Multimodal Exercise and Weight Loss in Older Veterans with Dysmobility

背景：肥胖是老年人行动能力受限的主要危险因素。据估计，1100万人 老年人有行动不便，有400万老年人使用行走辅助设备。行动不便 结果降低了步态的经济性、物理去条件化和峰值有氧能力(VO2峰值)。 步态经济性受损和生理储备减少可能会导致疲劳增加，减少 耐力，并最终导致功能独立性降低。改善的最佳干预措施 老年人、肥胖者的行动能力限制尚不清楚，特别是那些使用行走辅助设备的人， 而且，关于身体机能的改善能否随着时间的推移而持续下去的信息也有限。 初步研究表明，我们新的进步式团体多模式平衡干预(MMBI)， 注重侧向运动、加强腿部力量和动态越障可以提高 步态、平衡和活动能力限制了老年人的行动。然而，目前还不知道减肥是否结合在一起 使用MMBI将为行动能力有限的老年、肥胖退伍军人提供附加或协同改善。 我们假设我们的MMBI计划与低热量营养干预(营养)相结合 在改善肌肉质量、身体机能和步态经济性方面比单用MMBI更有效。在……里面 此外，我们假设营养+MMBI将比单独使用MMBI更有效地提高自我 报告的功能和残疾测量。 目的：我们提出了一项针对120名老年(60岁)社区居住区肥胖(BMI)的随机临床试验 &gt；30公斤/平方米)，行动不便的退伍军人使用行走辅助设备，我们将： 具体目标1：比较单独6个月的MMBI干预和6个月的联合营养的效果 +MMBI关于身体机能和步态的经济性。 具体目标2：比较两种干预措施对身体成分、肌肉质量、力量和 相对的石棺减少症。 具体目标3：在基线、6个月、12个月和24个月评估两种干预措施对他们自我意识的影响 报告使用晚年功能和残疾工具对功能和残疾进行衡量。 方法：登记参加研究的退伍军人将在巴尔的摩GRECC和VAMHCS进行基线测试 人体性能实验室由1)基于性能的结果测量组成，包括VO2峰值、步态 速度(步态仪式)、座椅站立、横向活动和平衡(四方步测试，图8)、SPPB、手柄 力量(测力)和步态经济性(6分钟步行时的便携式VO2测量)和 功能状态(ADL、IADLS)；2)下肢力量测试；3)全身DXA扫描，以及 腹部、臀部和大腿，用于测定下肢和核心肌肉成分；以及4) 生物标志物。在完成基线测试后，退伍军人将被随机分为两组 干预措施。营养课将由GRECC营养师带队。目标是让受试者失去10%的 体重在前6个月内增加，之后逐渐减轻。MMBI将由一个组动态组成 平衡课，一个有指导的障碍课程，以及腿部和核心强化。在3-、6-、12-和 24个月后，受试者将重复他们在基线时的评估。 影响：很少有运动康复研究针对年长、肥胖的退伍军人使用行走辅助设备和 事实上，使用行走辅助设备的人经常被排除在研究之外。这项研究 直接使退伍军人受益，因为它可能导致更有效的干预措施，改善机动性，降低跌倒风险， 并减少行动不便的老年退伍军人因受伤而住院和死亡的情况。这种营养 多式联运平衡干预很容易输出到社区，如果有额外的资源，可以 作为临床护理的一部分，在其他VAS中广泛实施。

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.