Executive Functioning and Physical Activity in Adolescents At-Risk for Type 2 Diabetes

有 2 型糖尿病风险的青少年的执行功能和体力活动

• 批准号: 10667026
• 负责人: LAUREN BERGER SHOMAKER
• 金额: $ 43.21万
• 依托单位: COLORADO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10667026
• 关键词: Adherence; Administrative Supplement; Adolescent; Adult; Affect; Aftercare; Age; Aggressive course; Behavior; Behavioral; Body Weight decreased; Body mass index; Cause of Death; Cognition; Cognitive; Cognitive Therapy; Collaborations; Color; Communities; Control Groups; Data; Diabetes prevention; Dimensions; Disease; Early treatment; Economics; Effectiveness; Exercise; Exercise Therapy; Face; Family; Fasting; Female Adolescents; Fostering; Foundations; Funding; Future; Goals; Health; Health behavior; Health behavior change; Informal Social Control; Insulin; Insulin Resistance; Intervention; Life Expectancy; Maintenance; Measures; Mental Depression; Metabolic; Moods; Neurocognitive; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Parents; Patient Self-Report; Phase; Physical activity; Prefrontal Cortex; Prevention; Process; Public Health; Research; Risk; Role; Sampling; Testing; Time; Weight; Work; Youth; acceptability and feasibility; behavior change; cardiorespiratory fitness; cognitive testing; depressive symptoms; diabetes risk; executive function; exercise intervention; exercise training; experience; feasibility testing; follow-up; girls; improved; mortality; prospective; skills; statistics; vulnerable adolescent

Project Abstract/Summary Prevention of youth-onset type 2 diabetes (T2D) is critical. Rates are escalating, especially in adolescent girls of color, and youth-onset T2D is difficult to treat and presents with a more aggressive course than adult-onset. Efficacious T2D prevention requires a more rigorous understanding of the underlying mechanisms of action that facilitate behavior change. Although physical activity is protective against worsening insulin resistance, a key antecedent of T2D, exercise training shows insufficient effectiveness for producing sustained change in physical activity, weight, or metabolic health in adolescents with obesity. The overarching hypothesis of the parent study, R01DK111604-01, is that depression is a driver of the difficulties that many adolescent girls at risk for T2D experience in initiating/sustaining physical activity. In the parent RCT, we are testing the hypothesis that delivering an empirically-supported depression intervention, cognitive-behavioral therapy (CBT), to decrease depression, followed sequentially by exercise training, will offer an efficacious strategy for increasing physical activity and improving insulin resistance. In this administrative supplement (NOT-OD-22-140), our overarching goal is to illuminate executive functioning (EF) dimensions that underlie decreasing depression and increasing physical activity. EF is theoretically central to self-regulation of cognitions/behaviors that support physical activity initiation and maintenance. Yet, in adolescents with obesity, most data are associational, directionality is unclear, and specific EF dimensions relevant to physical activity are not entirely understood. Elucidating dynamic, time- ordered changes that unfold in depression, EF, and physical activity throughout 12-week CBT/exercise could facilitate future intervention tailoring/optimization for adolescents at risk for T2D with mood concerns. However, rigorous tests of mechanisms of action require intensive repeated measures to capture temporal ordering during the intervention phase, making it essential to first establish feasibility/acceptability of intervention-phase intensive, repeated measures. Leveraging the parent RCT, we propose a feasibility and proof-of-concept study of EF as mechanism of action in N=95 (sample subset) adolescent girls at risk for T2D with elevated depression. Specific aims of this 1-year supplement are to: (1) Test feasibility/acceptability of intensive repeated measures of depression, EF, and physical activity across four 12-week (6-week6-week) sequences in girls at risk for T2D: i) CBTexercise, ii) exerciseCBT, iii) CBTCBT, and iv) exerciseexercise; (2) Describe longitudinal/ time-ordered changes and change-to-change associations for depression, EF, and physical activity across the intervention; and (3) Explore group differences in longitudinal/time-ordered change-to-change associations. This supplement fosters new collaborations with experts in neurocognitive processes in health behavior (Goldschmidt) and advanced statistics for longitudinal, intensive repeated measures (Aichele). Establishing feasibility/acceptability and proof-of-concept of EF's role in physical activity would lay a foundation for future tests of EF as a mechanism of action to be tested, and/or enhanced as a target, in future CBT/exercise interventions.

项目摘要/总结 预防青少年发病的 2 型糖尿病 (T2D) 发病率正在上升，尤其是在青春期女孩中。 颜色和青少年发病的 T2D 很难治疗，并且比成人发病的病程更具侵袭性。 有效的 T2D 预防需要更严格地了解潜在的作用机制， 促进行为改变虽然体力活动可以防止胰岛素抵抗升高，但这是一个关键。 作为 T2D 的前身，运动训练显示出不足以产生持续的身体变化 肥胖青少年的活动、体重或代谢健康状况。 父项研究的总体假设， R01DK111604-01，抑郁症是许多青春期女孩面临 T2D 风险的一个因素 在原始随机对照试验中，我们正在检验以下假设： 提供实证支持的抑郁症干预措施，即认知行为疗法（CBT），以减少 抑郁症，随后进行运动训练，将为增加体力提供有效的策略。 活性和改善胰岛素抵抗在这个行政补充（NOT-OD-22-140）中，我们的总体目标是。 目标是阐明执行功能（EF）维度，这些维度是减少抑郁和增加抑郁的基础 理论上，EF 对于支持身体活动的认知/行为的自我调节至关重要。 然而，在肥胖青少年中，大多数数据都是相关的，方向性尚不清楚， 与身体活动相关的具体 EF 维度尚未完全阐明。 在为期 12 周的 CBT/锻炼中，抑郁症、EF 和体力活动发生的有序变化可以 促进未来对有情绪问题的 T2D 风险青少年进行干预调整/优化。 对作用机制的严格测试需要密集的重复测量来捕获过程中的时间顺序 干预阶段，因此必须首先确定干预阶段的可行性/可接受性 利用母体随机对照试验，我们提出了一项可行性和概念验证研究。 EF 作为 N = 95 名（样本子集）患有 T2D 风险且抑郁程度升高的青春期女孩的作用机制。 这一为期一年的补充的具体目标是： (1) 测试强化重复措施的可行性/可接受性 在四个 12 周（6 周6 周）序列中，有抑郁症风险的女孩的抑郁、EF 和体力活动情况 T2D：i) CBT→运动，ii) 运动→CBT，iii) CBT→CBT，以及 iv) 运动→运动 (2) 描述纵向/ 抑郁症、EF 和身体活动的时间顺序变化和变化与变化的关联 干预；(3) 探索纵向/时间顺序的变化与变化关联的群体差异。 补充剂促进与健康行为神经认知过程专家的新合作 （Goldschmidt）和纵向、密集重复测量的高级统计（Aichele）。 EF 在身体活动中的作用的可行性/可接受性和概念验证将为未来的测试奠定基础 EF 作为一种行动机制，在未来的 CBT/运动干预中进行测试和/或作为目标得到加强。