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

描述（由申请人提供）：本提案将比较习惯Fit和Strong的有效性！一项针对患有骨关节炎（OA）的老年人的循证体育活动/行为改变计划，以及一项针对饮食和体重的增强版计划。骨关节炎是老年人致残的主要原因（Hootman et al., 2009），而下肢骨关节炎是这种致残发展的途径（Dunlop, Hughes, et al., 1998）。健康和强壮！针对老年LE OA患者。在最近的一项随机试验中，8周健康和强壮！该项目在18个月的身体活动维持方面显示出显著的益处，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 et al., 2010）。然而，健康和强大！目前还没有解决项目参与者的饮食/体重问题。这是一个重要的遗漏，因为与OA相关的LE症状是由肥胖引起或加重的。数据显示，10年期间体重减轻5.1公斤可使患膝关节炎的几率降低50%以上（Felson 1992）。2007年，60岁及以上人群中37%的男性和48%的女性肥胖（Flegal et al., 2010）。2003-2009年间，患有关节炎的成年人的肥胖患病率平均比没有关节炎的成年人高54% （Hootman et al., 2011）。患有关节炎的肥胖者缺乏运动的可能性也要高出44% （Hootman et al., 2011b）。肥胖患病率的上升可能解释了美国髋关节和膝关节置换手术使用的迅速增加，2004年总计91亿美元（Kim, 2008）。重要的是，最近的一项荟萃分析表明，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差距！加上一个增强版的健康和强大！这涉及到身体活动和饮食。我们将纳入ADAPT和ORBIT试验的共同元素，这些试验涉及体育活动和饮食/减肥。两项试验在18个月后都实现了约5%的体重减轻（Messier et al., 2004; Fitzgibbon et al., 2010）。我们将比较习惯Fit和Strong的有效性！为了健康和强壮！再加上在3个社区站点对400名参与者进行了为期24个月的随机对照试验。在第3- 24个月期间，两组都将接受锥形电话强化，以支持行为改变的维持。我们还将检查干预措施前后的卫生保健使用情况。我们假设Fit and Strong！此外，参与者在2、6、12、18和24个月时的饮食行为会有显著的改善，并在6个月时体重显著下降（约5%），并将保持在24个月。健康和强壮！此外，在所有时间点，参与者在身体活动维持方面也会表现出统计学上的显著改善，并伴有LE疼痛、僵硬和功能的改善，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.