Intervening on sedentary behavior to prevent weight regain in older adults

干预久坐行为以防止老年人体重反弹

• 批准号: 9145989
• 负责人: Barbara J Nicklas
• 金额: $ 14.92万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-30 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9145989
• 关键词: Activities of Daily Living; Address; Adult; Aerobic; Aerobic Exercise; Aftercare; Age; Awareness; Behavior; Behavior Therapy; Behavioral; Biological Adaptation; Blood Pressure; Body Composition; Body Weight; Body Weight decreased; Caloric Restriction; Chronic Disease; Clinical; Cognitive; Counseling; Data; Diet; Dietary intake; Eating; Elderly; Energy Intake; Energy Metabolism; Exercise; Fasting; Glucose; Goals; Group Processes; Guidelines; Health; Individual; Insulin; Intervention; Lead; Life Style; Light; Lipids; Maintenance; Methods; Monitor; Obesity; Outcome; Participant; Pattern; Performance; Persons; Phase; Physical Fitness; Physical Function; Physical activity; Population; Prevalence; Process Measure; Randomized; Randomized Controlled Trials; Recommendation; Reporting; Research; Rest; Science; Structure; Time; Treatment Efficacy; United States National Institutes of Health; Walking; Weight; Weight Gain; Wing; age group; awake; base; behavioral outcome; cardiometabolic risk; design; diet and exercise; disability; efficacy testing; evidence base; fitness; follow-up; improved; intervention effect; lifestyle intervention; novel; obesity treatment; prevent; recidivism; response; secondary outcome; sedentary; social; weight loss intervention; working group

 DESCRIPTION (provided by applicant): Chronic disease and decreased mobility associated with obesity in older (65+ yrs) adults emphasize the urgent need to identify obesity treatments in this population that are evidenced-based, effective in the long-term, and perhaps age-specific. The latest obesity treatment guidelines for all ages recommend an intensive intervention involving behavioral counseling, caloric restriction, and increased physical activity to achieve weight loss. However weight regain after treatment cessation is very common, especially in older adults in whom the currently recommended strategy of continued performance of high-volume structured exercise of 200-300 min/wk may be less feasible and effective. A key factor contributing to weight regain is the decrease in energy expenditure that occurs in response to weight loss, due mainly to a decline in non-exercise or spontaneous physical activity (SPA) that is the direct result of an increase in sedentary behavior (SB), or time spent sitting or reclining. Our pilot data show that decreases in SPA predict magnitude of weight regain. Since older adults spend 65-80% of their waking day sitting or prone, we hypothesize that intervening on SB will be a more effective method for preventing weight regain than the conventional approach of intervening on exercise behavior in this age group. The proposed research will test the efficacy of a novel, acceptable, behavioral intervention (SitLess) that focuses on increased awareness of SB employing accelerometry-based self-monitoring throughout the day. Our preliminary data show that this intervention improves weight loss during the intensive phase of treatment and prevents weight regain during a short (5-month) follow-up phase. The primary aim of this study is to determine whether addition of this intervention that targets SB to a conventional weight loss intervention that targets EX results in lower long-term reduction in body weight in older, obese adults. This will be accomplished with a 24-month trial in 225 obese (BMI=30-40 kg/m2) older (65-79 yrs) adults randomized to one of three treatments (n=75), all with dietary caloric restriction plus either: 1) moderate- intensity aerobic exercise (WL+EX); 2) intervening on SB (WL+SitLess); or 3) (WL+EX+SitLess). The primary hypothesis is that: WL+EX+SitLess will have lower 24-month body weight than either WL+EX or WL+SitLess. Secondary outcomes, including resting and physical activity energy expenditure, SB, dietary intake, body composition, physical fitness and function, cardiometabolic risk and intervention process measures, will also be examined. The results will provide the first randomized, controlled trial data on the efficacy o self-monitoring of a key contributor to the adaptive thermogenic response to weight loss. Increasing awareness of weight loss-induced reductions in SPA, and behavioral promotion of decreasing SB to counteract these reductions, may provide for a more effective, safe, non- pharmacologic, and sustainable strategy to reduce weight regain after weight loss in older adults.

 描述（由申请人提供）：与老年人（65 岁以上）肥胖相关的慢性病和活动能力下降强调迫切需要在该人群中确定基于证据的、长期有效的、可能针对特定年龄的肥胖治疗方法。针对所有年龄段的最新肥胖治疗指南建议采取强化干预措施，包括行为咨询、热量限制和增加体力活动，以实现减肥。然而，停止治疗后体重反弹非常常见，尤其是对于老年人，目前推荐的持续进行 200-300 分钟/周的大容量结构化运动的策略可能不太可行和有效。体重反弹的一个关键因素是体重减轻后能量消耗的减少，这主要是由于非运动或自发体力活动（SPA）的减少，而自发身体活动（SPA）是久坐行为（SB）或坐着或躺着的时间增加的直接结果。 我们的试验数据表明，SPA 的减少可以预测体重反弹的幅度。由于老年人醒着时有 65-80% 的时间是坐着或俯卧的，因此我们推测，与干预该年龄段运动行为的传统方法相比，对 SB 进行干预将是预防体重反弹的更有效方法。拟议的研究将测试一种新颖的、可接受的行为干预措施 (SitLess) 的功效，该干预措施的重点是通过全天采用基于加速度测量的自我监控来提高 SB 的意识。我们的初步数据表明，这种干预措施可以在强化治疗阶段改善体重减轻，并在短期（5个月）随访阶段防止体重反弹。本研究的主要目的是确定是否将这种针对 SB 的干预措施添加到传统减肥方法中 针对 EX 的干预措施可减少老年肥胖者体重的长期下降。这将通过对 225 名肥胖（BMI=30-40 kg/m2）老年人（65-79 岁）进行为期 24 个月的试验来完成，这些成年人被随机接受三种治疗方法中的一种（n=75），所有治疗方法均限制饮​​食热量并加其中一种：1）中等强度有氧运动（WL+EX）； 2）干预SB（WL+SitLess）；或 3) (WL+EX+SitLess)。主要假设是：WL+EX+SitLess 的 24 个月体重将低于 WL+EX 或 WL+SitLess。次要结果，包括休息和体力活动能量消耗、SB、饮食摄入、身体成分、身体健康和功能、心脏代谢风险和干预过程措施也将受到检查。研究结果将提供第一个关于体重减轻适应性生热反应关键因素自我监测功效的随机对照试验数据。提高对减肥引起的 SPA 减少的认识，以及通过减少 SB 来抵消这些减少的行为促进，可以提供更有效、安全、非药物和可持续的策略来减少老年人减肥后的体重反弹。