Comparative Effectiveness of Customary Fit and Strong! vs. Fit and Strong! Plus

描述(由申请人提供)：这项提案将比较针对患有骨关节炎(OA)的老年人的循证体力活动/行为改变计划-习惯性健身和强壮！的有效性，与该计划的增强版本进行比较，该计划也涉及饮食和体重。骨性关节炎是老年人残疾的主要原因(Hootman等人，2009年)，而下肢骨性关节炎是这种残疾发展的途径(Dunlop，Hughes等人，1998年)。体格健壮！目标是患有LE OA的老年人。在最近的一次随机试验中，8周的身体健康和强壮！该计划在18个月后显示出显著的体力活动维持效益，同时改善了LE僵硬、疼痛、功能、力量和步态速度，并减少了焦虑和抑郁(Hughes等人，2010年)。但是，身体健康，身体强壮！目前没有解决计划参与者中存在的饮食/体重问题。这是一个重要的遗漏，因为与骨性关节炎相关的LE症状要么是由肥胖引起的，要么是由肥胖加剧的。数据显示，在10年内体重减轻5.1公斤，患膝骨性关节炎的几率降低50%以上(Felson 1992)。2007年，60岁及以上的男性中有37%肥胖，女性中有48%肥胖(FLegal等人，2010年)。2003-2009年间，患有关节炎的成年人的肥胖率平均比没有关节炎的人高54%(Hootman等人，2011a)。患有关节炎的肥胖者身体不活动的可能性也要高出44%(Hootman等人，2011b)。肥胖率的上升可能解释了美国髋关节和膝关节置换手术使用量迅速增加的原因，2004年美国髋关节和膝关节置换手术的总金额为91亿美元(Kim，2008)。重要的是，最近的一项荟萃分析记录了缺乏证据支持干预措施对老年人减肥的有效性(Witham和Avenell，2010)。我们将通过开发和测试Fit and Strong来解决这一严重的科学鸿沟！加号-增强版的Fit and Strong！这既涉及体力活动，也涉及饮食。我们将纳入适应和轨道试验的共同元素，这些试验涉及体力活动和饮食/减肥。两项试验均在18个月时实现了大约5%的体重减轻(Messier等人，2004年，Fitzgibbon等人，2010年)。我们会比较习惯合体和强健的效果！为了健康和强壮！外加超过24个月的随机对照试验，在3个社区站点有400名参与者。这两组人都将接受逐渐减少的电话强化，以支持在3-24个月期间保持行为改变。我们还将检查干预前后的卫生保健使用情况。我们假设这是适合和强壮的！此外，参与者将在2、6、12、18和24个月时表现出不同的、显著的饮食行为改善，同时在6个月时体重显著下降(e5%)，并将保持在24个月。体格健壮！此外，参与者还将在所有时间点显示差异统计数据，所有体力活动维持方面的显著改善都伴随着LE疼痛、僵硬和功能以及抑郁和焦虑的改善。

DESCRIPTION (provided by applicant): This proposal will compare the effectiveness of customary Fit and Strong!-an evidence-based physical activity/behavior change program for older adults with osteoarthritis (OA)-to an enhanced version of the program that also addresses diet and weight. OA is the primary cause of disability among older adults (Hootman et al., 2009), and lower extremity (LE) OA is the pathway through which this disability develops (Dunlop, Hughes, et al., 1998). Fit and Strong! targets older adults with LE OA. In a recent randomized trial, the 8-week Fit and Strong! program demonstrated significant benefits on physical activity maintenance at 18 months accompanied by improved LE stiffness, pain, function, strength, and gait speed as well as reduced anxiety and depression (Hughes et al., 2010). However, Fit and Strong! does not currently address diet/ weight issues present among program participants. This is an important omission because LE symptoms related to OA are either caused by or exacerbated by obesity. Data show that a weight loss of 5.1 kg over a 10-year period decreases the odds of developing knee OA by more than 50% (Felson 1992). In 2007, 37% of men and 48% of women 60 years of age and older were obese (Flegal et al., 2010). Between 2003-2009 obesity prevalence, on average, was 54% higher among adults with arthritis compared to those without the condition (Hootman et al., 2011a). Obese persons with arthritis were also 44% more likely to be physically inactive (Hootman et al., 2011b). This rise in obesity prevalence may explain rapid increases in the use of hip and knee replacement surgery in the U.S., which totaled $9.1 billion in 2004 (Kim, 2008). Importantly, a recent meta- analysis has documented a dearth of evidence supporting the efficacy of interventions to decrease weight in older adults (Witham and Avenell, 2010). We will address this serious scientific gap by developing and testing Fit and Strong! Plus-an enhanced version of Fit and Strong! that addresses both physical activity and diet. We will incorporate common elements from the ADAPT and ORBIT trials that addressed physical activity and diet/ weight loss. Both trials achieved weight loss of approximately 5% at 18 months (Messier et al., 2004, Fitzgibbon et al., 2010). We will compare the effectiveness of customary Fit and Strong! to Fit and Strong! Plus over 24-months using an RCT with 400 participants at 3 community sites. Both groups will receive tapered telephone reinforcement to support maintenance of behavior change during months 3- 24. We will also examine health care use before and after the interventions. We hypothesize that Fit and Strong! Plus participants will show differential, significant improvement in diet behaviors at 2, 6, 12, 18 and 24 months accompanied by significant weight loss (e 5%) at 6 months that will be maintained at 24 months. Fit and Strong! Plus participants will also show differential statisticall significant improvements in physical activity maintenance accompanied by improved LE pain, stiffness, and function as well as depression and anxiety at all time points.