Comparative Effectiveness of Customary Fit and Strong! vs. Fit and Strong! Plus

习惯贴合和强健的对比效果！

• 批准号: 8484329
• 负责人: Marian L. Fitzgibbon
• 金额: $ 58.68万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-06-15 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8484329
• 关键词: Address; Adult; Aerobic; Affect; Age-Years; Aging; Anxiety; Arthritis; Behavior; Body Weight decreased; Centers for Disease Control and Prevention (U.S.); Chicago; Chronic; Communities; Data; Degenerative polyarthritis; Diet; Dietary Intervention; Elderly; Elements; Employee Strikes; Enrollment; Epidemic; Evidence based program; Exercise; Exhibits; Funding; Gait; Healthcare; Hip region structure; Illinois; Impairment; Individual; Intervention; Intervention Trial; Joints; Knee Osteoarthritis; Learning; Lower Extremity; Maintenance; Measures; Medicare claim; Mental Depression; Meta-Analysis; Obesity; Odds Ratio; Operative Surgical Procedures; Outcome; Outcome Measure; Overweight; Pain; Participant; Pathway interactions; Patient Self-Report; Physical Function; Physical activity; Population; Prevalence; Protocols documentation; Psychological reinforcement; Public Health; Randomized; Replacement Arthroplasty; Reporting; Research; Risk; Role; Route; Site; Speed; Symptoms; Telephone; Testing; Time; Translations; Treatment Efficacy; Universities; Walking; Weight; Weight maintenance regimen; Weight-Bearing state; Woman; Work; behavior change; clinically significant; comparative; comparative effectiveness; compare effectiveness; cost; disability; disability weights; evidence base; health care service utilization; high risk; hip replacement arthroplasty; improved; knee replacement arthroplasty; men; population based; post intervention; primary outcome; programs; public health relevance; randomized trial; sedentary

DESCRIPTION (provided by applicant): This proposal will compare the effectiveness of customary Fit and Strong!-an evidence-based physical activity/behavior change program for older adults with osteoarthritis (OA)-to an enhanced version of the program that also addresses diet and weight. OA is the primary cause of disability among older adults (Hootman et al., 2009), and lower extremity (LE) OA is the pathway through which this disability develops (Dunlop, Hughes, et al., 1998). Fit and Strong! targets older adults with LE OA. In a recent randomized trial, the 8-week Fit and Strong! program demonstrated significant benefits on physical activity maintenance at 18 months accompanied by improved LE stiffness, pain, function, strength, and gait speed as well as reduced anxiety and depression (Hughes et al., 2010). However, Fit and Strong! does not currently address diet/ weight issues present among program participants. This is an important omission because LE symptoms related to OA are either caused by or exacerbated by obesity. Data show that a weight loss of 5.1 kg over a 10-year period decreases the odds of developing knee OA by more than 50% (Felson 1992). In 2007, 37% of men and 48% of women 60 years of age and older were obese (Flegal et al., 2010). Between 2003-2009 obesity prevalence, on average, was 54% higher among adults with arthritis compared to those without the condition (Hootman et al., 2011a). Obese persons with arthritis were also 44% more likely to be physically inactive (Hootman et al., 2011b). This rise in obesity prevalence may explain rapid increases in the use of hip and knee replacement surgery in the U.S., which totaled $9.1 billion in 2004 (Kim, 2008). Importantly, a recent meta- analysis has documented a dearth of evidence supporting the efficacy of interventions to decrease weight in older adults (Witham and Avenell, 2010). We will address this serious scientific gap by developing and testing Fit and Strong! Plus-an enhanced version of Fit and Strong! that addresses both physical activity and diet. We will incorporate common elements from the ADAPT and ORBIT trials that addressed physical activity and diet/ weight loss. Both trials achieved weight loss of approximately 5% at 18 months (Messier et al., 2004, Fitzgibbon et al., 2010). We will compare the effectiveness of customary Fit and Strong! to Fit and Strong! Plus over 24-months using an RCT with 400 participants at 3 community sites. Both groups will receive tapered telephone reinforcement to support maintenance of behavior change during months 3- 24. We will also examine health care use before and after the interventions. We hypothesize that Fit and Strong! Plus participants will show differential, significant improvement in diet behaviors at 2, 6, 12, 18 and 24 months accompanied by significant weight loss (e 5%) at 6 months that will be maintained at 24 months. Fit and Strong! Plus participants will also show differential statisticall significant improvements in physical activity maintenance accompanied by improved LE pain, stiffness, and function as well as depression and anxiety at all time points.

描述（由申请人提供）：该提案将比较传统的 Fit and Strong！（一项针对患有骨关节炎 (OA) 的老年人的基于证据的身体活动/行为改变计划）与该计划的增强版本（也涉及饮食问题）的有效性和重量。 OA 是老年人残疾的主要原因（Hootman 等，2009），下肢（LE）OA 是这种残疾发展的途径（Dunlop，Hughes 等，1998）。健康又强壮！针对患有 LE OA 的老年人。在最近的一项随机试验中，为期 8 周的 Fit and Strong!该计划在 18 个月时证明了对维持体力活动的显着益处，同时改善了 LE 僵硬、疼痛、功能、力量和步态速度，并减少了焦虑和抑郁（Hughes 等，2010）。然而，健康且坚强！目前不解决计划参与者中存在的饮食/体重问题。这是一个重要的遗漏，因为与 OA 相关的 LE 症状要么由肥胖引起，要么因肥胖而加剧。数据显示，10 年内体重减轻 5.1 公斤，患膝骨关节炎的几率会降低 50% 以上（Felson 1992）。 2007 年，60 岁及以上的男性和女性分别有 37% 和 48% 肥胖（Flegal 等，2010）。 2003 年至 2009 年间，患有关节炎的成年人的肥胖患病率平均比没有关节炎的成年人高出 54%（Hootman 等人，2011a）。患有关节炎的肥胖者缺乏身体活动的可能性也高出 44%（Hootman 等人，2011b）。肥胖患病率的上升可能解释了美国髋关节和膝关节置换手术的使用迅速增加，2004 年总计 91 亿美元（Kim，2008）。重要的是，最近的一项荟萃​​分析记录了缺乏证据支持干预措施对减轻老年人体重的有效性（Witham 和 Avenell，2010）。我们将通过开发和测试 Fit and Strong! 来解决这一严重的科学差距！ Plus-Fit and Strong 的增强版！这既解决了身体活动又解决了饮食问题。我们将纳入 ADAPT 和 ORBIT 试验中解决体力活动和饮食/减肥问题的共同要素。两项试验在 18 个月时均实现了约 5% 的体重减轻（Messier 等人，2004 年；Fitzgibbon 等人，2010 年）。我们将比较习惯Fit和Strong的效果！健康又强壮！加上在 3 个社区站点使用 400 名参与者的随机对照试验超过 24 个月。两组都将接受逐渐减少的电话强化，以支持在第 3 至 24 个月内维持行为改变。我们还将检查干预前后的医疗保健使用情况。我们假设健康且强壮！另外，参与者将在第 2、6、12、18 和 24 个月时表现出饮食行为的差异性显着改善，同时在 6 个月时体重显着减轻 (e 5%)，并将在 24 个月时保持这一状态。健康又强壮！此外，参与者还将在身体活动维持方面表现出差异性统计显着改善，并在所有时间点改善 LE 疼痛、僵硬和功能以及抑郁和焦虑。