Impact of brief daily functional resistance training on lower extremity physical performance

每日简短功能阻力训练对下肢身体表现的影响

• 批准号: 10564229
• 负责人: CHRISTOPHER N. SCIAMANNA
• 金额: $ 67.22万
• 依托单位: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10564229
• 关键词: Activities of Daily Living; Adherence; Affect; Anxiety; Cessation of life; Clinical; Control Groups; Data; Elderly; Electronic Mail; Enrollment; Exercise; Exertion; Feedback; Financial Hardship; Future; Goals; Guidelines; Health; Health Care Costs; Heterogeneity; Home; Hour; Intervention; Laws; Lead; Leg; Life; Lower Extremity; Measures; Mental Depression; Minority; Monitor; Multicenter Studies; Pain; Participant; Patients; Performance; Persons; Phase; Physical Function; Physical Performance; Public Health; Quality of life; Randomized; Recommendation; Reporting; Risk; Services; Silver; Subgroup; Supervision; Surveys; Techniques; Testing; Time; Training Programs; Upper Extremity; Visit; Walking; Woman; Work; behavior change; cost; design; disability; effective therapy; efficacy study; efficacy trial; evidence based guidelines; falls; functional disability; functional improvement; improved; improved mobility; improved outcome; meetings; men; novel; novel strategies; prevent; programs; resistance exercise; satisfaction; strength training; systematic review; treatment effect; uptake

ABSTRACT One of the most common, and untreated, health problems among older adults is mobility disability, observed in nearly one in five (17.9%) of older adults. Mobility disability is typically the first disability to develop and increases future risk for additional disabilities and death. Though the most effective treatments for mobility disability are forms of exercise, especially resistance training (RT), they are rarely used, with fewer than 20% of older adults meeting RT guidelines and even fewer among those with mobility disability. The core problem of disseminating the benefits of RT to older adults is adherence. One potential opportunity to enhance adherence to RT, which has not been tested, is to make RT programs shorter. Studies show that most of the benefits of RT accrue with the first few sets per week, consistent with the law of diminishing utility. While traditional RT programs for older adults, like those offered by Silver Sneakers, are typically 45 minutes three times weekly, fewer than 5% of older adults with free access to these programs participate. Our qualitative work shows that older adults often feel that 45 minute sessions are too challenging (e.g., “I don’t think I have the strength to do it for 45 minutes”) and 75% of older adults we surveyed preferred a 5 minute RT to a 45 minute RT option, assuming they were equally effective. In 2020, we set out to design a brief, home-based RT program that would lead to both high levels of adherence and functional improvement. We called the program FAST (Functional Activity Strength Training) and, to overcome its brevity, FAST was augmented with several standard behavior change techniques (e.g., feedback, reminders, self-monitoring) and a novel form of goal- setting, rarely used in RT studies, for the number of additional repetitions participants should be able to do during the study. In FAST-1, 24 healthy older adults were prescribed 30 seconds of squats and push-ups each day and given no personal supervision. Over 6 months, they performed the exercises on 73% of days and showed large increases in squat and push-up performance (Cohen’s d > 1.0). In FAST-2, we randomly assigned 97 older adults with mobility disability, and those assigned to 30 seconds each of chair stands and steps onto a stepper each day completed exercises on 81% of days (5.7 days per week) and improved their 5 time sit-to-stand test (-2.8 seconds, Cohen’s d=0.53), 30 second chair stand test (+4.2 repetitions, d=1.1) and One Leg Stand test (+3.7 seconds, d=0.40), versus controls. In this multicenter study, we will randomly assign 360 older adults with an SPPB score < 8 to 6 months of daily FAST or to a delayed control group. We will test the impact of FAST on physical performance, walking ability, falls and functional limitations. We hypothesize that FAST will improve these measures more than controls, and that those with greater adherence and perceived effort will improve the most. By rigorously testing FAST, we hope to change the paradigm of RT prescription from “More is better” to “What will people do that works?” and, if FAST proves superior, a future study will test whether FAST leads more older adults to do RT and, thereby, improve the public’s health.

抽象的 老年人中最常见且未经治疗的健康问题之一是行动障碍，在 近五分之一 (17.9%) 的老年人通常最先出现行动障碍。 尽管是最有效的行动能力治疗方法，但会增加未来额外残疾和死亡的风险。 残疾是运动的一种形式，尤其是阻力训练（RT），很少使用，不到 20% 符合 RT 指南的老年人，而行动不便的老年人则更少。 向老年人传播放疗的好处是提高依从性的一个潜在机会。 RT，尚未经过测试，是使RT 的程序变得更短 研究表明，RT 的大部分好处是。 RT 会随着每周前几组的增加而增加，这与传统 RT 的效用递减规律一致。 为老年人提供的项目，例如 Silver Sneakers 提供的项目，通常每周 3 次，每次 45 分钟， 我们的定性研究表明，只有不到 5% 的老年人可以自由参与这些计划。 老年人经常觉得 45 分钟的课程太有挑战性（例如，“我认为我没有力量做 45 分钟”），我们调查的 75% 的老年人更喜欢 5 分钟 RT 而非 45 分钟 RT 选项， 假设它们同样有效，我们在 2020 年开始设计一个简短的、基于家庭的 RT 计划。 将带来高水平的坚持和功能改进，我们称该计划为“快速”。 （功能性活动力量训练），为了克服其简洁性，FAST 增加了几个 标准的行为改变技术（例如反馈、提醒、自我监控）和一种新颖的目标形式 设置，在 RT 研究中很少使用，用于参与者应该能够做的额外重复次数 在 FAST-1 研究期间，24 名健康老年人被要求每人进行 30 秒的深蹲和俯卧撑。 在 6 个月的时间里，他们在 73% 的日子里进行了练习，并且没有进行个人监督。 在 FAST-2 中，我们随机地显示了深蹲和俯卧撑表现的大幅提高（Cohen 的 d > 1.0）。 分配了 97 名行动不便的老年人，并分配了每人站立 30 秒的椅子和 每天踏上踏步机 81% 的天（每周 5.7 天）完成锻炼，并提高了 5 时间坐站测试（-2.8 秒，Cohen d=0.53），30 秒椅子站立测试（+4.2 次重复，d=1.1）和 单腿站立测试（+3.7 秒，d=0.40）与对照组相比 在这项多中心研究中，我们将随机分配。 我们将对 360 名每天 FAST 的 SPPB 评分 < 8 至 6 个月的老年人或延迟对照组进行测试。 FAST 对身体表现、行走能力、跌倒和功能限制的影响。 FAST 比控制措施更能改善这些措施，并且那些具有更高依从性和 通过严格测试 FAST，我们希望改变 RT 的范式。 处方从“越多越好”到“人们会做什么有效？如果 FAST 被证明是优越的，那就是未来” 研究将测试 FAST 是否会导致更多老年人接受 RT，从而改善公众的健康。