Increasing physical activity in rural Pennsylvanians: The PA moves trial study protocol for a cluster randomized...

Approximately 20% of Americans live in rural communities. For several cancers, incidence rates for rural residents are over 8% higher than for urban residents. Increased physical activity (PA) can reduce risk for several cancers, but rural residents report lower PA than their urban counterparts. Multiple service delivery models have shown success with primary care providers (PCPs) promoting PA. We propose a cluster randomized controlled trial combining PCP PA counseling with telephone coaching to help rural adults increase their PA and reduce their cancer risk.

800-880 patients seeing 32-48 PCPs in 17 clinics will be enrolled in cohorts using a wait list control cluster parallel randomized design. Randomization occurs at the clinic level with the intervention offered either immediately or delayed until the final year of the study in a 1:1 ratio. PCPs receive training in evidence-based strategies through Project Extension for Community Healthcare Outcomes, a case-based learning model commonly used to deliver best practices to PCPs. After referral from PCPs, patients receive PA coaching from the MoveLine, a telephone-based coaching service grounded in evidence-based behavior change techniques. Feedback from MoveLine is provided to the PCP about patient progress through the program. An implementation evaluation occurs annually using rapid assessment procedures and qualitative interviews to suggest intervention delivery improvements. To examine contextual factors, clinic communities' PA environments and opportunities are assessed using established rural-specific methods.

The PA Moves trial is a multilevel randomized trial to address rural health disparities by intervening on PA to reduce cancer risk.

gov reference numbers: NCT05319821 and NCT05227105.