Building on Lessons Learned in a Mobile Intervention to Reduce Pain and Improve Health (MORPH): Protocol for the MORPH-II Trial

Abstract

Background Engaging in sufficient levels of physical activity, guarding against sustained sitting, and maintaining a healthy body weight represent important lifestyle strategies for managing older adults’ chronic pain. Our first Mobile Health Intervention to Reduce Pain and Improve Health (MORPH) randomized pilot study demonstrated that a partially remote group-mediated diet and daylong activity intervention (ie, a focus on moving often throughout the day) can lead to improved physical function, weight loss, less pain intensity, and fewer minutes of sedentary time. We also identified unique delivery challenges that limited the program’s scalability and potential efficacy. Objective The purpose of the MORPH-II randomized pilot study is to refine the MORPH intervention package based on feedback from MORPH and evaluate the feasibility, acceptability, and preliminary efficacy of this revised package prior to conducting a larger clinical trial. Methods The MORPH-II study is an iteration on MORPH designed to pilot a refined framework, enhance scalability through fully remote delivery, and increase uptake of the daylong movement protocol through revised education content and additional personalized remote coaching. Older, obese, and low-active adults with chronic multisite pain (n=30) will be randomly assigned to receive a 12-week remote group-mediated physical activity and dietary weight loss intervention followed by a 12-week maintenance period or a control condition. Those in the intervention condition will partake in weekly social cognitive theory–based group meetings via teleconference software plus one-on-one support calls on a tapered schedule. They will also engage with a tablet application paired with a wearable activity monitor and smart scale designed to provide ongoing social and behavioral support throughout the week. Those in the control group will receive only the self-monitoring tools. Results Recruitment is ongoing as of January 2021. Conclusions Findings from MORPH-II will help guide other researchers working to intervene on sedentary behavior through frequent movement in older adults with chronic pain. Trial Registration ClinicalTrials.gov NCT04655001; https://clinicaltrials.gov/ct2/show/NCT04655001 International Registered Report Identifier (IRRID) PRR1-10.2196/29013

A remote group-mediated daylong physical activity intervention for older adults with chronic pain: Results of the MORPH-II randomized pilot trial

“…Importantly, social connection plays a central role both in the experience of pain, as loneliness and pain operate bidirectionally ( 15 , 16 ), and in the uptake and maintenance of challenging health behaviors ( 17 , 18 ). Participation in regular physical activity—especially in a social context and when the activity is of moderate intensity in an intrinsically enjoyable format—and avoiding prolonged sitting is widely acknowledged as an effective medicine for addressing negative emotional states such as anxiety and negative affect ( 19 ). It is also notable that MVPA and sedentary behavior are interrelated and the relationships between these behaviors are affected by pain ( 20 ).…”

Successes and lessons learned from a mobile health behavior intervention to reduce pain and improve health in older adults with obesity and chronic pain: a qualitative study

“…These findings align with the systematic review completed by Changizi and Kaveh ( 23 ), which demonstrates the utility of mHealth as a useful platform in facilitating behavior change. MORPH participants also identified the need for support when technological issues arose and the inclusion of goal setting for incremental success as well as personalized, timely feedback ( 24 , 25 ).…”

Intervening on exercise and daylong movement for weight loss maintenance in older adults: A randomized, clinical trial

“…This study provides preliminary evidence that this approach is helpful for guarding against increased sitting in response to structured exercise, although the small sample with complete ActivPAL data suggest that this should be interpreted with caution. We have since conducted several iterative studies designed to refine this novel coaching model (17,41,42). An important limitation was that the COVID-19 pandemic prevented collection of objective follow-up data in two planned waves, reducing our sample size.…”