Rural Lifestyle Eating and Activity Program (Rural LEAP)

乡村生活方式饮食和活动计划（Rural LEAP）

• 批准号: 8719158
• 负责人: MICHAEL G PERRI
• 金额: $ 74.78万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-15 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8719158
• 关键词: Address; Adoption; Adult; Attention; Behavior; Blood Pressure; Body Weight; Body Weight Changes; Body Weight decreased; Cardiovascular Diseases; Chronic; Clinical effectiveness; Control Groups; Counseling; County; Eating; Education; Effectiveness; Effectiveness of Interventions; Electronic Mail; Health; Health education; Heart Diseases; Individual; Intake; Intervention; Knowledge; Life Style; Lipids; Long-Term Care; Long-Term Effects; Mails; Maintenance; Mediating; Medical; Mission; Modeling; Monitor; Morbidity - disease rate; Nutritional; Obesity; Outcome; Participant; Performance; Physical activity; Pilot Projects; Prevalence; Privacy; Problem Solving; Provider; Public Health; Publishing; Quality of life; Randomized; Randomized Controlled Trials; Reporting; Research; Research Infrastructure; Risk Factors; Rural; Rural Community; Series; Services; Telephone; Testing; Translations; Treatment outcome; Underserved Population; Work; base; blind; cardiovascular disorder risk; clinically significant; community setting; cost; cost effectiveness; dissemination research; effectiveness trial; follow-up; glycemic control; group intervention; group support; health related quality of life; improved; innovation; lifestyle intervention; medically underserved; mortality; nutrition; obesity management; obesity treatment; programs; public health relevance; rural area; rural disparities; sedentary; skills; treatment effect; urban area; vigilance

DESCRIPTION (provided by applicant): Higher rates of obesity and sedentary behavior represent significant contributors to the greater prevalence of cardiovascular disease (CVD) morbidity and mortality observed in rural versus urban areas. Yet little research attention has been given to modifying these important influences on the urban/rural disparity in heart disease. Lifestyle interventions can produce weight reductions of sufficient magnitude to improve health, but the existing research is limited with respect to two critical factors: (a) the long-term maintenance of treatment effects and (b) translation and dissemination to underserved populations. In a series of effectiveness trials, our rural obesity research program has demonstrated the feasibility and effectiveness of delivering lifestyle programs through the existing infrastructure of the USDA Cooperative Extension Service (CES), which has more than 2,900 offices nationwide and whose mission includes improving nutrition and health. We have also demonstrated that we can improve the long-term effects of treatment via extended-care programs consisting of either face-to-face treatment sessions or individual telephone counseling. However, both of these options entail relatively high costs, which inhibit their adoption in rural communities. In a recently published pilot study, we demonstrated the effectiveness of a group-based telephone intervention for obese adults from rural areas. This highly innovative approach addresses barriers to access, provides group support in a confidential setting, and appears to be as effective as individual phone treatment. Group support may be especially important for rural residents who tend to be isolated, have heightened concerns about privacy, and report lower levels of quality of life. The next logical step in this lne of research is to conduct a randomized controlled trial to evaluate the long-term effects of this potentially more efficient mode of providing extended care for the management of obesity in rural communities. We propose to conduct a single-blind, randomized controlled "effectiveness" trial in obese adults (N=540) to evaluate the effects of extended-care programs delivered via INDIVIDUAL or GROUP telephone counseling, compared to a health education control (CTRL) condition, on long-term (22 month) changes in body weight. Our principal hypothesis is that both the INDIVIDUAL and GROUP interventions will produce greater weight reductions at 22 months than the CTRL condition. We will evaluate the proportion of participants in each condition who demonstrate clinically significant weight losses (> 5% of initial body weight) at long-term follow-up. We also will examine the effects of treatment on CVD risk factors, and we will evaluate the costs and cost effectiveness of the interventions.

描述（由申请人提供）：与城市地区相比，肥胖率和久坐行为较高是农村地区心血管疾病 (CVD) 发病率和死亡率较高的重要原因。然而，很少有研究关注改变这些对城乡心脏病差异的重要影响。生活方式干预措施可以实现足够程度的体重减轻以改善健康，但现有研究在两个关键因素方面受到限制：（a）治疗效果的长期维持；（b）向服务不足的人群转化和传播。在一系列有效性试验中，我们的农村肥胖研究计划证明了通过美国农业部合作推广服务 (CES) 的现有基础设施提供生活方式计划的可行性和有效性，该服务在全国设有 2,900 多个办事处，其使命包括改善营养和健康。我们还证明，我们可以通过包括面对面治疗课程或个人电话咨询在内的长期护理计划来改善治疗的长期效果。然而，这两种选择都需要相对较高的成本，这阻碍了它们在农村社区的采用。在最近发表的一项试点研究中，我们证明了基于团体的电话干预对农村地区肥胖成年人的有效性。这种高度创新的方法解决了访问障碍，在保密环境中提供团体支持，并且似乎与个人电话治疗一样有效。对于倾向于孤立、对隐私高度关注且生活质量较低的农村居民来说，团体支持可能尤其重要。该研究的下一个合乎逻辑的步骤是进行一项随机对照试验，以评估这种为农村社区肥胖管理提供扩展护理的潜在更有效模式的长期影响。我们建议在肥胖成人 (N=540) 中进行一项单盲、随机对照“有效性”试验，以评估通过个人或团体电话咨询提供的长期护理计划与健康教育对照 (CTRL) 条件相比对长期（22 个月）体重变化的影响。我们的主要假设是，与 CTRL 条件相比，个人和团体干预措施在 22 个月时将产生更大的体重减轻效果。我们将评估在长期随访中每种情况下表现出临床显着体重减轻（> 初始体重的 5%）的参与者比例。我们还将研究治疗对 CVD 危险因素的影响，并评估干预措施的成本和成本效益。