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Principal Investigator: LAUREN M ABBATE
Organization: VA EASTERN COLORADO HEALTH CARE SYSTEM
Fiscal Year: 2024
Funding agency: Veterans Affairs
Background: Exercise is an evidence-based intervention for the management of chronic conditions, yet the
majority of Veterans are inactive. Group telehealth (GT) delivered exercise can potentially improve access to
and participation in exercise. GT exercise sessions may increase exercise participation by providing social
support, but a better understanding of the feasibility and acceptability of this format is needed. Telehealth
delivered exercise programs should be designed with initiation and maintenance phases, but there is not
consensus regarding the strategies for delivering exercise maintenance interventions. Skills for exercise
initiation and maintenance differ, and interventions that focus on one or the other are not likely to result in
sustained exercise participation.
Significance/Impact: As the Veterans Health Administration is the largest integrated health care system in the
US, implementing successful exercise programs could have a profound impact of public health. National
priorities including telehealth and access to care as well as management of chronic conditions will be
addressed by the development of this GT exercise initiation and maintenance intervention.
Innovation: GT exercise combines the benefits of group exercise sessions, such as social support, and
telehealth technology. There have been no studies comparing GT exercise booster sessions plus text
messaging to text messaging alone to support exercise maintenance. These two strategies will be used as a
multi-faceted approach to improving exercise maintenance.
Specific Aims:
Aim 1: Adapt evidenced-based exercise components for a group telehealth (GT) exercise intervention, guided
by stakeholder input. Using qualitative methods, I will explore the perspectives of stakeholders through focus
groups and interviews. Intervention development will include an iterative approach and formative evaluation.
Aim 2: Conduct a randomized pilot trial to assess the feasibility and acceptability of the GT exercise initiation
and maintenance program. I will use lower extremity osteoarthritis (OA) as a model to conduct this work
because: 1) lower extremity osteoarthritis (OA) is a prevalent condition among Veterans, 2) exercise is a first
line recommendation for the management of lower extremity OA, and 3) I have previous experience in OA.
Veterans with lower extremity OA (n=50) will be randomized to the intervention. I will assess feasibility (i.e.
referral, retention, data collection) and acceptability (i.e. number of sessions attended, number of text message
responses, participant and provider feedback).
Aim 3: Determine contextual factors related to successful implementation and sustainability of telehealth-
delivered exercise programs within VA. Gerofit, an existing telehealth-delivered VA exercise program
implemented at multiple sites, will be used as a model. An explanatory sequential mixed methods design will
be used to describe site characteristics and simultaneously explore the perspectives of the site personnel,
using survey and interview data.
Methodology: The Practical Robust Implementation and Sustainability Model (PRISM), a conceptual
framework for translating health interventions into practice, will be used with Dissemination and Implementation
Science methods. Specifically, qualitative methods will be used to obtain stakeholder perspectives to design a
GT delivered exercise program. A randomized pilot trial design will be used to pilot the GT exercise
intervention to evaluate feasibility and acceptability. Mixed methods will be used to identify contextual factors
related to successful implementation and sustainment.
Next Steps/Implementation: This formative work will be used in a future larger, single site trial to test the
effectiveness and evaluate the implementation of the GT exercise initiation and maintenance intervention.
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