Exploring mechanisms of improvement in the Active Brains intervention for older adults with chronic pain and early cognitive decline

Objectives: We iteratively developed, optimized, and established the feasibility of a virtual, group-based, mind-body activity program (Active Brains, AB), supported by Fitbit for older adults with chronic pain (CP) and early cognitive decline (ECD). Guided by the principles of the NIH stage model we 1) explore signals of improvement in AB outcomes and hypothesized mechanisms of action and 2) explore relationships between changes in out-comes with changes in mechanisms.Methods: Participants were N = 15 older adults (age >= 60) with CP-ECD from two NIH stage 1 pilot studies of AB. We conducted paired t-tests to explore prepost improvements, and correlations to investigate associations between changes in outcomes and mechanisms.Results: We observed small to large improvements across co-primary and secondary outcomes (d = 0.24-1.09). We observed small to medium improvements in 4 out of 5 hypothesized mechanisms (d = 0.23-0.47). Overall, improvements in outcomes had moderate to large associations with improvements in hypothesized mechanisms. Conclusion: AB was associated with improvements across several co-primary and secondary outcomes, and hypothesized mechanisms. Pain-specific coping and general coping skills are promising treatment targets to address the CP-ECD comorbidity among older adults.