Physical Activity and Weight Loss to Improve Function and Pain after Total Knee Replacement

项目总结/摘要 父母R 01正在检查行为减肥计划与慢性减肥计划相比的效果。 疾病自我管理（CDSM）计划对体重，身体功能，疼痛和身体活动， 全膝关节置换术（TKR）后的成年人。拟议的补充项目旨在增加一个阿尔茨海默氏症 疾病及其相关的痴呆症（AD/ADRD）集中在我们的项目，通过检查行为体重是否 减肥计划和体力活动可能对TKR成人患者的AD/ADRD具有保护作用， 维持认知。越来越多的人正在接受TKR，虽然手术有助于 为了最初降低死亡率，手术后几十年内的大多数死亡是由于AD/ADRD， 心血管疾病AD/ADRD的医疗保健成本在美国是最高的， 社会的经济负担。虽然AD/ADRD在成年人中死亡率过高的原因是 全膝关节置换术尚不清楚，需要采取策略来帮助降低这一人群的高风险， AD/ADRD以及这种手术和疾病给社会带来的相应经济负担。 补充的第一个目的是检查多组分（饮食和身体）的初步效果。 活动）减肥计划与CDSM对照组在6个月时的认知方面进行比较。第二个目的 我将研究饮食、有氧运动和体重的变化如何与6岁时的认知能力相关 个月最后的目的是检查短期步行对认知的急性影响。检查目标 1和2，参与者（n=60）将被随机分配到两个12个月的计划之一：（1）PACE减肥 程序或（2）CDSM。基线和6个月时的评估将包括认知、体重、 客观测量的身体活动和饮食摄入量。为了检验目标3，将采用交叉设计 在基线评估时，受试者（n=60）将被随机分配至即刻或延迟 步行条件。随机分配至立即组的受试者将首先完成6分钟步行测试，而 随机分配到延迟组的参与者将在6分钟休息期后完成步行测试。一个简短的认知 将在基线评估时完成3次评估处理速度的测试，以检查 一场关于认知的激烈较量 这一补充项目的预期成果是确定以下方面的初步影响： TKR术后成人体重、有氧运动和饮食摄入对认知的影响。如果一个行为 减肥计划和/或简短的活动可以维持老龄人口的认知能力， 促进这些生活方式行为的改变有助于预防或延迟AD/ADRD的发作。

Project Summary/Abstract The Parent R01 is examining the effects of a behavioral weight loss program as compared to a chronic disease self-management (CDSM) program on weight, physical function, pain, and physical activity among adults after total knee replacement (TKR). The proposed supplemental project aims to add an Alzheimer’s disease and its related dementias (AD/ADRD) focus to our project by examining whether a behavioral weight loss program and physical activity may have a protective effect against AD/ADRD among adults with TKR by sustaining cognition. An increasing number of individuals are undergoing TKR, and although the surgery helps to initially reduce mortality, the majority of deaths in the decades after surgery are from AD/ADRD and cardiovascular disease. Healthcare costs from AD/ADRD are among the highest in the US, placing substantial economic burden on society. Although the reasons for the excess mortality from AD/ADRD among adults with TKR are unknown, strategies are needed to help reduce this population’s high risk for the development of AD/ADRD as well as the corresponding economic burden that this surgery and conditions place on society. The first Aim of the supplement is to examine the preliminary effects of a multicomponent (diet and physical activity) weight loss program as compared to a CDSM control group on cognition at 6 months. The second Aim will examine how changes in diet, aerobic physical activity, and weight are associated with cognition at 6 months. The final Aim is to examine the acute effects of a brief bout of walking on cognition. To examine aims 1 and 2, participants (n=60) will be randomized to one of two 12-month programs: (1) PACE weight loss program or (2) CDSM. Assessments at baseline and 6 months will include measures of cognition, weight, objectively-measured physical activity, and dietary intake. To examine aim 3, a cross-over design will be used at the baseline assessment, in which participants (n=60) will be randomized to either Immediate or Delayed walking conditions. Participants randomized to Immediate will complete the Six-min walking test first, whereas participants randomized to delayed will complete the walking test after a 6-min rest period. A brief cognitive test assessing processing speed will be completed 3 times at the baseline assessment to examine the effect of an acute walking bout on cognition. The expected outcome from this supplemental project is to determine the preliminary effects of changes in weight, aerobic physical activity, and dietary intake on cognition in adults after TKR. If a behavioral weight loss program and/or briefs bouts of activity can sustain cognition among an aging population, the promotion of changes in these lifestyle behaviors could help to prevent or delay the onset of AD/ADRD.