Cooperative Lifestyle Intervention Programs (CLIP-II)

描述（由申请人提供）：老年人心血管疾病和代谢综合征（MetS）的并发症是行动障碍。事实上，心脏和循环系统疾病是导致60岁以上成年人残疾的主要原因。专家们认为，对患有冠状动脉疾病的老年人进行医疗护理的首要目标应该是改善身体机能，延长无残疾生存期。美国心脏协会最近的一项立场声明将体重管理确定为心血管疾病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是心血管疾病患者的常见疾病，也是已知的身体残疾的危险因素。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，评估老年人饮食引起的体重减轻（WL）和运动对活动能力、肌肉功能和肥胖相关疾病等结果的独立和附加效应。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）。在该研究中，288名肥胖、患有心血管疾病或MetS的老年人被随机分配到成功的衰老控制治疗组（SA）、有氧运动训练组（AT）或AT+WL组，为期18个月。主要结果是行动不便，我们的工作人员与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。虽然与SA相比，AT组的运动能力明显改善，但AT+WL优于SA或AT，并且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的干预措施的转化意义，由YMCA社区合作伙伴独家提供，我们的员工作为期望行为改变的“培训师和顾问”。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对肥胖、患有心血管疾病或MetS的老年人的运动能力的影响，与WL结合体育活动相比。由于考虑到瘦质量的损失，促进老年人WL的最佳方法存在不确定性，因此该设计还允许在AT+WL和阻力运动训练（RT）之间进行肌肉力量的对比。主要的结果将是行动障碍和肌肉力量。

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.