Effects of Walking in Greenspace and the Built Environment in Adults with Prediabetes: A Randomized Crossover Trial

糖尿病前期成人在绿地和建筑环境中行走的影响：随机交叉试验

• 批准号: 10749410
• 负责人: TERESA H HORTON
• 金额: $ 70.27万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10749410
• 关键词: Adult; Air Pollution; Anxiety; Area; Attention; Behavioral; Biological; Biological Markers; Blood Glucose; Blood Pressure; Buffers; Carbon Black; Cardiometabolic Disease; Cardiovascular Diseases; Chicago; Communities; Cross-Over Trials; Diabetes Mellitus; Disease; Economics; Elements; Enrollment; Environment; Etiology; Exercise; Exposure to; Green space; Health; Health Benefit; Hormonal Change; Hydrocortisone; Hyperglycemia; Individual; Inflammation; Inflammatory; Infrastructure; Insulin; Insulin Resistance; Lipids; Location; Measures; Mediating; Mediation; Modeling; Monitor; Moods; Morbidity - disease rate; Nature; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Oxidative Stress; Particulate Matter; Pathway interactions; Persons; Physical activity; Physiological; Play; Poaceae; Policies; Pollution; Population; Prediabetes syndrome; Prevalence; Preventive measure; Psychological Stress; Psychosocial Stress; Public Health; Randomized; Risk; Risk Marker; Role; Salivary; Science; Site; Stress; Target Populations; Time; Trees; Urbanization; Walking; Water; biological adaptation to stress; blood glucose regulation; built environment; burden of illness; cardiometabolic risk; climate change; diabetes prevention program; diabetes risk; disorder risk; effectiveness trial; environmental stressor; experimental study; health goals; health inequalities; heart rate variability; high risk; improved; indexing; innovation; metropolitan; mortality; multi-site trial; novel; obesogenic; patient engagement; perceived stress; prevent; primary outcome; psychologic; psychosocial; psychosocial stressors; response; restoration; social stressor; stress reduction; trial comparing; urban area; urban setting; walking intervention

PROJECT SUMMARY: Given the substantial adverse health and economic consequences of diabetes, preventing progression of prediabetes (prevalence of 38% in U.S. adults) to type 2 diabetes (T2D) is a major public health goal. The environment plays a critical role in determining risk for T2D. Urbanization has been associated with increased psychosocial stress and adverse health outcomes. Stress responses cause hormonal changes that lead to insulin resistance, hyperglycemia, inflammation, oxidative stress, and obesity. Increased exposure to air pollution has been associated with higher risk of diabetes and cardiovascular disease. ‘Greenspace’ is defined as publicly accessible areas with predominant naturalistic elements (e.g., trees, grass, water features, etc.). Previous studies in adults support the hypothesis that exposure to Greenspace (‘Green’) may have several health benefits relative to urban built (‘Gray’) environments. These benefits may include better autonomic functioning as assessed by improved heart rate variability (HRV), reductions in anxiety/stress, and enhanced psychological restoration, with Greenspace also serving to buffer air pollution. Walking is the most common form of moderate-intensity physical activity and has a beneficial influence on blood glucose control. Preliminary studies have suggested walking and exposure to Greenspace may act together to improve health outcomes. Yet, aside from our preliminary studies, rigorous experimental studies have not been conducted to examine how regular walking may interact with exposure to urban Greenspace, compared to urban Grayspace, to improve health. These studies are needed to investigate novel and highly generalizable strategies for “Green exercise”, capable of being implemented at the population-level to reduce the burden of disease. Therefore, we will conduct a mechanistic randomized crossover trial to compare differences in physiological, psychological, air pollution, and cardiometabolic risk measures between walking interventions completed in urban Green and Gray environments in adults with prediabetes. This multisite trial will include 180 individuals within metropolitan areas of Minneapolis/St. Paul, MN and Chicago, IL. Walking interventions will be completed in urban Green and urban Gray environments, with participants engaging in 150 minutes/week of walking for 6 weeks in each environment, separated by a 5-week washout. Specific Aims: Aim 1: Measure and compare psychosocial stress between Green and Gray walking. Aim 2: Measure and compare physiological stress over six weeks between Green and Gray walking. Aim 3: Measure real-time individual exposure to ambient particulate matter using personal air pollution monitors with GPS tracking while walking in Green and Gray environments. Aim 4: Measure individual cardiometabolic disease risk scores (index of blood glucose, insulin, lipids, systolic blood pressure, and waist) and inflammatory factors before and after 6 weeks of Green and Gray walking. Aim 5 (exploratory): Examine whether physiological, psychological, and air pollution measures mediate the differential impact of Green vs. Gray walking on cardiometabolic risk and inflammation using regression-based mediation models.

项目摘要：鉴于糖尿病的严重不利健康和经济后果， 防止前糖尿病前期（美国成年人的患病率38％）为2型糖尿病（T2D）是主要的 公共卫生目标。环境在确定T2D风险方面起着至关重要的作用。城市化已经过去了 与增加的社会心理压力和不良健康结果有关。压力反应会导致horsemonal 导致胰岛素抵抗，高血糖，感染，氧化应激和肥胖的变化。增加 暴露于空气污染与更高的糖尿病风险和心血管疾病有关。 “绿空间”被定义为具有主要自然主义元素的公共接近区域（例如，树木，草， 水特征等）。先前在成人的研究支持了暴露于绿空间（'绿色'）的假设 相对于城市建筑（“灰色”）环境，可能有几种健康益处。这些好处可能包括更好 通过改善心率变异性（HRV），动画/压力减少和 增强的心理恢复，绿空间也用于缓冲空气污染。步行是最大的 现代强度体育锻炼的常见形式，对血糖控制具有有益的影响。 初步研究表明，步行和接触绿空间可能会共同采取行动以改善健康 结果。然而，除了我们的初步研究，还没有进行严格的实验研究 与Urban Grayspace相比 改善健康。需要这些研究来调查“绿色的新颖且高度可推广的策略” 运动”，能够在人群级别实施以减少疾病的燃烧。因此，我们 将进行机械随机跨界试验，以比较物理，心理，空气的差异 在城市绿色和灰色完成的步行干预措施之间的污染和心脏代谢风险度量 成人前糖尿病的环境。这项多站点试验将包括大都会地区的180个人 明尼阿波利斯/街保罗，明尼苏达州和伊利诺伊州芝加哥。步行干预措施将在Urban Green和Urban完成 灰色环境，参与者在每种环境中进行150分钟/周步行6周， 用5周的冲洗量隔开。具体目的：目标1：衡量和比较社会心理压力 绿色和灰色步行。目标2：衡量和比较绿色和之间六周的身体压力 灰色步行。 AIM 3：使用个人空气来衡量实时个人接触特定问题 在绿色和灰色环境中行走时，通过GPS跟踪监视污染。目标4：衡量个人 心脏代谢疾病风险评分（血糖，胰岛素，脂质，收缩压和腰围的指数） 以及6周的绿色和灰色步行前后的炎症因素。目标5（探索性）：检查 身体，心理和空气污染是否介导了绿色V的不同影响。 使用基于回归的调解模型，在心脏代谢风险和注射型心脏代谢风险上行走。