Momentary Biobehavioral Effects on Physical Activity in Adults with T2 Diabetes

成人2型糖尿病患者运动对瞬时生物行为的影响 摘要 独立之路奖的候选人是辛西娅·弗里奇（Cynthia Fritschi），博士，注册护士，她最近 在伊利诺伊大学芝加哥护理学院完成了博士研究。博士 Fritschi将由Eileen柯林斯，博士，注册护士，终身副教授在UIC CON和一个 研究职业科学家在康复研究和发展在爱德华海因斯小。部 退伍军人事务医院这个应用程序的目标是协助Fritschi博士建立一个独立的程序 2型糖尿病患者的身体活动研究。本文提出的独立研究将 扩大我们对阻碍或促进身体健康的多层次生物，心理和社会因素的了解 活动行为长期目标是帮助久坐的2型糖尿病成年人保持最佳的 健康和功能，帮助他们增加身体活动行为。这将是完成 通过在自然环境中使用新颖的实时干预。候选人的短期职业目标 是获得必要的技能和经验，以制定一项与此相关的研究计划， 重要的话题。 Fritschi博士在她的研究"疲劳运动与糖尿病"（F31 NR009751）中， 在横截面生物学和自我报告数据收集方法方面积累了丰富的经验， 多元回归分析她探讨了一个重要的患者报告的结果（疲劳）及其 2型糖尿病患者的饮食习惯然而，这些研究的结果受到限制， 使用横断面设计结合回忆数据收集方法。现在，新颖的实时数据 收集方法，包括连续葡萄糖监测（CGM）和活动监测仪（活动记录仪）， 结合生态瞬时评价方法，有效地研究了 生物行为因素和体力活动之间复杂的多层次关系。在K99中， Fritschi博士将评估持续使用实时技术的可行性， 天来测量身体活动（腕关节活动记录）、疲劳（自我报告）、血糖水平（CGM），以及 相关的自我护理行为（夜间日记），以及其他相关因素的回顾性测量， 2型糖尿病患者的饮食习惯可行性包括：（1）参与者的可接受性;（2） 使用;（3）对日常活动的侵入性;（4）数据质量。可行性研究的结果将指导 修订独立研究，加强候选人对分析方法的学习， 实现自己的短期和长期职业目标。 独立阶段（R00）的主要目的是使用最先进的生态瞬时 检查选定的基线特征（健康/身体状况， 一般疲劳、身体成分、抑郁和人口统计学因素）和实时生物行为因素 （疲劳和血糖水平）对PA在110名成人2型糖尿病患者。通过生态瞬间 为了评估身体活动与葡萄糖水平和疲劳发作的关系，Fritschi博士和她的团队将 能够检查自然环境中的实时协变和时间关联。至今没有 另一项研究在2型糖尿病患者中对这些关系进行了真实的研究。通过发现 他们的身体活动水平与疲劳和身体活动的其他生物行为决定因素之间的关系， 这项研究的结果将指导开发针对增加身体活动的定制干预措施 从而降低患有2型糖尿病的久坐成年人的残疾风险。 K99培训阶段的目标是加强Fritschi博士作为独立临床医生的卓越能力， 护士研究员培训计划的首要目标是增加Fritschi博士在该领域的知识 以及运动能力、实时身体活动监测和运动行为的实验室测试。她将 还将在纵向和干预研究设计和分析方面得到指导。第二个培训目标是 提高她在使用生态瞬时评估数据收集方法方面的知识和技能， 分析，特别是与身体活动和相关的健康行为。

Momentary Biobehavioral Effects on Physical Activity in Adults with Type 2 Diabetes Abstract The candidate for this Pathway to Independence award is Cynthia Fritschi, PhD, RN, who recently completed her doctoral studies at the University of Illinois at Chicago College of Nursing (UIC CON). Dr. Fritschi will be mentored by Eileen Collins, PhD, RN, a tenured Associate Professor at the UIC CON and a Research Career Scientist in Rehabilitation Research and Development at the Edward Hines Jr. Department of Veterans Affairs Hospital. The goal of this application is to assist Dr. Fritschi to build an independent program of research in physical activity for people with type 2 diabetes. The independent research proposed herein will expand our knowledge of multilevel biological, psychological, and social factors that impede or foster physical activity behavior. The long-term goal is to assist sedentary adults with type 2 diabetes to maintain optimal health and functioning by helping them to increase physical activity behaviors. This will be accomplished through use of novel, real-time interventions in the natural environment. The candidate's short-term career goal is to acquire the skills and experience necessary to develop a program of research related to this very important topic. In her study, "Fatigue Exercise, and Diabetes" (F31 NR009751) as a predoctoral fellow, Dr. Fritschi developed extensive experience in cross-sectional biological and self-report data collection methods and multivariate regression analyses. She explored an important patient-reported outcome (fatigue) and its correlates and impact on women with type 2 diabetes. However, findings from these studies were limited by use of a cross-sectional design in combination with recall data collection methods. Now, novel, real-time data collection methods, including continuous glucose monitoring (CGM) and activity monitors (actigraphy) in combination with ecological momentary assessment methods have made it possible to effectively study the complex multilevel relationships between biobehavioral factors and physical activity. In her proposed K99 mentored research, Dr. Fritschi will evaluate the feasibility of using real-time technology continuously over 6 days to measure physical activity (wrist actigraphy), fatigue (self-report), blood glucose levels (CGM), and related self-care behaviors (nightly diary), alongside retrospective measures of other factors associated with physical activity in adults with type 2 diabetes. Feasibility includes: (1) acceptability to participants; (2) ease of use; (3) invasiveness into daily activities; and (4) data quality. Findings from the feasibility study will guide revision of the independent research and enhance candidate learning of the analytical methods necessary to achieve her short- and long-term career goals. The primary aim of the independent phase (R00) is to use state-of-the-science ecological momentary assessment methods to examine the influence of selected baseline characteristics (health/physical status, general fatigue, body composition, depression, and demographic factors) and real-time biobehavioral factors (fatigue and blood glucose levels) on PA in 110 adults with type 2 diabetes. Through ecological momentary assessment of physical activity in relation to glucose levels and fatigue episodes, Dr. Fritschi and her team will be able to examine real-time covariation and temporal associations in the natural environment. To date, no other study has examined these relationships in real time among people with type 2 diabetes. By discovering how their physical activity levels relate to fatigue and other biobehavioral determinants of physical activity, findings from this study will guide development of tailored interventions targeted at increasing physical activity and thus reducing the risks for disability in sedentary adults with type 2 diabetes. The goal of the K99 training phase is to strengthen Dr. Fritschi's ability to excel as an independent clinical nurse researcher. The first and primary goal of the training plan is to increase Dr. Fritschi's knowledge in field and laboratory tests of exercise capacity, real-time physical activity monitoring, and exercise behavior. She will also be mentored in longitudinal and intervention research design and analysis. The second training goal is to advance her knowledge and skills in the use of ecological momentary assessment data collection methods and analysis, especially related to physical activity and related health behaviors.