BACKGROUND/RATIONALE:
Veterans with post-traumatic stress disorder (PTSD), prevalent in Veterans, experience high rates of obesity and related conditions due to unique activity and healthy diet barriers; and reduced effectiveness of VA's MOVE! program. This CDA studies MOVE!+UP, a program designed to address these issues. MOVE!+UP is co-led by a psychologist and peer support counselor in 16 in-person group sessions that include 90 minutes of general weight loss support, coupled with Cognitive Behavior Therapy skills to address PTSD barriers. Each session includes a 35-minute community-based walk to address activity barriers. In addition to potential health behavior and weight loss benefits, MOVE!+UP is expected to address PTSD symptoms.

OBJECTIVE(S):
1) Test acceptability and feasibility of MOVE!+UP, and change from baseline on outcomes and mediators, in an uncontrolled pilot trial among overweight Veterans with PTSD.
2) Conduct interviews with VA providers and stakeholders to assess MOVE!+UP's feasibility.
3) Compare MOVE!+UP to MOVE! among overweight Veterans with PTSD in a Hybrid Type 1 trial to test its effectiveness and identify implementation barriers and facilitators.

METHODS:
This CDA involves two studies that will assess MOVE!+UP's acceptability and feasibility, informing its refinement and future implementation: 1) an uncontrolled pilot trial with 44 overweight Veterans with PTSD; and 2) qualitative interviews with VA Puget Sound staff regarding MOVE!+UP. The refined MOVE!+UP intervention will be tested in a two-site Hybrid Type 1 effectiveness trial to 1) determine whether MOVE!+UP leads to better weight loss than usual care MOVE! among 154 overweight Veterans with PTSD, 2) assess MOVE!+UP's impact on secondary outcomes such as PTSD symptoms and quality of life; and 3) identify implementation barriers, facilitators, and strategies.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
This CDA seeks to address the health, mental health, and quality of life of Veterans with PTSD, thereby addressing several top VA priorities. Preliminary findings suggest MOVE!+UP is positioned to impact a substantial Veteran subgroup, important given high prevalence of PTSD among Veterans, and substantial burden of overweight/obesity and related conditions among Veterans with PTSD.

PUBLICATIONS:

Journal Articles

1. Haibach JP, Hoerster KD, Dorflinger L, McAndrew LM, Cassidy DG, Goodrich DE, Bormann JE, Lowery J, Asch SM, Raffa SD, Moin T, Peterson AL, Goldstein MG, Neal-Walden T, Talcott GW, Hunter CL, Knight SJ. Research translation for military and veteran health: research, practice, policy. Translational behavioral medicine. 2021 Mar 16; 11(2):631-641.
2. Hoerster KD, Gray K, Raffa SD. Weight Management and Healthy Lifestyles. JAMA internal medicine. 2020 Oct 1; 180(10):1403-1404.
3. Hoerster KD, Tanksley L, Simpson T, Saelens BE, Unützer J, Black M, Greene P, Sulayman N, Reiber G, Nelson K. Development of a Tailored Behavioral Weight Loss Program for Veterans With PTSD (MOVE!+UP): A Mixed-Methods Uncontrolled Iterative Pilot Study. American Journal of Health Promotion : AJHP. 2020 Jul 1; 34(6):587-598.
4. Black M, LaCroix R, Hoerster K, Chen S, Ritchey K, Souza M, Utech A, Thielke S. Healthy Teaching Kitchen Programs: Experiential Nutrition Education Across Veterans Health Administration, 2018. American journal of public health. 2019 Dec 1; 109(12):1718-1721.
5. Browne KC, Hoerster KD, Piegari R, Fortney JC, Nelson KN, Post EP, Fihn SD, Mori AM, Trivedi RB. Clinical Care Quality Among Veterans Health Administration Patients With Mental Illness Following Medical Home Implementation. Psychiatric services (Washington, D.C.). 2019 Sep 1; 70(9):816-823.
6. Hoerster KD, Campbell S, Dolan M, Stappenbeck CA, Yard S, Simpson T, Nelson KM. PTSD is associated with poor health behavior and greater Body Mass Index through depression, increasing cardiovascular disease and diabetes risk among U.S. veterans. Preventive medicine reports. 2019 Sep 1; 15:100930.
7. Angel CM, Smith BP, Pinter JM, Young BB, Armstrong NJ, Quinn JP, Brostek DF, Goodrich DE, Hoerster KD, Erwin MS. Team Red, White & Blue: a community-based model for harnessing positive social networks to enhance enrichment outcomes in military veterans reintegrating to civilian life. Translational behavioral medicine. 2018 Jul 17; 8(4):554-564.
8. Gray KE, Hoerster KD, Reiber GE, Bastian LA, Nelson KM. Multiple domains of social support are associated with diabetes self-management among Veterans. Chronic Illness. 2019 Dec 1; 15(4):264-275.
9. McGinn MM, Hoerster KD, Stryczek KC, Malte CA, Jakupcak M. Relationship satisfaction, PTSD symptom severity, and mental healthcare utilization among OEF/OIF veterans. Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43). 2017 Feb 1; 31(1):111-116.
10. Hoerster KD, Wilson S, Nelson KM, Reiber GE, Masheb RM. Diet quality is associated with mental health, social support, and neighborhood factors among Veterans. Eating Behaviors. 2016 Dec 1; 23:168-173.
11. Painter JM, Gray K, McGinn MM, Mostoufi S, Hoerster KD. The relationships of posttraumatic stress disorder and depression symptoms with health-related quality of life and the role of social support among Veterans. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2016 Oct 1; 25(10):2657-2667.
12. Goodrich DE, Klingaman EA, Verchinina L, Goldberg RW, Littman AJ, Janney CA, Kim HM, Maguen S, Hoerster KD, Owen RR, Holleman RG, Roman P, Lai Z, Bowersox NW. Sex Differences in Weight Loss among Veterans with Serious Mental Illness: Observational Study of a National Weight Management Program. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2016 Jul 1; 26(4):410-9.
13. Maguen S, Hoerster KD, Littman AJ, Klingaman EA, Evans-Hudnall G, Holleman R, Kim HM, Goodrich DE. Iraq and Afghanistan veterans with PTSD participate less in VA's weight loss program than those without PTSD. Journal of affective disorders. 2016 Mar 15; 193:289-94.
14. Klingaman EA, Hoerster KD, Aakre JM, Viverito KM, Medoff DR, Goldberg RW. Veterans with PTSD report more weight loss barriers than Veterans with no mental health disorders. General hospital psychiatry. 2016 Mar 1; 39:1-7.
15. Washington DL, Gray K, Hoerster KD, Katon JG, Cochrane BB, LaMonte MJ, Weitlauf JC, Groessl E, Bastian L, Vitolins MZ, Tinker L. Trajectories in Physical Activity and Sedentary Time Among Women Veterans in the Women's Health Initiative. The Gerontologist. 2016 Feb 1; 56 Suppl 1:S27-39.
16. Janney CA, Kilbourne AM, Germain A, Lai Z, Hoerster KD, Goodrich DE, Klingaman EA, Verchinina L, Richardson CR. The Influence of Sleep Disordered Breathing on Weight Loss in a National Weight Management Program. Sleep. 2016 Jan 1; 39(1):59-65.
17. Millstein RA, Hoerster KD, Rosenberg DE, Nelson KM, Reiber G, Saelens BE. Individual, Social, and Neighborhood Associations With Sitting Time Among Veterans. Journal of physical activity & health. 2016 Jan 1; 13(1):30-5.
18. Hoerster KD, Millstein RA, Hall KS, Gray KE, Reiber GE, Nelson KM, Saelens BE. Individual and contextual correlates of physical activity among a clinical sample of United States Veterans. Social science & medicine (1982). 2015 Oct 1; 142:100-8.
19. Hoerster KD, Jakupcak M, Hanson R, McFall M, Reiber G, Hall KS, Nelson KM. PTSD and depression symptoms are associated with binge eating among US Iraq and Afghanistan veterans. Eating Behaviors. 2015 Apr 1; 17:115-8.
20. Hall KS, Hoerster KD, Yancy WS. Post-traumatic stress disorder, physical activity, and eating behaviors. Epidemiologic Reviews. 2015 Jan 16; 37(1):103-15.
21. Hoerster KD, Jakupcak M, Stephenson KR, Fickel JJ, Simons CE, Hedeen A, Dwight-Johnson M, Whealin JM, Chaney E, Felker BL. A pilot trial of telephone-based collaborative care management for PTSD among Iraq/Afghanistan war veterans. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2015 Jan 1; 21(1):42-7.
22. Littman AJ, Damschroder LJ, Verchinina L, Lai Z, Kim HM, Hoerster KD, Klingaman EA, Goldberg RW, Owen RR, Goodrich DE. National evaluation of obesity screening and treatment among veterans with and without mental health disorders. General hospital psychiatry. 2015 Jan 1; 37(1):7-13.
23. Hoerster KD, Lai Z, Goodrich DE, Damschroder LJ, Littman AJ, Klingaman EA, Nelson KM, Kilbourne AM. Weight loss after participation in a national VA weight management program among veterans with or without PTSD. Psychiatric services (Washington, D.C.). 2014 Nov 1; 65(11):1385-8.
24. Blais RK, Hoerster KD, Malte C, Hunt S, Jakupcak M. Unique PTSD clusters predict intention to seek mental health care and subsequent utilization in US veterans with PTSD symptoms. Journal of traumatic stress. 2014 Apr 1; 27(2):168-74.
25. Chesney MA, Darbes LA, Hoerster K, Taylor JM, Chambers DB, Anderson DE. Positive emotions: exploring the other hemisphere in behavioral medicine. International Journal of Behavioral Medicine. 2005 Jan 1; 12(2):50-8.

Journal Other

1. Hoerster KD, Hall K, Shirazipour C, Rosenbaum S, de Groot M. Two Birds One Stone: Improving Mental and Physical Health Simultaneously through Health Behavior Interventions. [Abstract]. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2019 Mar 1; 53:S422.
2. Mc Andrew L, Breland J, Hoerster K, Earnest D, Runnels T, Litke D. Listening to Patient and Clinician Voices in Order to be Heard: Reverse Translation in Action. [Abstract]. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2019 Mar 1; 53:S460.

Conference Presentations

1. Hoerster KD. An Examination of Relationship Satisfaction and PTSD among Veterans and Romantic Partners Enrolled in the Post-9/11 Caregiver Program. Paper presented at: International Society for Traumatic Stress Studies Annual Symposium; 2015 Nov 6; New Orleans, LA.
2. Hoerster KD. Modeling the direct and indirect effects of PTSD on cardio-metabolic health among Veterans. Recognized by the Aging, Trauma, and the Lifecourse Special Interest Group. Poster session presented at: International Society for Traumatic Stress Studies Annual Symposium; 2015 Nov 5; New Orleans, LA.

DRA: Mental, Cognitive and Behavioral Disorders, Diabetes and Other Endocrine Disorders
DRE: Technology Development and Assessment, Treatment - Efficacy/Effectiveness Clinical Trial
Keywords: QUERI Implementation
MeSH Terms: none