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: 8658817
• 负责人: Latha P Palaniappan
• 金额: $ 59.15万
• 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 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8658817
• 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) 影响着美国 2580 万人，并且患病率和发病率正在增加。体力活动在 T2DM 管理中的益处已得到充分证明，当患者在研究环境中遵循结构化锻炼计划时，可以实现较低的血糖控制。鉴于 T2DM 饮食改变的已知益处，营养推荐在当前的临床实践中很常见。尽管运动也有同样众所周知的好处，但在临床环境中身体活动转诊并不容易获得。目前美国糖尿病协会（ADA）指南建议T2DM患者应同时进行有氧运动和阻力训练活动，每周至少150分钟中等强度的有氧运动，每周进行3次阻力训练。大多数（约 70%）T2DM 患者不进行推荐水平的运动（38%）或根本不进行运动（31%）。虽然在高度结构化的研究环境中对糖尿病患者进行这种强化身体活动干预的功效已得到证明，但仍需要实用的方法将这些发现转化并扩展到临床环境中。虽然大多数其他转化研究已经探索了将身体活动干预措施适应其他社区环境（例如基督教青年会），但我们独特地建议在临床环境中将身体活动资源制度化，因为这传达了患者医疗保健团队对身体活动的隐含认可。随着最近（2006 年）ADA 指南中增加了阻力训练，为运动提供监督和支持以防止受伤并最大限度地提高健康效益变得尤为重要。为了满足这些需求，我们建议实施一项三臂随机对照试验，以比较在已建立的 T2DM 共享医疗预约中添加专门的身体活动成分的临床有效性、以患者为中心的结果和成本效益。共享医疗预约 (SMA) 是 60-90 分钟的团体预约（6-12 名患者），得到美国家庭医学学会和美国医师学会的认可，并已在各种临床环境中实施。与常规护理相比，拟议的糖尿病 SMA 体力活动 (PAD-SMA) 将涉及在临床环境中以不同频率（每周一次或每周三次）进行结构化团体锻炼。拟议的研究旨在测试一种通过体力活动改善血糖控制的创新方法。临床中启动和维持体力活动 (IMPACT) 糖尿病研究的目标是将受监督的体力活动的已知益处转化为临床环境。