Randomized Trial to Reduce Sitting Time and Improve Cardiometabolic Health in Obese Older Adults

摘要 近40%的60岁以上的成年人肥胖。平均而言，这些人每天花10多个小时 坐着这是一个令人担忧的问题，因为新的研究表明，坐得时间越长， 心血管和代谢健康。事实上，大多数肥胖的老年人都患有心血管代谢障碍。 条件干预措施，可以减少坐在这个高风险人群的时间可以改善健康， 降低医疗保健成本。因此，需要更多的研究来开发有效减少久坐的干预措施。 老年肥胖成年人的时间。拟议的研究将解决这一重要目标，并建立在有希望的基础上。 我们的I-STAND随机试点研究的结果。这项研究发现，一个基于理论的，多模态的行为 结合电话咨询和基于技术的行为提示的干预是可行的， 可接受，并显著减少了坐立时间（与对照组相比，干预组为-75分钟/天 组，p < .01）。在基线血压升高的患者中， 我们的试点研究。简而言之，我们发现I-STAND值得在一项大型随机对照试验中进行评价。 目前的研究将比较I-STAND与参与者的注意力匹配控制干预， 年龄60岁，肥胖，每天坐8小时以上（N = 284）。这两种干预措施都包括一个- 电话会议和9个后续电话。实验参与者还将收到站立的提示 通过腕戴式技术和家庭环境审计来识别修改以改善站立时间。所有 参与者将被跟踪12个月。6个月后，实验参与者将被重新随机分配到 接受5个额外的助推器呼叫或没有进一步的干预，使我们能够评估最初的影响， 干预和助推器会议。主要结果将是减少坐着的时间， 大腿上的activPAL倾斜计和血压。次要结局包括以下变化： 心脏代谢风险因素（如体重、血脂、空腹血糖）。具有显著治疗效果的介质将 也可以探索。如果有效，I-STAND可以很容易地由卫生保健系统实施，以改善 全国肥胖老年人的健康状况。

Abstract Nearly 40% of adults over age 60 are obese. On average, these individuals spend over 10 hours a day sitting. This is a concern since emerging research shows higher sitting time is associated with worse cardiovascular and metabolic health. In fact, most obese older adults have comorbid cardiometabolic conditions. Interventions which can reduce sitting time in this high-risk population could improve health and lower health care costs. As such, more research is needed to develop interventions to effectively reduce sitting time among older obese adults. The proposed study will address this important goal and build on the promising results of our I-STAND randomized pilot study. This study found that a theory-based, multi-modal behavioral intervention which combined phone counseling and technology-based behavioral prompts was feasible, acceptable, and significantly reduced sitting time (-75 minutes/day in the intervention compared to control group, p < .01). Among those with elevated blood pressure at baseline, blood pressure also improved in two of our pilot studies. In short, we found that I-STAND warrants evaluation in a large randomized controlled trial. The current study will compare I-STAND to an attention-matched control intervention among participants over age 60, with obesity, and who sit more than 8 hours per day (N = 284). Both interventions include one in- person session and 9 follow-up phone calls. Experimental participants will also receive prompts for standing via wrist-worn technology and a home environment audit to identify modifications to improve standing time. All participants will be followed for 12 months. After 6 months, experimental participants will be re-randomized to receive either 5 additional booster calls or no further intervention, allowing us to assess the effects of the initial intervention and booster sessions. The primary outcomes will be reduction in sitting time as measured by a thigh-worn activPAL inclinometer and blood pressure. The secondary outcomes include changes in cardiometabolic risk factors (e.g. weight, lipids, fasting glucose). Mediators of significant treatment effects will also be explored. If effective, I-STAND could easily be implemented by health care systems to improve the health of older obese adults nationwide.