Project Summary/Abstract
Over 25% of midlife adults suffer from chronic pain, and promotion of physical activity (PA) among this
population is essential to increasing quality of life and function at older age. Exercise programs have
increasingly been offered in healthcare systems, however, adherence to exercise prescription is poor, with
attrition rates as high as 50%. One of the major challenges to increasing PA among adults with chronic pain is
that up to 70% experience increased pain during activity. Although increased pain during PA has frequently
been cited as a major barrier to PA, additional work is needed to establish PA-induced pain as a key
mechanism explaining nonadherence to PA among midlife adults with chronic pain. The proposed study will
leverage an ongoing RCT by our research team (R01AG069349), which aims to test the effects of a
recommendation for self-paced PA (i.e., PA of a self-selected intensity) versus prescribed moderate intensity
PA on PA behavior among midlife adults using ecological momentary assessment (EMA) methodology. We will
capitalize on this infrastructure to test two novel research questions among the subset of participants who
endorse chronic pain: (1) Does increased pain during PA predict subsequent PA behavior? and (2) Does a
recommendation for self-paced (vs. prescribed moderate intensity) PA reduce PA-induced pain, and
subsequently increase future PA behavior? Indeed, self-paced PA may reduce PA-induced pain by providing
the opportunity to reduce PA intensity when pain begins to increase. We will leverage this experimental
manipulation (i.e., randomization to self-paced vs. prescribed moderate intensity) to use an experimental
medicine approach to test whether manipulation-driven reductions in PA-induced pain (test of target
engagement) increase subsequent PA behavior (test of target validity). We will also explore the more distal
effects of PA on chronic pain severity and indices of successful aging at a six-month follow-up assessment.
The applicant’s long-term goal is to conduct research focused on promoting adherence to healthful
behaviors among individuals with chronic pain, and this study represents an important next step in a
systematic line of research that has the potential to inform clinical practice. This award will allow the applicant
to receive specialized training in the development/provision of physical activity promotion interventions, the
healthy aging process, and the collection/analysis of intensive longitudinal and ambulatory assessment data.
This award will also facilitate further development of the applicant’s research program via completion of
manuscripts, presentation of research findings at scientific meetings, and development of additional research
questions. Brown University is the ideal research/training environment for this project, as the applicant will
have extensive opportunities for collaboration and training with expert behavioral medicine researchers. The
hands-on training and pilot data obtained through this project will improve the applicant’s ability to obtain a
competitive academic research position and increase potential for a productive research career.