Initiate and Maintain Physical Activity in Clinics: The IMPACT Diabetes Study

在诊所启动和维持体力活动：IMPACT 糖尿病研究

• 批准号: 8499936
• 负责人: Latha P Palaniappan
• 金额: $ 61.35万
• 依托单位: PALO ALTO MEDICAL FOUNDATION RES INST
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-05-10 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8499936
• 关键词: Academy; Address; Adoption; Adult; Aerobic; Aerobic Exercise; Affect; American; American College of Physicians; Appointment; Caring; Chronic; Clinic; Clinical; Clinical effectiveness; Consent; Data; Diabetes Mellitus; Diet; Effectiveness; Electronic Health Record; Exercise; Family; Family Practice; Foundations; Frequencies; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Goals; Group Structure; Guidelines; Health Benefit; Healthcare; Incidence; Individual; Injury; Intervention; Length; Medical; Medical Care Team; Meta-Analysis; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Patient Self-Report; Patient-Focused Outcomes; Patients; Phase; Physical Fitness; Physical activity; Physical therapy exercises; Physicians; Prevalence; Process Measure; Quality of life; Randomized; Randomized Controlled Trials; Recommendation; Recruitment Activity; Regimen; Research; Resistance; Resources; Secure; Self Management; Structure; Supervision; Surveys; Testing; Time; Training; Training Activity; Training Programs; Translating; Visit; Weight; arm; base; clinical practice; college; community setting; cost effectiveness; diabetic; empowered; follow-up; glycemic control; improved; innovation; interest; medical appointment; novel; nutrition; patient population; prevent; primary outcome; programs; public health relevance; satisfaction; strength training; three-arm study; translational study; treatment as usual; uptake

DESCRIPTION (provided by applicant): Type 2 diabetes (T2DM) affects 25.8 million people in the U.S., and the prevalence and incidence is increasing. The benefits of physical activity in T2DM management have been well demonstrated, with lower glycemic control achieved when patients follow a structured exercise program in a research setting. Given the known benefits of dietary changes in T2DM, nutrition referrals are common in current clinical practice. Despite the similarly known benefits of exercise, physical activity referrals are not readily available in the clinical setting. The current American Diabetes Association (ADA) guidelines recommend that individuals with T2DM should engage in both aerobic and resistance training activity, with at least 150 minutes of moderate-intensity aerobic activity per week and resistance exercises 3 times per week. Most (~70%) T2DM patients do not exercise at recommended levels (38%) or at all (31%). While the efficacy of such intensive physical activity interventions among diabetics in a highly structured research setting has been proven, practical approaches to translating and extending these findings into the clinical setting are needed. While most other translational studies have explored adapting physical activity interventions to other community settings (e.g., YMCA), we uniquely propose institutionalizing physical activity resources within a clinical setting, as this conveys an implicit endorsement of physical activity by a patient's health care team. With the recent (2006) addition of resistance training to the ADA guidelines, it is especially important to provide supervision and support for exercise, to prevent injury and maximize health benefits. In order to address these needs, we propose to implement a three-arm RCT to compare the clinical effectiveness, patient centered outcomes, and cost- effectiveness of adding a specialized physical activity component to an established Shared Medical Appointment for T2DM. Shared Medical Appointments (SMAs) are 60-90 minute group appointments (6-12 patients) which are endorsed by the American Academy of Family Practice and the American College of Physicians, and have been implemented in a variety of clinical settings. The proposed Physical Activity for Diabetes SMA (PAD-SMA) will involve structured group exercise sessions in a clinical setting at varying levels of frequency (once vs. three times per week), compared to usual care. The proposed study seeks to test an innovative approach for adoption of physical activity to improve glycemic control. The goal of the Initiate and Maintai Physical Activity in Clinics (IMPACT) Diabetes Study is to translate the known benefits of supervised physical activity in a clinical setting.

描述（由申请人提供）：2型糖尿病（T2DM）影响美国2580万人，并且患病率和发病率正在增加。体育活动在T2DM管理中的好处已经得到很好的证明，当患者在研究环境中遵循结构化运动计划时，血糖控制较低。鉴于T2DM饮食变化的已知好处，营养转诊在当前的临床实践中很常见。尽管运动具有类似的益处，但在临床环境中，体育锻炼转介尚不容易获得。当前的美国糖尿病协会（ADA）指南建议患有T2DM的个体应同时进行有氧和抵抗训练活动，每周至少进行150分钟的中等强度有氧运动活动，每周3次耐药性练习。大多数（〜70％）T2DM患者不以建议的水平（38％）或根本不运动（31％）。尽管已经证明了在高度结构化的研究环境中糖尿病患者中这种强化体育锻炼干预措施的疗效，但需要将这些发现和将这些发现扩展到临床环境的实用方法。尽管大多数其他翻译研究都探索了对其他社区环境（例如YMCA）的适应体育锻炼干预措施，但我们唯一地提出了在临床环境中的体育活动资源的制度化，因为这表达了患者的医疗保健团队对体育活动的隐含认可。随着最近（2006年）在ADA指南中增加了抵抗培训，为锻炼提供监督和支持以防止伤害和最大化健康益处，这一点尤其重要。为了满足这些需求，我们建议实施三臂RCT，以比较将专门的体育活动组件添加到T2DM的已建立的共享医疗任命中的临床有效性，以患者为中心的结果以及成本效益。共同的医疗预约（SMA）是60-90分钟的小组任命（6-12名患者），由美国家庭实践学院和美国医师学院认可，并已在各种临床环境中实施。与通常的护理相比，糖尿病SMA（PAD-SMA）的体育活动将在临床环境中涉及临床环境中的结构化组运动疗程（每周一次，每周三次）。拟议的研究旨在测试采用体育活动以改善血糖控制的创新方法。诊所（影响）糖尿病研究中开始和维持体育活动的目的是转化临床环境中监督体育活动的已知好处。