Multimodal Exercise and Weight Loss in Older Veterans with Dysmobility

行动不便的老年退伍军人的多模式锻炼和减肥

• 批准号: 10232048
• 负责人: Leslie I. Katzel
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-10-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10232048
• 关键词: Abdomen; Aerobic; Age; American; Area; Baltimore; Biological Markers; Biomechanics; Body Composition; Body Weight decreased; Body fat; Body mass index; Capsicum; Cessation of life; Collaborations; Communities; Dietary Intervention; Dietitian; Dual-Energy X-Ray Absorptiometry; Effectiveness; Elderly; Energy Intake; Energy Metabolism; Enrollment; Equilibrium; Exercise; Fatigue; Fatty acid glycerol esters; Gait; Gait speed; Geriatrics; Goals; Hip region structure; Hospitalization; Human; Impairment; Individual; Injury; Intervention; Intramuscular; Isometric Exercise; Laboratories; Lateral; Lead; Lower Extremity; Maryland; Measurement; Measures; Mediation; Medical; Medical center; Methods; Movement; Muscle; Muscular Atrophy; Nutritional; Obesity; Outcome Measure; Patient Self-Report; Performance; Physical Function; Physical activity; Physiological; Prevalence; Quality of life; Randomized; Randomized Clinical Trials; Research; Resources; Risk Factors; Robotics; Scanning; Self-Help Devices; Spiral Computed Tomography; Step Tests; Structure; Supervision; System; Testing; Thigh structure; Time; Translating; Universities; Upper Extremity; Veterans; Walking; Weight; X-Ray Computed Tomography; adult obesity; base; clinical care; clinical center; comorbidity; deconditioning; dietary; disability; education research; effective intervention; exercise intervention; exercise rehabilitation; experience; fall risk; fitness; functional independence; functional status; group intervention; improved; improved functioning; improved mobility; instrument; instrumental activity of daily living; intervention program; multidisciplinary; multimodality; muscle form; novel; nutrition; obese person; portability; programs; sarcopenia; sarcopenic obesity; walking speed; weight loss program

Background: Obesity is a major risk factor for mobility limitation in older adults. It is estimated that 11 million older adults have mobility disability and > 4 million older adults use walking assistive devices. Mobility disability results in decreased economy of gait, physical deconditioning and reduced peak aerobic capacity (VO2peak). Impaired economy of gait and decreased physiological reserve may lead to increased fatigue, reduced endurance, and ultimately contribute to reduced functional independence. The optimal intervention to improve mobility limitations in older, obese adults is not known, particular in those who use walking assistive devices, and there is limited information on whether improvements in physical function can be sustained over time. Preliminary studies demonstrate that our novel progressive group multimodal balance intervention (MMBI), focusing on lateral movements, lower extremity strengthening and dynamic obstacle negotiation can improve gait, balance, and strength in mobility limited older adults. However, it is no known if weight loss in combination with MMBI will provide additive or synergistic improvements in mobility limited older, obese Veterans. We hypothesize that our MMBI program in combination with a hypocaloric nutritional intervention (Nutrition) will be more effective than MMBI alone in improving muscle quality, physical function and economy of gait. In addition, we hypothesize that the Nutrition + MMBI will be more effective than MMBI alone at improving self- reported measures of function and disability. Objective: We propose a randomized clinical trial in 120 older (age > 60 yr) community-dwelling obese (BMI >30 kg/m2), Veterans with mobility limitations who use walking assistive devices in which we will: Specific aim 1: Compare the effects of a 6-month MMBI intervention alone to a 6-month combination Nutrition + MMBI on physical functioning and economy of gait. Specific aim 2: Compare the effects of the two interventions on body composition, muscle mass, strength and relative sarcopenia. Specific aim 3: Assess the effects of the two interventions at baseline, 6, 12 and 24 months on their self- reported measures of function and disability using the Late-Life Function and Disability Instrument (LLFDI). Methods: Veterans enrolled into the study will have baseline testing at the Baltimore GRECC and VAMHCS Human Performance Laboratory consisting of 1) performance-based outcome measures include VO2peak, gait speed (gait rite), chair stands, lateral mobility and balance (four square step test, figure eight), SPPB, handgrip strength (dynamometry), and economy of gait (portable VO2 measurement during 6 minute walk) and functional status (ADL, IADLs); 2) lower extremity strength testing, 3) total body DXA scan, and a CT scan of the abdomen, hips and thighs for determination of lower extremity and core muscle composition; and 4) biomarkers. After completion of baseline testing, the Veterans will be randomized to one of the two interventions. Nutrition classes will be led by a GRECC dietitian. The goal is for subjects to lose 10% of their weight over the first 6 months with gradual weight loss after that. The MMBI will consist of a group dynamic balance class, a supervised obstacle course, and lower extremity and core strengthening. After 3-, 6-, 12-, and 24-months, subjects will repeat the assessments that they had at baseline. Impact: Few exercise rehabilitation studies target older, obese Veterans who use walking assistive device and indeed individuals who use walking assistive devices are often excluded from the studies. This research directly benefits Veterans as it may lead to more effective interventions that improve mobility, reduce fall risk, and reduce injury-related hospitalization and death in older Veterans with mobility limitations. This nutritional and multimodal balance intervention is readily exportable to the community and with additional resources could be widely implemented at other VAs as part of clinical care.

背景：肥胖是老年人流动限制的主要危险因素。据估计有1100万 老年人患有行动障碍，> 400万老年人使用步行辅助设备。流动性残疾 导致步态经济降低，身体上的调解和峰值有氧能力降低（VO2PEAK）。 步态和生理储备降低的经济障碍可能导致疲劳增加，减少 耐力，最终导致功能独立性降低。改进的最佳干预措施 年龄较大的肥胖成年人的流动性限制尚不清楚，特别是在使用步行辅助设备的人中， 并且关于是否可以随着时间的推移可以维持身体机能的改善的信息有限。 初步研究表明，我们新型的渐进群体多模式平衡干预（MMBI）， 专注于横向运动，下肢加强和动态障碍谈判可以改善 移动性的步态，平衡和力量有限的老年人。但是，尚不清楚结合体重是否会减肥 MMBI将在有限的老年肥胖退伍军人中提供累加或协同改善。 我们假设我们的MMBI计划与低电量营养干预（营养）结合 将比单独使用MMBI在改善步态的肌肉质量，身体机能和经济方面更有效。在 此外，我们假设营养 + MMBI将比单独改善自我的MMBI更有效 报道了功能和残疾的衡量标准。 目的：我们提出了一项在120岁（年龄> 60岁）社区居住肥胖的随机临床试验（BMI） > 30 kg/m2），具有行动限制的退伍军人使用步行辅助设备，我们将在其中： 特定目标1：将6个月MMBI干预的影响与6个月的组合营养 + MMBI关于步态的身体功能和经济。 特定目标2：比较两种干预措施对身体成分，肌肉质量，力量和 相对肌肉减少症。 特定目标3：评估基线两种干预措施，6、12和24个月对他们的自我的影响 报告了使用晚期功能和残疾仪器（LLFDI）的功能和残疾度量。 方法：参加研究的退伍军人将在巴尔的摩Grecc和VAMHC进行基线测试 人类绩效实验室由1）基于绩效的结果指标包括VO2PEAK，步态 速度（步态仪式），椅子架，横向移动性和平衡（四平方步骤测试，图8），SPPB，手夹 力量（元计）和步态经济性（步行6分钟的便携式VO2测量）和 功能状态（ADL，IADLS）; 2）下肢强度测试，3）总体DXA扫描和CT扫描 腹部，臀部和大腿用于确定下肢和核心肌肉组成；和4） 生物标志物。完成基线测试后，退伍军人将被随机分为两者之一 干预措施。营养课将由Grecc营养师领导。目标是让受试者损失10％ 重量在最初的6个月内，此后逐渐减肥。 MMBI将由组动态组成 平衡班，有监督的障碍物以及下肢和核心加强。 3-，6-，12-和 24个月，受试者将重复他们在基线时进行的评估。 影响：很少有运动康复研究针对使用步行辅助设备和 实际上，使用步行辅助设备的个人通常被排除在研究之外。这项研究 直接使退伍军人受益，因为它可能会导致更有效的干预措施，以提高移动性，降低跌倒风险， 并减少具有行动率限制的老年退伍军人的与伤害有关的住院和死亡。这种营养 并且多模式平衡干预易于向社区导出，并且有其他资源可以 作为临床护理的一部分，可以在其他VAS上广泛实施。