production notes thus enhancing program sustainability. The program will encourage a variety of protein foods including fish and pulses based on the 2020 Dietary Guidelines while following modified American Heart Association dietary guidelines with lean protein intakes of 25% of total calories. The dietary recommendations will be based on a 1500-2000 calorie diet (94 to 125g protein) daily. The eight-week intervention will target protein-rich foods, emphasizing those high in leucine, whey, and vitamin D since research has suggested better outcomes with these within the constructs of a heart-healthy diet. Videos highlighting how to prepare low-cost, easy-to-make protein-rich meals and snacks will be incorporated.Follow-up Messaging (Weekly; Weeks 11-18): Following the intensive eight-week intervention, participants will receive a weekly email newsletter reinforcing sarcopenia risk reduction behaviors. The use of email newsletters is effective in maintaining behavior change following a PA intervention. This newsletter will highlight key messages from the newsletter, link to current sarcopenia news, other Extension resources, etc. It is also anticipated that this will foster community building between participants across states. The newsletters will also be stored within the canvas course. In addition, the research team will create and manage a private Facebook group for StrengthenHer participants to opt into to create a supportive community. Facebook is the selected platform since the research team found Facebook to be the most used social media platform of adults ages 40 years and older. These sustainable features will enhance the impact of the StrengthenHer program.Objective 2: To implement the StrengthenHer intervention in 7 states among community-residing women ages 50-75 years using an Extension-delivery model. (SMT Step 4; Years 2-5; continuous enrollment) [EXTENSION]StrengthenHer will be facilitated by a team of four ISU Extension Food and Health Program specialists. It is anticipated that StrengthenHer will be offered at least six times annually or up to 24 times during the project beginning in Year 2. Programming information (e.g., registration, dates, times, Zoom links) will be shared with all seven states.Objective 2 Proposed Activities:StrengthenHer will use an outcomes evaluation design and will be implemented using a diverse convenience sample of women ages 50 to 75 years. Each participant will take part for a total of 19 weeks and be encouraged to continue the PA beyond the implementation phase. Program recruitment and enrollment will be ongoing throughout Years 2 through 5. Enrollment will be limited to women based on the Health ABC findings reported by Delmonico et al. which suggest that muscle mass (along with fat mass) plays a key role in predicting future functional limitations and that intervention strategies should target retention of lean mass and reducing fat mass, particularly in women.Objective 3: To evaluate to what extent the StrengthenHer Program can reduce sarcopenia risk among community-residing women ages 50-75 years. (SMT Step 5; Weeks 1, 9, 19, and 43; Years 2-5) [RESEARCH]StrengthenHER program evaluation will utilize a mixed methods approach using validated questionnaires and qualitative program feedback that will be completed online.Objective 3 Proposed Activities. All participants will complete online program evaluation surveys at four time points (Weeks 1 [BASELINE], 10 [MID], 19 [POST], 43 [FOLLOW-UP]).