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

描述(申请人提供)：2型糖尿病(T2 DM)在美国影响着2580万人，而且患病率和发病率都在增加。体力活动在T2 DM管理中的好处已经得到了很好的证明，当患者在研究环境中遵循有组织的运动计划时，可以实现较低的血糖控制。考虑到饮食改变对2型糖尿病的已知益处，营养转诊在当前的临床实践中很常见。尽管锻炼有类似的已知益处，但体力活动转诊在临床环境中并不容易获得。目前的美国糖尿病协会(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运动，每周进行3次阻力训练。大多数(约70%)的T2 DM患者没有达到推荐的运动量(38%)或根本没有(31%)。虽然在高度结构化的研究环境中对糖尿病患者进行这种密集的体力活动干预的有效性已经得到证实，但需要实用的方法将这些发现转化为临床环境并将其推广到临床环境中。虽然大多数其他转化性研究都探索了将体力活动干预措施适应其他社区环境(例如，基督教青年会)，但我们唯一的建议是在临床环境中将体力活动资源制度化，因为这传达了患者医疗团队对体力活动的隐含认可。随着最近(2006年)将抵抗力训练添加到ADA指南中，为运动提供监督和支持尤其重要，以防止受伤和最大限度地提高健康效益。为了满足这些需求，我们建议实施一项三臂随机对照试验，以比较在已建立的T2 DM共享医疗预约中增加专门的体力活动部分的临床有效性、以患者为中心的结果和成本效益。共享医疗预约(SMA)是由美国家庭实践学会和美国医师学会认可的60-90分钟的小组预约(6-12名患者)，已在各种临床环境中实施。与通常的护理相比，拟议的糖尿病体力活动(PAD-SMA)将包括在临床环境中以不同水平的频率(每周一次对三次)进行有组织的集体锻炼。这项拟议的研究旨在测试一种采用体力活动来改善血糖控制的创新方法。INITIAL和Maintai的临床体力活动(IMPACT)糖尿病研究的目标是将有监督的体力活动的已知益处转化为临床环境。

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.