Developing an Intervention to Prevent Visceral Fat in Premenopausal Women: (CBID)

描述(由申请人提供)： 女性在更年期时患心血管疾病(CVD)的风险增加，与年龄无关。在一项对更年期妇女进行的长达15年的纵向研究中，我们发现，绝经后荷尔蒙环境中睾酮的优势增加，这促进了内脏脂肪的发展，内脏脂肪是一个重要的心血管疾病危险因素。虽然更年期不能被改变，但我们已经证明，久坐的生活方式和长期的压力也与高内脏脂肪水平独立相关。因此，我们假设，成功地持续增加体力活动和减少慢性压力的干预措施可以减少与更年期相关的内脏脂肪的发展，从而降低女性早期心血管疾病的风险。这项建议旨在开发一种同时针对个人、社会网络和社区的多层次干预措施，目的是持续增加体力活动和减少慢性压力。目标社区是获得流行病学数据的同一社区。从而提供了通过改善健康来回馈社会的机会。研究团队拥有心理学、流行病学、物理医学、生物统计学、内分泌学、传播学和卫生经济学等学科的专业知识。社区合作伙伴包括15年流行病学研究的参与者和以社区为基础的组织。持续变革理论、社会认知理论、创新扩散理论、社区参与研究理论、沟通理论和效用理论为干预的发展提供了理论依据。它将分三个阶段发展。第一项研究探讨成功维持体力活动超过9年的个人的心理和社会特征，确定在变化的早期阶段防止辍学的最佳方法，并从质量上探索可纳入治疗工具箱的潜在活动。第二项是“概念验证研究”，旨在确定社区支持的最佳长度和价值。第三项是对改进干预措施的受控试点研究，这将产生设计后续临床试验所需的估计。相关性：迫切需要找到治疗方法，以降低妇女患心血管疾病的风险，心血管疾病是她们的头号杀手。我们的目标是开发一种干预措施，通过持续增加体力活动和减少慢性压力来降低绝经前妇女发生内脏脂肪的早期风险。背景是一个在过去15年里与我们合作提供流行病学数据的社区，这些数据构成了这项工作的基础。我们的目标是通过合作开发一个可以改善他们健康的项目来回馈这个社区。(摘要结束)

DESCRIPTION (provided by applicant): Risk for cardiovascular disease (CVD) increases in women as they traverse the menopause, independently of aging. In a 15-year longitudinal study of women undergoing the menopause, we have shown that menopause increases in the predominance of testosterone in the hormonal milieu which promotes the development of visceral fat, an important CVD risk factor. Although menopause cannot be modified, we have shown that sedentary lifestyle and chronic stress are also independently associated with high levels of visceral fat. Thus, we hypothesize that an intervention that is successful in producing a sustained increase physical activity and reduction in chronic stress could reduce the menopause-related development of visceral fat and, as such, reduce early cardiovascular risk in women. This proposal aims to develop a multi-level intervention targeting simultaneously the individual, the social network, and the community, for the purpose of producing a sustained increase in physical activity and reduction in chronic stress. The targeted community is the same community from which the epidemiologic data were obtained. Thus providing the opportunity to give back by improving health. The research team features expertise in the disciplines of psychology, epidemiology, physical medicine, biostatistics, endocrinology, communications, and health economics. The community partners include participants in the 15-year epidemiologic study and community- based organizations. Development of the intervention has been informed by theory concerned with sustained change, namely Self-Determination Theory, Social Cognitive Theory, Diffusion of Innovation Theory, Community-Based Participatory Research, Communications Theory, and Utility Theory. It will be developed in 3 phases. The first explore psychological and social characteristics in individuals who have been successful at sustaining physical activity over 9 years, determine the best way to prevent drop-outs in the early phase of change, and exploring qualitatively potential activities that would be included in a treatment tool box. The second is a "proof of concept study" aimed at determining optimum length and the value of community support. The third is a controlled pilot study of the refined intervention which will generate estimates needed for the design of a subsequent clinical trial. RELEVANCE: There is an urgent need to find treatments to reduce risk for CVD in women which is their number one killer. We aim to develop an intervention to reduce early risk for developing visceral fat in pre-menopausal women by producing a sustained increase in physical activity and reduction in chronic stress. The setting is in a community that has partnered with us over the past 15 years to provide the epidemiologic data that form the basis of this work. We aim to give back to this community by partnering to develop a program that could improve their health. (End of Abstract)