Fitness and Exercise for Post-Bariatric Patients

减肥后患者的健身和锻炼

基本信息

批准号：
8112034
负责人：
Karen Jacqueline Coleman
金额：
$ 25.74万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-08-25 至 2013-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8112034
关键词：
Adopted Adult Aerobic Aerobic Exercise Affect Arthritis Attenuated Back Bariatrics Body Weight Body Weight decreased Caring Chronic Disease Comorbidity Control Groups Degenerative polyarthritis Development Disease remission Elements Exercise Foundations Funding Future Goals Habits Healthcare Hour Individual Injury Intervention Investments Learning Maintenance Managed Care Measurement Methods Modeling Morbid Obesity Muscle Non-Insulin-Dependent Diabetes Mellitus Obesity Obstructive Sleep Apnea Operative Surgical Procedures Outcome Participant Patient Self-Report Patients Persons Phase Physical activity Population Postoperative Period Procedures Randomized Recruitment Activity Relapse Resolution Resources Severities Social support Testing Time Translating United States National Institutes of Health Weight Weight-Bearing state Work bariatric surgery base bone loss bone mass clinical care design efficacy trial experience fitness flexibility group intervention health related quality of life indexing post intervention prevent programs sound standard of care treatment as usual treatment effect waist circumference

项目摘要

DESCRIPTION (provided by applicant): Surgical weight loss has become the most effect treatment for the severely obese patient. By 2020, it is estimated that at least 13% of the U.S. population will be eligible for the procedure (BMI > 40 kg/m2). Recent studies have highlighted the importance of regular exercise for positive surgical outcomes. Exercise may have a number of benefits post-surgery, such as attenuating the muscle and bone loss that accompanies massive, rapid weight loss. We have assembled a team of experts in bariatric surgery and exercise promotion in severely obese people and people with conditions limiting physical activity to develop and test a pilot exercise program adapted to the needs of persons who have undergone bariatric surgery. This program builds upon an effective 12 week intervention our team developed and tested for adults with arthritis: Fitness for People with Arthritis (FEPA). Severely obese individuals often have conditions such as osteoarthritis, which limit their mobility and participation in exercise programs, making FEPA a sound foundation for the development of a safe and effective program for them. This program is also ideal for post-bariatric patients in that it focuses on all aspects of fitness (strength, flexibility, and endurance) without an emphasis on body weight. We will further adapt FEPA specifically to the bariatric population, which has had difficulty adopting and adhering to regular exercise in the past, by including progressive exercise goals across a longer period of time (six months instead of 12 weeks), using a mastery learning approach to achieving these goals, adding a maintenance phase with booster exercise sessions and social support, and integrating the program into the regular post-operative care. Our goals are to determine effective strategies for initially recruiting post-bariatric surgery patients into randomized studies on group exercise, determine factors affecting program attrition over a one year period for participants in the intervention group and measurement attrition over the same period of time for participants in both control and intervention groups, and determine the acceptability and appropriateness of the exercise intervention for post-bariatric patients including what level of exercise can be sustained by this population. With the completion of these aims, we will apply for funding from the NIH to conduct an efficacy trial to provide the evidence that we will need to translate our program into the standard of care for persons in the first year after bariatric surgery. This will provide the crucial empirical evidence needed to integrate functional fitness programs into best practices for the long-term health care of persons after bariatric surgery. PUBLIC HEALTH RELEVANCE: We are at the beginning of a substantial investment of resources into bariatric surgery as a viable treatment for severe obesity, type 2 diabetes mellitus (T2DM), and obstructive sleep apnea (OSA). However, despite the promise of bariatric surgery for permanent weight loss and co-morbidity resolution, there is evidence that a proportion of patients are gaining their weight back, and that some patients who experienced remission of T2DM with surgery are relapsing to pre-surgical T2DM severity. It is imperative that we develop methods to insure that these patients maintain their weight loss and resulting resolution of chronic disease. Developing uniquely tailored exercise programs that can be integrated into the clinical care of these patients will protect the managed-care investment in bariatric surgery.

描述（申请人提供）：手术减肥已成为严重肥胖患者最有效的治疗方法。到 2020 年，预计至少 13% 的美国人口将有资格接受该手术（BMI > 40 kg/m2）。最近的研究强调了定期锻炼对于积极的手术结果的重要性。手术后锻炼可能有很多好处，例如减少伴随体重快速大幅下降的肌肉和骨质流失。我们组建了一个减肥手术和针对严重肥胖者和身体活动受限者进行运动促进的专家团队，以开发和测试适合接受减肥手术者需求的试点锻炼计划。该计划建立在我们团队针对成人关节炎患者开发和测试的有效的 12 周干预措施之上：关节炎患者健身 (FEPA)。严重肥胖者通常患有骨关节炎等疾病，这限制了他们的活动能力和参与锻炼计划，这使得 FEPA 成为为他们制定安全有效计划的坚实基础。该计划也非常适合减肥后患者，因为它专注于健身的各个方面（力量、灵活性和耐力），而不强调体重。我们将进一步调整 FEPA，专门针对过去难以接受和坚持定期锻炼的肥胖人群，通过采用掌握学习方法，在较长一段时间内（六个月而不是 12 周）纳入渐进锻炼目标为了实现这些目标，增加了包含加强锻炼课程和社会支持的维持阶段，并将该计划纳入常规术后护理中。我们的目标是确定最初招募减肥手术后患者参加团体锻炼随机研究的有效策略，确定影响干预组参与者一年内计划减员的因素，并测量干预组参与者在同一时间段内的减员情况。对照组和干预组，并确定减肥后患者运动干预的可接受性和适当性，包括该人群可以维持什么水平的运动。随着这些目标的完成，我们将向 NIH 申请资金来进行功效试验，以提供证据证明我们需要将我们的计划转化为减肥手术后第一年的护理标准。这将为将功能性健身计划整合到减肥手术后患者长期保健的最佳实践中提供所需的关键经验证据。公共健康相关性：我们正开始对减肥手术进行大量资源投资，将其作为严重肥胖、2 型糖尿病 (T2DM) 和阻塞性睡眠呼吸暂停 (OSA) 的可行治疗方法。然而，尽管减肥手术有望实现永久性体重减轻和消除共病，但有证据表明，部分患者的体重正在回升，并且一些通过手术缓解 T2DM 的患者正在复发至手术前的 T2DM严重程度。我们必须开发方法来确保这些患者保持体重减轻并最终解决慢性疾病。开发可融入这些患者临床护理的独特定制锻炼计划将保护减肥手术的管理护理投资。