Cooperative Lifestyle Intervention Programs (CLIP-II)

描述（由申请人提供）：老年人中CVD和代谢综合征（MetS）的并发症是活动障碍。事实上，心脏和循环系统疾病是60岁以上成年人残疾的主要原因。专家认为，对患有冠心病的老年人进行医疗护理的主要目标应该是改善身体功能和延长无残疾生存期。AHA最近的立场声明将体重管理确定为CVD二级预防计划的核心组成部分。这是一个重要的进展，因为肥胖是MetS的核心，MetS是CVD患者的常见疾病，也是身体残疾的已知风险因素。2005年，美国营养学会和肥胖学会强调需要进行长期随机对照临床试验，评估老年人饮食诱导的体重减轻（WL）和运动对活动性，肌肉功能和肥胖相关疾病等结果的独立和叠加效应。为了响应这一呼吁，我们最近完成了一项由NHLBI资助的转化研究，即合作生活方式干预计划（CLIP）。在这项研究中，288名患有CVD或MetS的肥胖老年人被随机分配到成功的衰老控制治疗（SA），有氧运动训练（AT）或AT+WL 18个月。主要结果是行动障碍，我们的工作人员与来自北卡罗来纳州合作推广中心社区基础设施内3个县的代理人共同提供干预措施。与SA相比，AT组的活动性显著改善，AT+WL上级SA或AT，AT+WL观察到的改善具有临床意义。在CLIP的基础上，我们现在建议增加我们干预措施的翻译意义，让他们完全由基督教青年会社区合作伙伴提供，我们的工作人员作为“培训师和顾问”，以实现所需的行为改变。此外，该研究将提供第一个大规模随机对照临床试验，以评估饮食诱导的WL o移动性在肥胖、患有CVD或MetS的老年人中与WL结合体力活动相比的效果。由于担心瘦体重的损失，对于促进老年人WL的最佳方法存在不确定性，因此该设计还允许AT+WL和阻力运动训练（RT）对肌肉力量的对比。主要结果将是行动能力残疾和肌肉力量。 公共卫生相关性：这项研究将为公共卫生提供重要信息，为患有CVD或MetS的肥胖老年人提供减肥的最佳方法。它还探讨了一个新的环境下，使用社区基督教青年会的基础设施的方案交付和可持续性。

DESCRIPTION (provided by applicant): A complication of CVD and the metabolic syndrome (MetS) among older adults is mobility disability. In fact, diseases of the heart and circulatory systems are a major cause of disability in adults over the age of 60yrs. Experts have argued that the primary goal of medical care for older adults who have coronary disease should be to improve physical function and to extend disability-free survival. A recent position statement by the AHA identified weight management as a core component of secondary prevention programs for CVD. This is an important development because obesity is central to MetS, a common condition of patients with CVD, and a known risk factor for physical disability. In 2005, the American Society for Nutrition and the Obesity Society highlighted the need for long-term randomized controlled clinical trials evaluating the independent and additive effects of diet-induced weight loss (WL) and exercise in older persons on outcomes such as mobility, muscle function, and obesity related diseases. In response to this call, we have recently completed a translational study funded by NHLBI, the Cooperative Lifestyle Intervention Program (CLIP). In that investigation, 288 obese, older adults with CVD or MetS were randomized to a successful aging control treatment (SA), aerobic exercise training (AT), or AT+WL for 18-months. The primary outcome was mobility disability and our staff co- delivered the interventions with agents from 3 counties within the community infrastructure of North Carolina Cooperative Extension Centers. Whereas mobility improved significantly in the AT group compared to SA, AT+WL was superior to either SA or AT and the improvement observed with AT+WL was clinically significant. Building on CLIP, we now propose to increase the translational significance of our interventions by having them delivered exclusively by YMCA community partners with our staff as "trainers and advisers" for desired behavior change. In addition, this study will provide the first large scale randomized controlled clinical trial to evaluate the effects of diet-induced WL o mobility in obese, older adults with CVD or the MetS as compared to WL combined with physical activity. Because uncertainty exists about the best approach for promoting WL in older adults due to concerns with the loss of lean mass, the design also permits a contrast between AT+WL and resistance exercise training (RT) on muscle strength. The primary outcomes will be mobility disability and muscle strength. PUBLIC HEALTH RELEVANCE: This study will provide important information for public health regarding the best approach for prescribing physical activity in weight loss among obese, older adults that have either CVD or MetS. It also explores a novel context for program delivery and sustainability using the infrastructures of community YMCAs.