Development and Preliminary Feasibility Testing of PACERS, a Physical Activity-Centered Intervention for Rural Older...

A high prevalence of hypertension is observed among American rural residents. This study aimed to engage rural community members in designing, developing, and preliminarily testing the feasibility of a physical activity (PA)-centered health promotion intervention integrating Fitbit-based activity monitoring and text messaging among rural older adults (50+ years) with hypertension (PACERS). We also tested the feasibility of measuring candidate outcomes for future studies.

Sixteen participants residing in rural South Carolina communities were interviewed to inform the intervention design and development. Over 12 weeks, 10 older adults diagnosed with hypertension with no or low PA participated in preliminary feasibility testing of the intervention and pre- and post-intervention measurements. Finally, we conducted a post-intervention focus group discussion (FGD, n = 5).

We reviewed health reports, analyzed EHR data, engaged the community to establish health needs, designed and developed PACERS, assessed barriers and facilitators, and tested the preliminary feasibility of the PACERS intervention. Preliminary feasibility was measured by recruitment, retention, fidelity, participants' attendance and acceptability, and candidate outcomes included blood pressure (BP), PA, arterial compliance, cognition, overall health, and quality of life.

Key pre-design themes included as follows: accessibility, intervention delivery through existing health systems, social isolation, hypertension-cognition relationship, accountability, and perceived positive health impacts. FGD themes included as follows: hypertension-cognition links, financial preparation for retirement and isolation management. Recruitment (90.9%), retention (100%), attendance (93%), adherence (90%), and intervention fidelity (98.5%) rates, as well as average acceptance (4.8/5), were promising. Some Candidate outcomes showed improvement: quality of life (0.084; 95% CI: 0.022, 0.146; p = 0.008), systolic BP (-34.28; 95% CI: -57.77, -10.78; p = 0.004), diastolic BP (-19.14; 95% CI: -31.68, -6.60; p = 0.003), arterial compliance (-15.13; 95% CI: -28.00, -2.30; p = 0.021), and average steps per day (3612; 95% CI: 855, 6370; p = 0.010).

This study provides valuable insights into intervention development for older adults in under-resourced settings.