Home Program to Enhance Mobility in Older Veteran Diabetics

描述(由申请人提供)： 这项拟议的研究的目标是测试长期久坐的糖尿病退伍军人的锻炼计划是否会在行动能力和体力活动方面产生持续的改善。为了促进长期计划的坚持，我们计划了一个带有行为支持的个性化家庭锻炼/体力活动(PA)增强计划。这项计划的理由基于：1)先前资助的VA RR&D对照试验(由本研究团队领导)在久坐不动的老年糖尿病患者中改善活动能力，特别是通常的步速的可行性；2)对老年糖尿病患者进行长期和功能相关的干预(特别是以活动为导向)的必要性；3)使用电话护士支持帮助克服锻炼障碍和处理并发疾病的可能性，这些因素在这一共同存在的患者组中是关键的因素；以及4)增加对客观测量的体力活动的关注的可能性。在这项拟议的研究中，240名久坐不动的老年糖尿病患者(60岁及以上)将被随机分配到定制的、主要基于家庭的、以功能为导向的锻炼计划中，并在4周、6个月和1年时与灵活性和调理、健康教育对照组(C)组进行比较，并测试功能活动和体力活动。主要目标。确定家庭计划是否改善活动能力假设：在患有糖尿病的老年患者中，主要由功能性运动训练和增强体力活动以及护士电话行为支持组成的家庭干预将导致一年后活动能力的改善，与基线组和灵活性和调理、健康教育控制组(C组)相比。探索性目标：确定家庭计划是否能改善体力活动假设：与C组相比，I组的体力活动(通过活动记录仪上的加权活动计数来衡量)从基线到一年将不成比例地增加。这项研究可以导致一个锻炼/PA增强计划，该计划可以与退伍军人管理局的外展计划相协调，目标是不在退伍军人事务部主要地点附近的老年退伍军人。最终，这应该会创造一个模式，让医生和其他提供者可以推荐患有糖尿病的患者。 公共卫生相关性： 这项拟议的研究的目标是测试长期久坐的糖尿病退伍军人的锻炼计划是否会在行动能力和体力活动方面产生持续的改善。在这项拟议的研究中，240名久坐的老年糖尿病患者(60岁及以上)将被随机分配到定制的、主要基于家庭的、以功能为导向的锻炼计划中，并在4周、6个月和一年时与灵活性和调理、健康教育对照(C)组进行对比，并测试功能活动和体力活动的结果。这项研究可以导致一个锻炼/PA增强计划，该计划可以与退伍军人管理局的外展计划相协调，目标是不在退伍军人事务部主要地点附近的老年退伍军人。最终，这应该会创造一个模式，让医生和其他提供者可以推荐患有糖尿病的患者。

DESCRIPTION (provided by applicant): The goal of the proposed research is to test whether a long-term exercise program in sedentary veterans with diabetes will produce sustained improvement in mobility performance and physical activity. To facilitate adherence to a long-term program, we plan an individualized, home exercise/physical activity (PA) enhancement program with behavioral support. The rationale for this program is based on: 1) the feasibility of a previously funded VA RR&D controlled trial (led by the present research team) in sedentary older adults with diabetes that improved mobility performance, specifically usual gait speed; 2) the need for longer term and functionally-relevant interventions (specifically mobility-oriented) for older adult diabetics; 3) the potential to use telephonic nurse support to assist in overcoming barriers to exercise and in dealing with intercurrent illness, factors that are key in this comorbid patient group; and 4) the potential to increase the focus on objectively measured physical activity. In this proposed research, 240 sedentary older adult diabetics (aged 60 and over) will be randomly allocated into a customized, primarily home-based, functionally-oriented exercise program with nurse support intervention (I) group versus a flexibility and toning, health education control (C) group, and test outcomes in functional mobility and physical activity at 4 weeks, 6 months and one year. Primary Aim. Determine whether a home program improves mobility Hypothesis: In older adults with diabetes, a primarily home intervention consisting of functional exercise training and enhanced physical activity with nurse telephonic behavioral support will result in improved mobility performance at one year, compared to baseline and a flexibility and toning, health education control (C) group. Exploratory Aim: Determine whether a home program improves physical activity Hypothesis: Physical activity, as measured by weighted activity counts on actigraphy, will increase disproportionately from baseline to one year, in the I group as compared to the C group. This research can lead to an exercise/PA enhancement program that can coordinate with VA outreach programs, targeting older veterans who are not in the immediate vicinity of a major VA site. Ultimately, this should create a model to which physicians and other providers could refer comorbid diabetes patients. PUBLIC HEALTH RELEVANCE: The goal of the proposed research is to test whether a long-term exercise program in sedentary veterans with diabetes will produce sustained improvement in mobility performance and physical activity. In this proposed research, 240 sedentary older adult diabetics (aged 60 and over) will be randomly allocated into a customized, primarily home- based, functionally-oriented exercise program with nurse support intervention (I) group versus a flexibility and toning, health education control (C) group, and test outcomes in functional mobility and physical activity at 4 weeks, 6 months and one year. This research can lead to an exercise/PA enhancement program that can coordinate with VA outreach programs, targeting older veterans who are not in the immediate vicinity of a major VA site. Ultimately, this should create a model to which physicians and other providers could refer comorbid diabetes patients.