Maintaining Resistance Training in Older Prediabetic Adults: Theoretical Approach

老年糖尿病前期患者维持阻力训练：理论方法

• 批准号: 7729633
• 负责人: BRENDA M DAVY
• 金额: $ 70.87万
• 依托单位: VIRGINIA POLYTECHNIC INST AND ST UNIV
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-01 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7729633
• 关键词: Activities of Daily Living; Adherence; Adult; Aerobic; Affect; Age; Aging; Area; Behavior Therapy; Behavioral; Beta Cell; Body Weight decreased; C-Peptide; Cells; Clinical Trials; Communities; Data; Diabetes prevention; Disease; Elderly; Exercise; Exhibits; Family; Fatty acid glycerol esters; Generic Drugs; Glucose; Glycogen (Starch) Synthase; Health; Health Benefit; Healthy People 2010; Homeostasis; Impaired fasting glycaemia; Individual; Informal Social Control; Insulin; Intervention; Investments; Life Style; Maintenance; Measures; Mediating; Metabolic; Modality; Modeling; Modification; Muscle; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; Oral; Outcome; Outcome Measure; Phase; Phase II Clinical Trials; Physical activity; Population; Prediabetes syndrome; Prevalence; Prevention Research; Prevention strategy; Property; Protocols documentation; Public Health; Randomized; Reporting; Research; Resistance; Risk; Self Efficacy; Specificity; Supervision; Time; Training; Woman; Work; base; blood glucose regulation; density; disability; disorder prevention; fasting glucose; fitness; glucose tolerance; impaired glucose tolerance; improved; inclusion criteria; indexing; insulin sensitivity; meetings; men; primary outcome; programs; public health relevance; sarcopenia; skills; social cognitive theory; strength training; theories

DESCRIPTION (provided by applicant): The aim of this Phase II Clinical Trial is to demonstrate the efficacy of social cognitive theory (SCT) based intervention for initiating, and most importantly, maintaining resistance training in older adults with pre-diabetes (i.e., impaired glucose tolerance or impaired fasting glucose) to improve glucose homeostatis. The overall aim is consistent with NIDDK's Behavioral/Prevetion Research Program's forcus on individual, family, and community-based strategies for prevention of diabetes and its complications. Resistance training is particularly applicable to older, prediabeteic adults given the loss of lean body mass and worsening of glucose tolerance with aging. The proposed research program evaluates a 15-month SCT based intervention for maintenance of resistance training with older adults. Men and women 50-69 (N=220) with pre-diabetes, defined as exhibiting either impaired glucose tolerance (IGT; 2-h glucose 140-199 mg/dl) or impaired fasting glucose (IFG; 100-125 mg/dl), will first follow the same standard, supervised 3-month initiation period with resistance training. All people completing the Initial Phase will be randomly assigned to 1 of 3 maintenance conditions: 1. a long-term SCT based, ASPIRE intervention, emphasizing self-regulation and other SCT strategies to optimize training, with faded contact; 2. a long-term Generic intervention lacking a number of SCT components but with the same faded contact, or, 3. a Standard intervention with more minimal contact. The primary outcome measures are indices of pre-diabetes (glucose tolerance and fasting glucose concentration) and strength. Secondary measures include adherence; ss-cell responsivity, insulin sensitivity, and disposition index, as determined by the oral glucose and C-peptide minimal model; fat free mass, other indicators of health and metabolic fitness, and SCT measures. Assessments will occur at baseline, at the end of the Initiation Phase (3 months), at the end of the different interventions (9 months) and 6 months after all contact has ended (15 months from baseline). It is hypothesized that SCT based resistance training with faded contact will produce better outcomes than Generic based training with faded contact, which in turn, will produce better outcomes than Standard-based resistance training at 9 month and 15 month assessments. It also is hypothesized that improvements in glucose homeostasis and in strength from resistance training will be mediated by adherence, self-efficacy, and use of self-regulation strategies. Resistance training has become an important component in the treatment and prevention of diseases and disabilites, and especially so for Type 2 diabetes. Critical to public health and a focus of NIDDK are theory-based interventions that enable, effective long-term resistance training with minimal supervision after an initiation phase and where improvements in adherence and outcomes are facilitated by theoretical constructs. PUBLIC HEALTH RELEVANCE: Pre-diabetes is present is more than half of adults aged 60-74 years. Resistance (strength) training appears to be another modality besides weight loss and physical activity that is effective for pre-diabetes prevention. Even though these health benefits can be accrued from a limited time investment, only 10-15 percent of people over 55 report performing any strengthening activities. Prior work suggests that resistance training (RT) can be effectively initiated in well-supervised settings, however there are very few theory-based studies showing effective maintenance of RT in minimally supervised settings. In the absence of such theoretically based efficacy studies on long-term maintenance, it is likely that although people such as those with pre-diabetes will initiate RT, a high percentage will soon discontinue RT. Therefore, we propose to demonstrate the efficacy of a social cognitive theory-based intervention for initiating and maintaining RT in older adults with pre-diabetes to improve glucose homeostasis.

描述（由申请人提供）：本 II 期临床试验的目的是证明基于社会认知理论 (SCT) 的干预措施对患有糖尿病前期（即糖耐量受损或空腹血糖受损）的老年人启动并最重要的是维持阻力训练以改善血糖稳态的有效性。总体目标与 NIDDK 的行为/预防研究计划的重点是一致的，该计划的重点是个人、家庭和社区预防糖尿病及其并发症的策略。鉴于随着年龄的增长，去脂体重会减少，糖耐量会恶化，阻力训练特别适用于老年糖尿病前期患者。拟议的研究计划评估了一项为期 15 个月的基于 SCT 的干预措施，用于维持老年人的阻力训练。患有糖尿病前期的男性和女性 50-69 岁 (N=220)，被定义为表现出糖耐量受损（IGT；2 小时血糖 140-199 mg/dl）或空腹血糖受损（IFG；100-125 mg/dl），将首先遵循相同的标准，在为期 3 个月的监督下开始进行阻力训练。所有完成初始阶段的人员将被随机分配到 3 个维持条件中的 1 个： 1. 基于长期 SCT 的 ASPIRE 干预，强调自我调节和其他 SCT 策略来优化训练，具有褪色接触； 2. 长期通用干预，缺乏许多 SCT 组件，但具有相同的褪色接触，或者， 3. 具有更最小接触的标准干预。主要结果指标是糖尿病前期指数（葡萄糖耐量和空腹血糖浓度）和强度。次要措施包括坚持；由口服葡萄糖和 C 肽最小模型确定的 ss 细胞反应性、胰岛素敏感性和处置指数；除脂体重、其他健康和代谢健康指标以及 SCT 测量。评估将在基线、启动阶段结束时（3 个月）、不同干预措施结束时（9 个月）以及所有接触结束后 6 个月（距基线 15 个月）进行。据推测，在 9 个月和 15 个月的评估中，基于 SCT 的褪色接触阻力训练将比基于通用褪色接触的阻力训练产生更好的结果，而后者又将比基于标准的阻力训练产生更好的结果。还假设葡萄糖稳态和抗阻训练力量的改善将通过坚持、自我效能和自我调节策略的使用来介导。阻力训练已成为治疗和预防疾病和残疾的重要组成部分，尤其是 2 型糖尿病。对公共卫生至关重要，也是 NIDDK 的重点是基于理论的干预措施，这些干预措施能够在启动阶段后以最少的监督进行有效的长期阻力训练，并且通过理论构建促进坚持和结果的改善。公共卫生相关性：超过一半的 60-74 岁成年人患有糖尿病前期。阻力（力量）训练似乎是除减肥和体育活动之外的另一种有效预防糖尿病前期的方式。尽管这些健康益处可以通过有限的时间投入获得，但只有 10-15% 的 55 岁以上的人报告说进行过任何强化活动。先前的研究表明，阻力训练 (RT) 可以在良好监督的环境中有效启动，但很少有基于理论的研究表明在最低限度监督的环境中有效维持 RT。由于缺乏这种基于理论的长期维持疗效研究，尽管糖尿病前期患者等人会开始接受 RT，但很大一部分人可能会很快停止 RT。因此，我们建议证明基于社会认知理论的干预措施对于患有糖尿病前期的老年人启动和维持 RT 以改善血糖稳态的有效性。