Self Regulation and Physical Activity Adherence in Type 2 Diabetes Mellitus

描述（由申请人提供）：拟议的项目旨在通过建立自我效能、自我调节和认知功能如何随着时间的推移影响体力活动行为的模型来检查2型糖尿病（T2 DM）患者的体力活动行为。目的是阐明特定人群中身体活动行为的心理社会决定因素和机制。其次，该项目将测试基于社会认知理论（SCT;班杜拉，2004）的行为改变干预的家庭锻炼计划的有效性。流行病学证据表明，T2 DM患者的运动坚持率极低，尽管体力活动被认为是可以显著改善病程的一线治疗。这项建议将从神经科学和社会认知的角度来研究目标人群坚持体育活动的机制。 据推测，自我调节策略的使用，这可能是 认为包括认知控制，将通过自我效能间接影响身体活动行为。由于与葡萄糖失调相关的认知障碍可能会干扰成功应对自我调节和行为依从性所需挑战的能力，因此假设专门关注自我调节策略和自我效能增强的身体活动干预可能有效改善依从性，其次是代谢健康参数。此外，假设与常规护理组相比，参与为期四周的专门设计的体力活动行为改变干预将改善T2 DM患者的体力活动行为，并且观察到的差异将持续6个月随访。 招募将包括来自伊利诺伊州中东部的80名确诊为T2 DM的男性和女性（年龄40-70岁），他们将被随机分配到干预组或常规护理组。干预参与者将在干预开始后的1个月内多次参加小组研讨会，在那里将提供基于社会认知的运动行为干预课程。干预参与者将被教导和鼓励定期跟踪在家活动。测量将包括身体活动行为（通过加速度计）;空腹血糖;自我效能;自我调节策略的使用，包括自我监测和目标设定;和认知功能。将在基线、m1和m7时进行测量。 提高这一特定人群的运动坚持性有望显著改善健康状况，并减轻个人和社会的健康负担。拟议的项目将加深对目标人群坚持体育活动机制的理解。 公共卫生相关性：拟议项目的公共卫生相关性相当大，因为它解决了一个突出的公共卫生负担，并针对主要不活跃的人口，因此更有可能经历进一步的疾病负担。T2 DM发生和疾病进展的促成因素包括饮食不良和体力活动不足。有规律的有氧运动已多次被证明是有效的改善胰岛素敏感性和葡萄糖调节那些谁有T2 DM。然而，大多数美国人没有达到推荐的常规有氧运动量。更少的T2 DM患者达到推荐的身体活动量以获得健康益处。对于我们社会中的大多数人来说，坚持长期体育活动是相当困难的，特别是患有代谢疾病的人，这些疾病可能涉及其他合并症。目前尚不清楚为什么在这一人群中坚持体力活动特别困难。这个项目将检查身体活动行为的因素，这可能是必要的坚持：信心，自我监控和执行认知功能。解决这一人群的运动依从性问题可以显著改善T2 DM患者当前和未来的健康状况，并减轻社会负担。

DESCRIPTION (provided by applicant): The proposed project aims to examine physical activity behavior in persons with type 2 diabetes mellitus (T2DM) by modeling how self-efficacy, self-regulation and cognitive function impact physical activity behavior over time. The goal is to elucidate psychosocial determinants and mechanisms of physical activity behaviors in the specified population. Secondly, the project will test the effectiveness of a home-based exercise program coupled with a behavior change intervention based in Social Cognitive Theory (SCT; Bandura, 2004). Epidemiological evidence indicate that persons affected by T2DM have extremely low rates of exercise adherence despite the fact that physical activity is considered a first line treatment that can significantly improve disease course. This proposal will examine mechanisms of physical activity adherence in the target population from a neuroscience and social cognitive perspective. It is hypothesized that self-regulatory strategy use, which could be argued to include cognitive control, will indirectly influence physical activity behavior through self-efficacy. As cognitive impairments related to glucose dysregulation may interfere with the ability to successfully maneuver challenges required for self-regulation and behavioral adherence, it is hypothesized that a physical activity intervention specifically focusing on self- regulatory strategies and self-efficacy enhancement may be effective to improve adherence and, secondarily, metabolic health parameters. Additionally, it is hypothesized that participation in the four week, specifically designed physical activity behavior change intervention will improve physical activity behavior in individuals with T2DM compared to a usual care group, and that observed differences will be sustained for a six month follow-up. Recruitment will include 80 men and women (ages 40-70 years) with diagnosed T2DM from east central Illinois who will be randomly assigned into the intervention or usual care group. Intervention participants will meet several times, within 1 month of beginning the intervention, in group workshops where a social-cognitive based exercise behavior intervention curriculum will be delivered. Intervention participants will be taught and encouraged to regularly track at home activity. Measures will include physical activity behavior (via accelerometry); fasting blood glucose; self-efficacy; self-regulatory strategy use, which include self-monitoring and goal-setting; and cognitive function. Measures will be taken at baseline, m1, and m7. Improving exercise adherence in this specific population promises significant health improvement and would lessen individual and society health burdens. The proposed project will deepen understanding concerning mechanisms of physical activity adherence in the target population. PUBLIC HEALTH RELEVANCE: The public health relevance of the proposed project is considerable as it addresses a prominent public health burden and targets a population that is primarily inactive and is thereby at greater risk for experiencing further disease burden. Contributing factors to the development and disease progression of T2DM include poor diet and inadequate physical activity. Regular aerobic physical activity has been repeatedly shown to be effective in improving insulin sensitivity and glucose regulation for those who has T2DM. However, most Americans do not meet the recommended amount of regular aerobic exercise. Even fewer with T2DM meet the recommended amount of physical activity for health benefits. Adhering to long-term physical activity is quite difficult for most people in our society, especialy individuals with metabolic disease which may involve other comorbidities. It remains unclear why physical activity adherence is especially difficult in this population. This project will examie physical activity behavior in light of factors which may be necessary for adherence: confidence, self-monitoring and executive cognitive function. Addressing the problem of exercise adherence in this population could significantly improve the current and future health status of individuals with T2DM as well as reduce the societal burden.