Weight Loss and Exercise for Communities with Arthritis in North Carolina (WE-CAN)

北卡罗来纳州关节炎社区的减肥和锻炼 (WE-CAN)

• 批准号: 9766072
• 负责人: LEIGH Fleming CALLAHAN
• 金额: $ 110.74万
• 依托单位: WAKE FOREST UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9766072
• 关键词: Age; American; Arthritis; Behavioral; Body Weight decreased; Clinical; Communities; Computers; Control Groups; County; Data; Diet; Effectiveness; Exercise; Health Benefit; Healthy People 2020; Intervention; Knee Osteoarthritis; Measures; Modality; Modeling; North Carolina; Obesity; Outcome; Overweight; Pain; Palpable; Paper; Participant; Patient Monitoring; Patient Self-Report; Patients; Physicians; Policies; Public Health; Questionnaires; Rheumatology; Risk Factors; Rural; SF-36; Testing; Translating; Walking; Western Ontario and McMaster Universities Arthritis Index; Woman; adult obesity; aged; attentional control; base; biomedical referral center; clinically significant; cohort; college; community intervention; community setting; cost; cost effective; cost effectiveness; design; diet and exercise; effective intervention; efficacy trial; exercise intervention; exercise program; health related quality of life; improved; improved functioning; indexing; knee pain; men; modifiable risk; multimodality; pain reduction; pain relief; programs; public health relevance; rural counties; socioeconomics; weight loss intervention; weight loss program

 DESCRIPTION (provided by applicant): Obesity is a modifiable risk factor for knee osteoarthritis (OA), and weight loss is an effective non- pharmacologic treatment to reduce pain. Recently, we determined that under ideal, highly controlled circumstances, a diet-induced weight loss of 10% combined with exercise was significantly better at reducing pain than either intervention alone. Compared to previous long-term weight loss and exercise trials of knee OA, our diet-induced weight loss and exercise group was twice as effective at relieving pain. Whether our groundbreaking results can be generalized to less rigorously monitored patient cohorts is unknown. Thus, the policy relevant and clinically significant question is: How can we adapt this successful solution to a pervasive public health problem so that it provides a cost-effective intervention for real-world clinical and community settings? This study aims to develop and to demonstrate the effectiveness of a systematic, practical, cost-effective diet-induced weight loss and exercise intervention that communities can implement to reduce pain and improve other clinical outcomes in knee OA patients. This pragmatic community-based trial will determine if the important benefits realized by participants in our previous trial translate to rea-world settings. Participants will be 820 ambulatory, community-dwelling, overweight and obese (BMI = 27 kg/m2) men and women aged = 50 years who meet the American College of Rheumatology clinical criteria for knee OA which includes knee pain on most days of the week plus at least 3 of the following 6: age = 50 years; stiffness < 30 min/day; crepitus; bony tenderness; bony enlargement; no palpable warmth. The primary aim is to determine whether a pragmatic, community-based 18-month diet-induced weight loss and exercise intervention implemented in three North Carolina counties with diverse residential (from urban to rural) and socioeconomic composition significantly decreases knee pain in overweight and obese adults with knee OA relative to an attention control group. Secondary aims will determine whether this intervention improves self-reported function, health-related quality of life, and mobility. We will also establish the cost-effectiveness of this pragmatic, community-based intervention by conducting cost-effectiveness and budgetary impact analyses using data from the current trial in a validated computer-simulated model of knee OA. Many physicians who treat people with knee OA have no practical means to implement weight loss and exercise treatments. This study is significant in that it will test the effectiveness of a long-awaited and much needed community program that will serve as a blueprint for clinicians and public health officials in urban and rura communities to implement a weight loss and exercise program designed to reduce knee pain and improve other clinical outcomes in overweight and obese adults with knee OA.

 描述（由申请人提供）：肥胖是膝骨关节炎（OA）的一个可改变的危险因素，减肥是减轻疼痛的有效非药物治疗方法。最近，我们确定，在理想的、高度控制的情况下，饮食诱导的体重减轻 10% 与运动相结合，在减轻疼痛方面明显优于单独的任何一种干预措施。与之前针对膝骨关节炎的长期减肥和运动试验相比，饮食诱导的减肥和运动组在缓解疼痛方面的效果是之前的两倍。我们的突破性结果是否可以推广到监测不那么严格的患者群体尚不清楚。因此，与政策相关且具有临床意义的问题是：我们如何将这一成功的解决方案应用于普遍的公共卫生问题，以便为现实世界的临床和社区环境提供具有成本效益的干预措施？本研究旨在开发并证明系统性、实用性、成本效益高的饮食诱导减肥和运动干预的有效性，社区可以实施该干预来减轻膝骨关节炎患者的疼痛并改善其他临床结果。这项基于社区的务实试验将确定参与者在我们之前的试验中实现的重要好处是否可以转化为现实世界的环境。 参与者将是 820 名年龄 = 50 岁的流动、社区居住、超重和肥胖 (BMI = 27 kg/m2) 男性和女性，符合美国风湿病学会膝关节 OA 临床标准，其中包括一周中大部分时间的膝关节疼痛以及以下 6 项中的至少 3 项：年龄 = 50 岁；硬度 < 30 分钟/天；捻发音；骨压痛；骨质增生；没有明显的温暖。主要目的是确定在居住地（从城市到农村）和社会经济构成不同的北卡罗来纳州三个县实施的、以社区为基础的为期 18 个月的饮食诱导减肥和运动干预是否能显着减轻超重和肥胖膝骨关节炎成人患者的膝关节疼痛（相对于注意力对照组）。次要目标将确定这种干预措施是否改善自我报告的功能、与健康相关的生活质量和活动能力。我们将 还通过使用经过验证的膝关节骨关节炎计算机模拟模型中当前试验的数据进行成本效益和预算影响分析，确定这种务实的、基于社区的干预措施的成本效益。 许多治疗膝骨关节炎患者的医生没有实际的方法来实施减肥和运动治疗。这项研究的意义重大，因为它将测试一项期待已久且急需的社区计划的有效性，该计划将作为城市和乡村社区的临床医生和公共卫生官员实施减肥和锻炼计划的蓝图，旨在减轻患有膝骨关节炎的超重和肥胖成人的膝盖疼痛并改善其他临床结果。

项目成果

Clinical, Health-Related Quality of Life, and Gait Differences Among Obesity Classes in Adults With Knee Osteoarthritis.

膝骨关节炎成人肥胖类别之间的临床、健康相关生活质量和步态差异。

• DOI: 10.1002/acr.25265
• 发表时间: 2024
• 期刊: Arthritis care & research
• 影响因子: 4.7
• 作者: Messier,StephenP;Gill,MaliaE;Mihalko,ShannonL;Beavers,DanielP;Queen,Kate;Miller,GaryD;Losina,Elena;Katz,JeffreyN;Loeser,RichardF;DeVita,Paul;Hunter,DavidJ;Quandt,SaraA;Lyles,MaryF;Hudson,David;Callahan,LeighF
• 通讯作者: Callahan,LeighF