Multimodal Exercise and Weight Loss in Older Veterans with Dysmobility

行动不便的老年退伍军人的多模式运动和减肥

• 批准号: 9192322
• 负责人: Leslie I. Katzel
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-10-01 至 2020-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9192322
• 关键词: Abdomen; Adult; Aerobic; Age; American; Area; Baltimore; Biological Markers; Biomechanics; Body Composition; Body Weight decreased; Body fat; Capsicum; Cessation of life; Clinical; Collaborations; Communities; Comorbidity; Diet; Dietary Intervention; Dietitian; Dual-Energy X-Ray Absorptiometry; Effectiveness; Elderly; Energy Intake; Energy Metabolism; Enrollment; Equilibrium; Exercise; Fatigue; Fatty acid glycerol esters; Gait; Gait speed; Geriatrics; Goals; Hip region structure; Hospitalization; Human; Individual; Injury; Intervention; Intramuscular; Isometric Exercise; Laboratories; Lateral; Lead; Lower Extremity; Maryland; Measurement; Measures; Mediation; Medical; Medical center; Methods; Movement; Muscle; Nutritional; Obesity; Outcome Measure; Overweight; Patient Self-Report; Performance; Physical Function; Physical activity; Physiological; Prevalence; Quality of life; Randomized; Randomized Clinical Trials; Research; Resources; Risk Factors; Robotics; Scanning; Self-Help Devices; Spiral Computed Tomography; Step Tests; Structure; System; Testing; Thigh structure; Time; Translating; Universities; Upper Extremity; Veterans; Walking; Weight; X-Ray Computed Tomography; base; clinical care; deconditioning; disability; education research; effective intervention; exercise intervention; exercise rehabilitation; experience; fall risk; fitness; functional status; group intervention; improved; improved functioning; improved mobility; instrument; intervention program; multidisciplinary; multimodality; muscle form; novel; nutrition; programs; sarcopenia; sarcopenic obesity; walking speed

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.

背景：肥胖是老年人行动受限的主要危险因素。估计有1100万 老年人有行动障碍，超过 400 万老年人使用步行辅助设备。行动不便 导致步态经济性下降、身体状况不佳以及峰值有氧代谢能力 (VO2peak) 降低。 步态经济性受损和生理储备减少可能导致疲劳增加、 耐力，最终导致功能独立性的降低。改善的最佳干预措施 老年人、肥胖者的行动限制尚不清楚，特别是那些使用步行辅助设备的人， 关于身体机能的改善能否随着时间的推移持续改善的信息有限。 初步研究表明，我们新颖的渐进式团体多模式平衡干预（MMBI）， 专注于横向运动、下肢强化和动态越障可以提高 步态、平衡和活动力量限制了老年人。但不知道是否能同时减肥 MMBI 将为行动不便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、身体功能和步态经济性方面比单独使用 MMBI 更有效。在 此外，我们假设营养+ MMBI 在改善自我方面比单独使用 MMBI 更有效。 报告功能和残疾的测量。 目的：我们建议对 120 名社区居住的肥胖 (BMI) 老年人（年龄 > 60 岁）进行一项随机临床试验 >30 kg/m2），行动不便且使用步行辅助设备的退伍军人，我们将： 具体目标 1：比较单独 6 个月 MMBI 干预措施与 6 个月联合营养干预措施的效果 + MMBI 关于身体机能和步态经济性。 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 相对肌少症。 具体目标 3：评估两种干预措施在基线、6、12 和 24 个月时对他们的自我影响的影响。 报告了使用晚年功能和残疾工具（LLFDI）对功能和残疾进行的测量。 方法：参加该研究的退伍军人将在巴尔的摩 GRECC 和 VAMHCS 进行基线测试 人类表现实验室包括 1) 基于表现的结果测量，包括 VO2peak、步态 速度（步态仪式）、椅子站立、横向移动性和平衡性（四方步测试，八字形）、SPPB、手柄 力量（测力）和步态的经济性（6 分钟步行期间的便携式摄氧量测量）以及 功能状态（ADL、IADL）； 2) 下肢力量测试，3) 全身 DXA 扫描，以及 CT 扫描 腹部、臀部和大腿，用于测定下肢和核心肌肉成分；和 4) 生物标志物。完成基线测试后，退伍军人将被随机分配到两个 干预措施。营养课程将由 GRECC 营养师主持。目标是让受试者失去 10% 前 6 个月体重增加，此后体重逐渐下降。 MMBI 将由一个充满活力的团体组成 平衡课程、监督障碍课程以及下肢和核心强化课程。 3、6、12 和之后 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使用步行辅助装置和肥胖的老年退伍军人 事实上，使用步行辅助设备的个人经常被排除在研究之外。这项研究 直接使退伍军人受益，因为它可能会导致更有效的干预措施，以改善活动能力，降低跌倒风险， 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。这个营养 多模式平衡干预措施很容易向社区输出，并且通过额外的资源可以 作为临床护理的一部分在其他 VA 广泛实施。