Health Promotion Intervention:Sedentary Care Patients

描述(由申请人提供)： 体力活动和适当营养的好处已经被很好地确立，以预防和减少慢性疾病的破坏性影响，包括心血管疾病、糖尿病和肥胖症。不幸的是，近80%的人没有得到足够的锻炼和适当的饮食来改变这些健康障碍。在美国，医生通常不会就体力活动和营养问题向患者提供咨询。虽然很少有研究考察在初级保健环境中促进体力活动的情况，但大多数研究都令人失望。实现和保持健康行为仍然是促进健康和照顾疾病的主要挑战。本研究建议旨在a)评估改善初级保健办公室久坐患者体力活动和饮食行为的三种行为改变干预策略；b)通过成本效益分析，评估每种模式干预的影响。经过OHSU内科和家庭实践诊所的初步招募和筛选，105名久坐的患者将被随机分配到模式1、模式2或模式3。模式1是一种被称为动机访谈的一对一个性化咨询干预措施，基于行为改变的跨理论模式，将在第一年使用12次健康教育人员咨询会议和10个每周10次的双周电话随访，在干预的第二年将进行6次60分钟的会议。模式2是以团队为中心的干预，其中健康促进课程由团队促进者向患者团队讲授(基于社会影响理论)，包括12个60分钟的同伴促进小组会议和10个后续电话，其中6个会议发生在全面结果研究的第二年。小组辅导员将接受培训，并使用脚本化的教案。模式3，常规操作控制条件(使用医生建议咨询练习或配速形式的5分钟医生建议)。型号1和型号2的接触时间相同。01年是修订和完善课程和学习方案的先导研究。全面干预将持续两年，而行为改变的持久性将在另一整年进行评估。这项研究的主要结果是通过峰值摄氧量和调查来衡量体力活动的增加，通过摄入量调查来评估饮食变化，以及通过DEXA来衡量身体成分的变化。次要观察指标包括血压、血脂和脂蛋白水平、炎症生化标记物(CRP)和肥胖的激素标记物。结果将使用重复测量设计进行评估。将确定调解人之间的关系、干预和结果衡量标准。

DESCRIPTION (provided by applicant): The benefits of physical activity and proper nutrition have been well established to prevent and reduce the devastating effects of chronic illness including, cardiovascular disease, diabetes, and obesity. Unfortunately, nearly 80% of individuals fail to get enough exercise and eat a proper diet to alter these health disorders. In the United States, physicians do not routinely counsel patients about physical activity and nutrition. Although few studies have examined promotion of physical activity in the primary care setting, most have been disappointing. Achieving and maintaining healthy behaviors remain a major challenge to promoting health and caring for illness. This research proposals aims are to a) evaluate three behavior change intervention strategies to improve physical activity and dietary behaviors among sedentary patients in a primary care office; and b) assess by cost-benefit analysis, the impact of each model intervention. After initial recruitment and screening from OHSU Internal Medicine and Family Practice clinics, 105 sedentary patients will be randomly assigned to Model 1, Model 2, or Model 3. Model #1, a one-on-one, individualized counseling intervention known as Motivational Interviewing, based on the transtheoretical model of behavior change, will use twelve health educator counseling meetings and ten bi-weekly follow-up phone calls the first year and six 60-minute sessions will occur in the second year of the intervention. Model #2, a team-centered intervention where the health promotion curriculum is delivered by a group facilitator to a team of patients (based on the social influence theory) consists of twelve 60-minute peer facilitated group meetings and ten follow-up phone calls, with six sessions occurring the second year of the full outcome study. Group facilitators will be trained and use scripted lesson plans. Model #3, a usual practice control condition (5 minute physician advice using the Physician Advice Counseling Exercise or PACE format). Models 1 and 2 contact hours are the same. Year 01 is the pilot study to revise and refine the curriculum and study protocol. The full intervention will last two years while the behavior change durability will be assessed over another full year. The study's primary outcomes are increased physical activity as measured by peak oxygen uptake and survey, dietary changes assessed by intake survey, and body composition changes as measured by DEXA. Secondary outcome measures include blood pressure lipid and lipoprotein levels, biochemical markers of inflammation (CRP) and hormonal markers of obesity. Outcomes will be assessed using repeated measures design. Relationships among mediators, the intervention, and the outcome measures will be identified.