Physical inactivity is associated with poor asthma control and quality of life, and greater health care utilization. Rates of physical inactivity, asthma, and asthma mortality among African American (AA) women are higher than those of their White counterparts. Our formative work identified barriers to PA among AA women with asthma including a lack of social support, self-efficacy, unsafe neighborhood and fear related to experiences with life-threatening asthma exacerbations. Given the unique barriers to PA and high rates of physical inactivity that are associated with poor asthma outcomes in AA women, there is an urgent need to optimize PA interventions for this population. The proposed study uses our theory-driven intervention (ACTION: A lifestyle physiCal acTivity Intervention for minOrity womeN with asthma) to deliver a 24-week lifestyle physical activity intervention designed for and by urban AA women with asthma. This trial will provide the first ever evidence of the efficacy of a lifestyle physical activity intervention among urban AA women with asthma, a population that is understudied yet plagued by low levels of PA and poor health outcomes. Our study has high potential to advance clinical treatment of asthma, and further the mechanistic understanding of physical activity interventions in minority populations living in low-resourced urban environments.

Aim 1A. Determine efficacy of ACTION intervention on asthma control. We will test the hypothesis that at 24-weeks, African American women with asthma that receive the intervention will have a greater improvement in asthma control (asthma control questionnaire-ACQ) compared to women in the control group (education control). Outcome assessments will occur at baseline, 12- and 24-weeks (efficacy endpoint).

Aim 1B: Examine the maintenance effects of the ACTION intervention on asthma control at 48-weeks. We will examine the long-term impact of the intervention on asthma control (e.g. control, quality of life). We hypothesize the effects of ACTION on asthma outcomes will be maintained at 48-weeks.

Aim 2. Explore the behavioral mediators (e.g. self-efficacy, social support, self-regulation and daily PA levels) and contextual moderators (e.g. baseline asthma severity, neighborhood environment, co-morbid conditions, social determinants of health) that contribute to treatment responsiveness. Mediation and moderation analyses will be performed with behavioral mediators and contextual moderators.

Aim 3. Assess the reach and implementation potential of ACTION. Reach will be measured by the number of potential participants (based on the recruitment pool) who are randomized into the study. Implementation potential will be measured using a mixed methods approach to identify important explanatory factors underlying the performance of the intervention components.

Participants will be recruited through two urban health care systems that care for a diverse urban AA population. Patients will be randomized to one of two groups: 1) ACTION intervention (group sessions, physical activity self-monitoring and text-based support for goal-setting), or 2) education control (an individual asthma education session and text messages related to asthma education). Participants will be followed for an additional 24-weeks after the intervention to assess for the maintenance of intervention effects on asthma health outcomes.

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