Home vs Center-Based Weight Loss & Exercise in Menopause

描述(由申请人提供)：多方面的肥胖治疗显示了最佳的减肥效果，但最有效的治疗地点和方法和后续治疗仍然难以捉摸。让持续的治疗之谜雪上加霜的是，女性的老龄化与越来越久坐的生活方式有关，这种生活方式减少了每天的总能量消耗，容易导致肥胖。此外，影响体重和体脂分布遗传力的候选基因也可能影响对WL治疗的反应。在一个肥胖症肆虐的国家，对治疗的需求远远超过了医疗保健系统提供个人护理的能力。这项研究的目的是：1)评估基于家庭和中心的多方面WL计划对WL、心血管疾病风险因素和心理社会因素的影响；2)确定多方面的基于家庭或中心的方法是否更有效地导致持续的治疗登记；以及3)回顾确定在选定的肥胖-能量消耗或胰岛素敏感候选基因中具有一个或多个变异的女性在治疗后和/或随访时是否与没有遗传倾向的女性有不同的结果。超重或肥胖(BMI 25-40公斤/平方米)妇女(n=100)绝经后至少一年但65岁将随机接受中心或家庭为基础的白线干预，包括低强度运动(步行)。所有女性将接受为期两周的现场中心或家庭计划的培训，并在为期6个月的中心或家庭计划开始之前收集基线数据。干预后将评估稳定的饮食和运动状态，在中心或家庭维护6个月后再次评估。多变量分析将被用来减少多次比较的误差膨胀，或者当多变量分析不可能时，将使用Bonferonni校正。由于强调健康促进，护理学是一门理想的学科，可以进行以研究为基础的、改变生活方式的WL干预措施并将其转化为实践。绝经后妇女能够接受和维持的世界卫生组织干预措施对于促进健康和在其生活中的重大脆弱时期预防疾病至关重要。

DESCRIPTION (provided by applicant): Multi-faceted obesity treatment demonstrates the best weight loss (WL) outcomes, yet the most effective site and methods for treatment delivery and follow-up remain elusive. Compounding the persistent treatment enigmas, aging in women is associated with an increasingly sedentary lifestyle that reduces total daily energy expenditure, predisposing to obesity. Moreover, candidate genes that contribute to the heritability of body weight and body fat distribution also may influence the response to WL treatment. In a nation with an unrelenting epidemic of obesity, the need for treatment far exceeds the capacity of the health care system to provide care on an individual basis. The purpose of this study is to: 1) assess the effects of a multi-faceted HOME-versus CENTER-based WL program on WL, CVD risk factors, and psychosocial factors; 2) determine whether a multi-faceted HOME- or CENTER-based approach more effectively leads to sustained treatment enrollment; and 3) retrospectively determine whether women with one or more variants in selected obesity-energy expenditure or insulin-sensitivity candidate genes have different outcomes post-treatment and/or at follow-up than women without a genetic predisposition. Overweight or obese (BMI 25-40 kg/m2) women (n=100) at least one year postmenopausal but < 65 years of age will be randomized to receive CENTER- or HOME-based interventions for WL that include low intensity exercise (walking). All women will receive 2 weeks of orientation to CENTER or HOME programs onsite and have baseline data collected before 6-month CENTER or HOME-based programs begin. Evaluation will be in a stable diet and exercise status post intervention, and again after 6 months maintenance at CENTER or HOME. Multivariate analyses will be used to reduce error inflation from multiple comparisons, or Bonferonni corrections will be used when multivariate analyses are not possible. With its health promotion emphasis, nursing is an ideal discipline to conduct and translate research-based, lifestyle-modification WL interventions into practice. WL interventions that postmenopausal women will accept and sustain are essential for promoting health and prevention disease during the period of major vulnerability in their lives.