# Activation for Self-Care Needs in Older Adults with Chronic Kidney Disease: ACTIVE SENIORS with CKD.

> **NIH VA IK2** · VETERANS HEALTH ADMINISTRATION · 2024 · —

## Abstract

Frailty, or having a decreased physiologic capacity to recover from a health-related stressor is common in
and fatal to older Veterans. Frailty is even more prevalent among older adults with chronic kidney disease
(CKD). Among older Veterans with CKD, physical activity frequency is the component of the frailty
phenotype that significantly predicts mortality or dialysis initiation. However, existing interventions are only
aimed to improve exercise capacity, do not apply behavior change theory to identify psychosocial
mechanisms that explain infrequent physical activity, and do not improve muscle weakness despite its
prevalence in CKD and associations with physical activity frequency in older adults. It also remains unknown
how to identify those who would experience the greatest response such that interventions can be targeted.
The ‘Capability, Opportunity, Motivation, Behavior’ (COM-B) theory of behavior change posits that a behavior
occurs when an individual is ‘Capable’ of engaging in a behavior; sees the ‘Opportunity’ to engage in the
environment; and feels the ‘Motivation’ to engage. My pilot data demonstrates that sedentary older adults
reported low Patient Activation (the skill and confidence to engage in a behavior). Patient Activation and is a
psychosocial factor that correspond to the ‘Motivation’ component of the COM-B theory. Thus, an
intervention to maximally increase physical activity frequency and reduce frailty risk among older Veterans
with CKD may need to be centered on improving Activation.
The frequency of physical activity behaviors among older adults strongly depends on lower extremity muscle
strength. Adults with CKD experience loss of muscle mass and exhibit poor lower extremity strength.
Resistance training improves muscle strength by placing or force or pressure against muscle. Thus, an
intervention to maximally increase physical activity frequency and reduce frailty risk among older Veterans
with CKD may need to include resistance training.
A maximally effective intervention requires that it be targeted to those would receive the greatest benefit.
Senescence is a phenomenon of cell cycle arrest that is implicated in frailty pathogenesis. Biomarkers of
senescence were recently shown to be predictive of treatment response after a physical activity intervention;
therefore, biomarkers of senescence may be a novel way to identify older Veterans with CKD who would
experience the greatest treatment response after a physical activity intervention.
This proposal will 1) test whether Patient Activation associates with physical activity frequency among older
Veterans with CKD; 2) explore whether other factors in COM-B theory associate with physical activity
frequency; 3) develop and pilot test a novel physical activity intervention targeted to the mechanisms identified;
and 4) explore if biomarkers of senescence predict intervention treatment response. The proposal is significant
because it aims to reduce the adverse sequelae of fra...

## Key facts

- **NIH application ID:** 10803503
- **Project number:** 1IK2CX002595-01A2
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Devika Nair
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2024-04-01 → 2029-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10803503

## Citation

> US National Institutes of Health, RePORTER application 10803503, Activation for Self-Care Needs in Older Adults with Chronic Kidney Disease: ACTIVE SENIORS with CKD. (1IK2CX002595-01A2). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10803503. Licensed CC0.

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