Weight Loss and Exercise for Communities with Arthritis in North Carolina (WE-CAN)

北卡罗来纳州关节炎社区的减肥和锻炼 (WE-CAN)

• 批准号: 9766072
• 负责人: LEIGH Fleming CALLAHAN
• 金额: $ 110.74万
• 依托单位: WAKE FOREST UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9766072
• 关键词: Age; American; Arthritis; Behavioral; Body Weight decreased; Clinical; Communities; Computers; Control Groups; County; Data; Diet; Effectiveness; Exercise; Health Benefit; Healthy People 2020; Intervention; Knee Osteoarthritis; Measures; Modality; Modeling; North Carolina; Obesity; Outcome; Overweight; Pain; Palpable; Paper; Participant; Patient Monitoring; Patient Self-Report; Patients; Physicians; Policies; Public Health; Questionnaires; Rheumatology; Risk Factors; Rural; SF-36; Testing; Translating; Walking; Western Ontario and McMaster Universities Arthritis Index; Woman; adult obesity; aged; attentional control; base; biomedical referral center; clinically significant; cohort; college; community intervention; community setting; cost; cost effective; cost effectiveness; design; diet and exercise; effective intervention; efficacy trial; exercise intervention; exercise program; health related quality of life; improved; improved functioning; indexing; knee pain; men; modifiable risk; multimodality; pain reduction; pain relief; programs; public health relevance; rural counties; socioeconomics; weight loss intervention; weight loss program

 DESCRIPTION (provided by applicant): Obesity is a modifiable risk factor for knee osteoarthritis (OA), and weight loss is an effective non- pharmacologic treatment to reduce pain. Recently, we determined that under ideal, highly controlled circumstances, a diet-induced weight loss of 10% combined with exercise was significantly better at reducing pain than either intervention alone. Compared to previous long-term weight loss and exercise trials of knee OA, our diet-induced weight loss and exercise group was twice as effective at relieving pain. Whether our groundbreaking results can be generalized to less rigorously monitored patient cohorts is unknown. Thus, the policy relevant and clinically significant question is: How can we adapt this successful solution to a pervasive public health problem so that it provides a cost-effective intervention for real-world clinical and community settings? This study aims to develop and to demonstrate the effectiveness of a systematic, practical, cost-effective diet-induced weight loss and exercise intervention that communities can implement to reduce pain and improve other clinical outcomes in knee OA patients. This pragmatic community-based trial will determine if the important benefits realized by participants in our previous trial translate to rea-world settings. Participants will be 820 ambulatory, community-dwelling, overweight and obese (BMI = 27 kg/m2) men and women aged = 50 years who meet the American College of Rheumatology clinical criteria for knee OA which includes knee pain on most days of the week plus at least 3 of the following 6: age = 50 years; stiffness < 30 min/day; crepitus; bony tenderness; bony enlargement; no palpable warmth. The primary aim is to determine whether a pragmatic, community-based 18-month diet-induced weight loss and exercise intervention implemented in three North Carolina counties with diverse residential (from urban to rural) and socioeconomic composition significantly decreases knee pain in overweight and obese adults with knee OA relative to an attention control group. Secondary aims will determine whether this intervention improves self-reported function, health-related quality of life, and mobility. We will also establish the cost-effectiveness of this pragmatic, community-based intervention by conducting cost-effectiveness and budgetary impact analyses using data from the current trial in a validated computer-simulated model of knee OA. Many physicians who treat people with knee OA have no practical means to implement weight loss and exercise treatments. This study is significant in that it will test the effectiveness of a long-awaited and much needed community program that will serve as a blueprint for clinicians and public health officials in urban and rura communities to implement a weight loss and exercise program designed to reduce knee pain and improve other clinical outcomes in overweight and obese adults with knee OA.

 描述（由适用提供）：肥胖是膝盖骨关节炎（OA）的可修改风险因素，体重减轻是一种有效的非药物治疗，可减轻疼痛。最近，我们确定在理想的，高度控制的环境下，饮食引起的体重减轻10％与运动相结合在减轻疼痛方面，比单独的任何一种干预措施都要好得多。与以前的长期体重减轻和膝盖OA的运动试验相比，我们的饮食引起的体重减轻和运动组在缓解疼痛方面有效。我们的开创性结果是否可以推广到不太严格监控的患者同伙。这是相关且具有临床意义的政策的是：我们如何将这种成功的解决方案适应普遍存在的公共卫生问题，从而为现实世界中的临床和社区环境提供了具有成本效益的干预措施？研究旨在发展和证明系统的，实用，具有成本效率的饮食诱导的体重减轻和运动干预的有效性，社区可以实施以减轻疼痛并改善膝关节OA患者的其他临床结果。这项基于社区的务实试验将确定参与者在我们以前的试验中所实现的重要好处是否转化为Rea-World设置。参与者将是820名卧床，社区居住，超重和肥胖（BMI）= 27 kg/m2）男性和女性= 50岁，他们遇到了美国风湿病学院的膝盖OA临床标准，其中包括一周中的大多数日子，至少在接下来的6：年龄= 50岁= 50岁；刚度<30分钟/天； crepitus;奖励温柔；没有明显的温暖。主要目的是确定在北卡罗来纳州的三个县（从城市到乡村）进行的务实的，基于社区的18个月饮食引起的体重减轻和运动干预措施是否显着减轻超重和肥胖的成人膝盖疼痛的膝盖疼痛。次要目的将确定这种干预措施是否改善了自我报告的功能，与健康相关的生活质量和流动性。我们将 还通过在经过验证的膝盖OA的计算机模拟模型中进行成本效益和预算影响分析来建立这种务实的基于社区干预的成本效益。许多治疗膝关节人士的医生没有实践手段来实施体重减轻和锻炼治疗。这项研究非常重要，因为它将测试期待已久的急需的社区计划的有效性，该计划将成为城市和鲁拉社区中临床医生和公共卫生官员的蓝图，以实施旨在减轻膝盖疼痛并改善膝盖成人肥胖和肥胖成人膝盖OA的临床疼痛的体重和运动计划。

项目成果

Clinical, Health-Related Quality of Life, and Gait Differences Among Obesity Classes in Adults With Knee Osteoarthritis.

膝骨关节炎成人肥胖类别之间的临床、健康相关生活质量和步态差异。

• DOI: 10.1002/acr.25265
• 发表时间: 2024
• 期刊: Arthritis care & research
• 影响因子: 4.7
• 作者: Messier,StephenP;Gill,MaliaE;Mihalko,ShannonL;Beavers,DanielP;Queen,Kate;Miller,GaryD;Losina,Elena;Katz,JeffreyN;Loeser,RichardF;DeVita,Paul;Hunter,DavidJ;Quandt,SaraA;Lyles,MaryF;Hudson,David;Callahan,LeighF
• 通讯作者: Callahan,LeighF