Initiate and Maintain Physical Activity in Clinics: The IMPACT Diabetes Study

描述（由申请人提供）：2型糖尿病（T2 DM）影响美国2580万人，患病率和发病率呈上升趋势。体力活动在T2 DM管理中的益处已得到充分证明，当患者在研究环境中遵循结构化运动计划时，血糖控制较低。鉴于饮食改变在T2 DM中的已知益处，营养推荐在当前临床实践中很常见。尽管运动的好处也是众所周知的，但在临床环境中，身体活动的转诊并不容易获得。目前美国糖尿病协会（ADA）指南建议T2 DM患者应同时进行有氧和阻力训练活动，每周至少进行150分钟的中等强度有氧活动，每周进行3次阻力训练。大多数（约70%）T2 DM患者不按推荐水平（38%）或根本不运动（31%）。虽然在高度结构化的研究环境中，这种密集的体力活动干预在糖尿病患者中的疗效已经得到证明，但需要将这些发现转化并扩展到临床环境中的实用方法。虽然大多数其他转化研究已经探索了使身体活动干预适应其他社区环境（例如，基督教青年会），我们独特地提出了在临床环境中的身体活动资源制度化，因为这传达了病人的医疗保健团队对身体活动的隐含认可。随着最近（2006年）ADA指南中增加阻力训练，为运动提供监督和支持，以防止受伤并最大限度地提高健康效益尤为重要。为了满足这些需求，我们建议实施一项三组RCT，以比较在已建立的T2 DM共享医疗预约中增加专门体力活动部分的临床有效性、以患者为中心的结局和成本效益。共享医疗预约（SMA）是60-90分钟的小组预约（6-12名患者），由美国家庭实践学院和美国医师学院认可，并已在各种临床环境中实施。与常规护理相比，拟定的糖尿病SMA体力活动（PAD-SMA）将涉及在临床环境中以不同频率水平（每周一次与每周三次）进行的结构化团体运动。这项拟议的研究旨在测试一种创新的方法，通过体力活动来改善血糖控制。在临床上开始和保持身体活动（IMPACT）糖尿病研究的目标是在临床环境中转化监督身体活动的已知益处。

DESCRIPTION (provided by applicant): Type 2 diabetes (T2DM) affects 25.8 million people in the U.S., and the prevalence and incidence is increasing. The benefits of physical activity in T2DM management have been well demonstrated, with lower glycemic control achieved when patients follow a structured exercise program in a research setting. Given the known benefits of dietary changes in T2DM, nutrition referrals are common in current clinical practice. Despite the similarly known benefits of exercise, physical activity referrals are not readily available in the clinical setting. The current American Diabetes Association (ADA) guidelines recommend that individuals with T2DM should engage in both aerobic and resistance training activity, with at least 150 minutes of moderate-intensity aerobic activity per week and resistance exercises 3 times per week. Most (~70%) T2DM patients do not exercise at recommended levels (38%) or at all (31%). While the efficacy of such intensive physical activity interventions among diabetics in a highly structured research setting has been proven, practical approaches to translating and extending these findings into the clinical setting are needed. While most other translational studies have explored adapting physical activity interventions to other community settings (e.g., YMCA), we uniquely propose institutionalizing physical activity resources within a clinical setting, as this conveys an implicit endorsement of physical activity by a patient's health care team. With the recent (2006) addition of resistance training to the ADA guidelines, it is especially important to provide supervision and support for exercise, to prevent injury and maximize health benefits. In order to address these needs, we propose to implement a three-arm RCT to compare the clinical effectiveness, patient centered outcomes, and cost- effectiveness of adding a specialized physical activity component to an established Shared Medical Appointment for T2DM. Shared Medical Appointments (SMAs) are 60-90 minute group appointments (6-12 patients) which are endorsed by the American Academy of Family Practice and the American College of Physicians, and have been implemented in a variety of clinical settings. The proposed Physical Activity for Diabetes SMA (PAD-SMA) will involve structured group exercise sessions in a clinical setting at varying levels of frequency (once vs. three times per week), compared to usual care. The proposed study seeks to test an innovative approach for adoption of physical activity to improve glycemic control. The goal of the Initiate and Maintai Physical Activity in Clinics (IMPACT) Diabetes Study is to translate the known benefits of supervised physical activity in a clinical setting.