title: Study protocol of "Worth the Walk": a randomized controlled trial of a stroke risk reduction walking intervention among racial/ethnic minority older adults with hypertension in community senior centers.
abstract: BACKGROUND
  Stroke disproportionately kills and disables ethnic minority seniors. Up to 30 % of ischemic strokes in the U.S. can be attributed to physical inactivity, yet most Americans, especially older racial/ethnic minorities, fail to participate in regular physical activity. We are conducting a randomized controlled trial (RCT) to test a culturally-tailored community-based walking intervention designed to reduce stroke risk by increasing physical activity among African American, Latino, Chinese, and Korean seniors with hypertension. We hypothesize that the intervention will yield meaningful changes in seniors' walking levels and stroke risk with feasibility to sustain and scale up across the aging services network.
  
  
  METHODS
  In this randomized single-blind wait-list control study, high-risk ethnic minority seniors are enrolled at senior centers, complete baseline data collection, and are randomly assigned to receive the intervention "Worth the Walk" immediately (N = 120, intervention group) or in 90 days upon completion of follow-up data collection (N = 120, control group). Trained case managers employed by the senior centers implement hour-long intervention sessions twice weekly for four consecutive weeks to the intervention group. Research staff blinded to participants' group assignment collect outcome data from both intervention and wait-list control participants 1 and 3-months after baseline data collection. Primary outcome measures are mean steps/day over 7 days, stroke knowledge, and self-efficacy for reducing stroke risk. Secondary and exploratory outcome measures include selected biological markers of health, healthcare seeking, and health-related quality of life. Outcomes will be compared between the two groups using standard analytic methods for randomized trials. We will conduct a formal process evaluation to assess barriers and facilitators to successful integration of Worth the Walk into the aging services network and to calculate estimated costs to sustain and scale up the intervention. Data collection is scheduled to be completed in December 2016.
  
  
  CONCLUSIONS
  If this RCT demonstrates superior improvements in physical activity and stroke knowledge in the intervention group compared to the control group and is found to be sustainable and scalable, Worth the Walk could serve as a primary stroke prevention model for racial/ethnic communities across the nation.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02181062 ; registered on June 30, 2014.
authors.affiliation: Department of Medicine, Division of Geriatrics, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave, Suite 2339, Los Angeles, CA, 90095, USA. IKwon@mednet.ucla.edu.
authors.forename: Ivy
authors.initials: I
authors.lastname: Kwon
authors.affiliation: Nursing Science, College of Health Sciences, UC Irvine, 100B Berk Hall, University of California Irvine, Irvine, CA, 92697, USA. sechoi@uci.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Choi
authors.affiliation: VA Greater Los Angeles Healthcare System, Center for Implementation Practice and Research Support, 16111 Plummer Street, North Hills, CA, 91343, USA. Brian.Mittman@va.gov.
authors.forename: Brian
authors.initials: B
authors.lastname: Mittman
authors.affiliation: UCLA Division of General Internal Medicine and Health Services Research, 911 Broxton Avenue, Los Angeles, CA, 90095, USA. Nazleen.Bharmal@gmail.com.
authors.forename: Nazleen
authors.initials: N
authors.lastname: Bharmal
authors.affiliation: Department of Biostatistics at UCLA, CHS 63-037A, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA. HHLiu@mednet.ucla.edu.
authors.forename: Honghu
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Neurology at UCLA, 710 Westwood Plaza, C109 RNRC, Los Angeles, CA, 90095, USA. BVickrey@ucla.edu.
authors.forename: Barbara
authors.initials: B
authors.lastname: Vickrey
authors.affiliation: Vascular Neurology at Rush University, Professional Office Building, 1725 W. Harrison St, Suite 1121, Chicago, IL, 60612, USA. sarah_song@rush.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Song
authors.affiliation: Department of Medicine, Division of Geriatrics, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave, Suite 2339, Los Angeles, CA, 90095, USA. DAraiza@mednet.ucla.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Araiza
authors.affiliation: Geriatrics Research Center, Division of Geriatrics, David Geffen School of Medicine at UCLA, 10880 Wilshire Boulevard, Suite 860, Los Angeles, CA, 90024, USA. HMcCreath@mednet.ucla.edu.
authors.forename: Heather
authors.initials: H
authors.lastname: McCreath
authors.affiliation: Department of Medicine, Division of Geriatrics, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave, Suite 2339, Los Angeles, CA, 90095, USA. TSeeman@mednet.ucla.edu.
authors.forename: Teresa
authors.initials: T
authors.lastname: Seeman
authors.affiliation: American Heart Association/American Stroke Association, One South Almaden Boulevard, Suite 500, San Jose, CA, 95113, USA. Sang-Mi.Oh@heart.org.
authors.forename: Sang-Mi
authors.initials: SM
authors.lastname: Oh
authors.affiliation: City of Los Angeles Department of Aging, 221 N. Figueroa St., Suite 180, Los Angeles, CA, 90012, USA. Laura.Trejo@lacity.org.
authors.forename: Laura
authors.initials: L
authors.lastname: Trejo
authors.affiliation: Department of Medicine, Division of Geriatrics, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave, Suite 2339, Los Angeles, CA, 90095, USA. CSarkisian@mednet.ucla.edu.|VA Greater Los Angeles Healthcare System Geriatric Research Education Clinical Center (GRECC), Building 220, Room 315 (11G), 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA. CSarkisian@mednet.ucla.edu.
authors.forename: Catherine
authors.initials: C
authors.lastname: Sarkisian
mesh_terms: D001741:Black or African American; D000368:Aged; D001213:Asian; D002681:China; D003625:Data Collection; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D017144:Focus Groups; D006630:Hispanic or Latino; D006801:Humans; D006973:Hypertension / Q000208:ethnology / Q000503:physiopathology* / Q000628:therapy*; D007723:Korea; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012107:Research Design; D012111:Residence Characteristics; D040242:Risk Reduction Behavior; D020377:Self Efficacy; D064407:Senior Centers; D016037:Single-Blind Method; D020521:Stroke / Q000208:ethnology* / Q000503:physiopathology / Q000517:prevention & control*; D014481:United States; D014850:Waiting Lists; D016138:Walking