NIDDM, EXERCISE REFERRAL, & OLDER AFRICAN AMERICAN WOMEN

描述(改编自申请人的摘要)：估计 总成本为900亿美元(仅医疗费用就为125亿美元)和 糖尿病的总患病率约为6%，对 医疗保健系统。在所有糖尿病病例中，90%至95%包括 2型糖尿病。非裔美国人中2型糖尿病的患病率 女性比例尤其高，估计至少占30%。 年龄在55岁以上。非洲裔美国人不仅面临着更大的风险 患有2型糖尿病，但患肾病的几率是前者的两倍， 与截肢相关的视网膜病变、截肢和住院死亡率。 运动、饮食和体重控制是已知的和潜在的可修改的 2型糖尿病相关并发症处理的危险因素。 然而，对于许多2型糖尿病患者来说，中等体重是非常 难以维持，减轻体重的干预措施有限 成功。从理论上讲，锻炼可以独立地改善代谢控制 减肥，一些小型干预研究证实 中等强度的运动(55到70&最大心率)可以改善 HbA1c在8到12周内至少下降15%，体重几乎或根本没有下降。 此外，运动对心血管健康和 总体生活质量。绝大多数(即至少80%)的人 然而，患有2型糖尿病的人不要锻炼。出于这个原因，医生 转介锻炼已经得到了广泛的推荐。它的有效性已经 很少被测试，但一项小型的未发表的研究使用了医生发起的 推荐精心设计的基于团体的锻炼计划产生了36%的 在22名50岁以上的非裔美国女性中，有7人被收养 领养的8个人已经参与了18个月以上。 这项研究的主要目的是实施、支持和评估 务实的医生发起的锻炼转介计划，最长可达24个月 在三个独立的社区初级保健诊所。初级阶段 结果将是基于小组的锻炼采用率和维持率，以及 整体体力活动水平的变化。次要目标将是 确定锻炼采用和维护的基线预测因素，并 干预期内的整体体力活动水平 并评估锻炼对健康和临床结果的影响。措施 次要目标包括糖化血红蛋白、胰岛素和口服降血糖剂量， 休息时和规定工作负荷下的血压和心率 渐进式运动测试，体重，人体测量，皮褶厚度， 自评健康功能和运动自我效能感。

DESCRIPTION (Adapted from the Applicant's Abstract): With an estimated total cost of $90 billion ($12.5 Billion for medical care alone) and an overall prevalence of about 6%, diabetes has an impressive impact on the health care system. Between 90 and 95% of all diabetes cases consist of type 2 diabetes. the prevalence of type 2 diabetes among African-American women is particularly high and is estimated to be at least 30% for those over the age of 55. African-Americans are not only at greater risk of developing type 2 diabetes, but experience twice the rate of nephropathy, retinopathy, amputation, and in-hospital mortality related to amputations. Exercise, diet and weight control represent known and potentially modifiable risk factors for the management of complications related to type 2 diabetes. For many type 2 diabetes patients, however, moderate weight is very difficult to maintain and interventions to reduce weight have had limited success. Theoretically, exercise can improve metabolic control independent of weight loss, and a few small intervention studies have confirmed that moderate-intensity exercise (55 to 70& of maximum heart rate) can improve HbA1c by at least 15% within 8 to 12 weeks with little or no weight loss. in addition, exercise holds great importance for cardiovascular health and overall quality of life. The vast majority (i.e. at least 80%) of persons with type 2 diabetes, however, do not exercise. for this reason, physician referral for exercise has been widely recommended. Its effectiveness has rarely been tested, but a small unpublished study using physician-initiated referral to a carefully designed group-based exercise program produced a 36% adoption rate among 22 African-American women over 50 years of age, and 7 of the 8 who adopted have participated for over 18 months. The primary aim of this study is to implement, support and evaluate a pragmatic physician-initiated exercise referral program for up to 24 months in three separate community based primary care clinics. The primary outcomes will be rates of group-based exercise adoption and maintenance and changes in overall physical activity level. The secondary aims will be to identify baseline predictors of exercise adoption and maintenance and overall physical activity level over the course of the intervention period and assess the effect of exercise on health and clinical outcomes. Measures for secondary aims include HbA1c, insulin and oral hypoglycemic dosages, blood pressure and heart rate at rest and at set workloads during progressive exercise testing, weight, anthropometrics, skinfold thicknesses, self-rated health and function and exercise self-efficacy.