Developing a patient-centered intervention to improve exercise adoption and adherence among post-9/11 women Veterans

Background: Women Veterans often report little or no exercise after leaving military service. Regular exercise contributes to significant benefits in physical and psychological health, including risk reduction for several chronic conditions, such as diabetes and cardiovascular disease. As such, women Veterans’ diminished exercise contributes to their increased risk for significant health conditions and can have a cumulative negative impact on their long-term health (e.g., obesity, cardiovascular disease, hypertension). Women Veterans lack access to effective approaches for increasing exercise, such as behavioral interventions (e.g., goal setting), that are tailored to their needs and can mitigate significant, preventable health conditions among this Veteran population. Psychological skills training (PST) interventions use evidence-based strategies (goal setting, imagery, self-talk, relaxation) to increase exercise participation and satisfaction. In the proposed project, we will adapt evidence-based strategies used in PST interventions to tailor a novel PST intervention known as STRIVE (Skills Training to Increase Veteran Exercise) to increase exercise adoption and adherence among women Veterans from the post-9/11 era. Significance/Impact: The post-9/11 era is the largest cohort of women Veterans and is rapidly growing. To mitigate the impact of significant, preventable health conditions among women Veterans and the subsequent burden on the VA healthcare system, approaches are needed to meet the distinct needs of this Veteran population. This proposal addresses (1) several objectives within the VA's Strategic Plan focused on women Veterans and improving their access to tailored health care and (2) HSR research priorities focused on women Veterans’ health care needs and interventions following military service. The proposed project is also timely and aligned with the recently signed Executive Order prioritizing research on women’s health issues. Findings will contribute to VA’s current exercise initiatives and efforts to tailor women Veterans’ health care. Innovation: Psychological skills training (PST) interventions have been effectively used and implemented in a variety of settings, such as the military, and have been found to increase exercise. PST interventions can also increase self-efficacy, which is one of the strongest determinants of consistent exercise. However, despite the demonstrated effectiveness of PST interventions on increasing exercise and self-efficacy, the application of PST interventions to increase exercise among women Veterans remains largely unexplored. Specific Aims: This study will determine exercise perceptions and support needs among women Veterans, (Aim 1), iteratively tailor a PST-based intervention protocol for exercise among women Veterans (Aim 2), and preliminarily pilot test the PST intervention for exercise to assess feasibility and acceptability (Aim 3). Methodology: This is a multimethod study. In Aim 1 we will use qualitative interviews to elicit perceptions of exercise behaviors from women Veterans (N=30). In Aim 2 we will assemble an advisory group (N=6-8) of VA clinicians and administrators to elicit input on how to tailor a PST-based intervention protocol for exercise for women Veterans. In Aim 3 we will conduct a preliminary pilot test using a sample of women Veterans (N=12) to qualitatively and quantitatively assess the feasibility and acceptability of the intervention developed in Aim 2. Implementation/Next Steps: We will develop implementation strategies in Aim 2 to facilitate broader testing, scalability, and future implementation of the STRIVE intervention. These strategies will be tested and refined in the planned future Merit Award application that will test STRIVE in a randomized controlled trial. More broadly, findings from Aim 1 and the implementation plan in Aim 2 can be used to augment existing services, such as the VA MOVE! Program or Whole Health. Adapted evidence-based strategies to promote exercise among women Veterans can also be implemented into clinical services (e.g., gynecology and primary care visits) and VA services that support women Veterans.