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Heart disease is the leading cause of death in the United States. African Americans and people of low socioeconomic status suffer disproportionately from heart disease-related morbidity and mortality. In Detroit, Michigan, a primarily African American and low-income urban area, heart disease mortality is at twice the national rate. Despite evidence for the effectiveness of self-management support interventions in reducing chronic disease burden for older adults, few are adapted for communities most in need. This article describes the process of adapting Take PRIDE, an evidence-based heart disease self-management intervention, for older adults in Detroit via the Replicating Effective Programs (REP) framework. Working within a community-academic partnership, we found REP useful in facilitating the identification of diverse stakeholders, core versus adaptable elements of the intervention and barriers to implementation. We also made several modifications to the REP framework in order to better fit our project needs. Overall, we found REP to be an effective, flexible tool that allowed us to successfully adapt a disease-management intervention for this setting. Processes, lessons learned, and recommendations offered in this article may help researchers and practitioners working to expand access to self-management support for populations most affected by chronic disease.

Objective: The primary objective of this study was to examine gender differences in engagement in physical activity over time among older U.S. adults with diabetes., Method: Using data from the Health and Retirement Study, we investigated physical activity between 2004 and 2010 among 1,857 adults aged 65 years and above with diabetes., Results: Less than half of adults were physically active at baseline. The probability of physical activity declined over the 6-year period, with no significant gender variation in the effect of time. Because the odds of physical activity were lower for women at baseline and the effect of time did not vary by gender, the trajectory of physical activity was less favorable for women than men., Discussion: The women in this cohort of older Americans started and remained less active than their male counterparts. Investigations covering a larger portion of the life course and those examining the impact of life events and transitions on physical activity among adults with diabetes are needed., (© The Author(s) 2015.)