Feasibility of an Exercise Intervention in HIV+ Older Adults with Central Obesity

描述(申请人提供)：作为一名老年医生和初级研究员，我致力于以患者为中心的研究的学术生涯。这个K23将为我成为一名独立的调查员奠定基础，在那里我可以领导翻译干预，以减轻艾滋病毒感染的老年人(HOA)的功能衰退。除了具体的课程作业和教学读物外，我在艾滋病毒和老龄化方面的成长将从一个对我的职业发展做出贡献的导师小组那里得到加强。职业发展计划的特点是有一个强大的、成熟的、多学科的指导小组，成员包括老龄化、艾滋病毒疾病、行为和动机、临床试验、身体成分、身体虚弱和运动生理学方面的专家。其他内容 主要资源包括罗切斯特大学的临床和翻译科学研究所及其艾滋病研究发展中心。有针对性的培训不仅将提高我在艾滋病毒和老龄化方面的知识，还将使我处于竞争地位，申请NIH R01，支持旨在改善HOA虚弱的临床试验。HOA存活率的提高对其功能状态和生活质量(QOL)有重大影响。 此外，中心性肥胖的骨性关节炎患者的虚弱风险增加，功能衰退加速。虽然众所周知，锻炼可以改善一般老年人口的身体机能，但艾滋病毒感染人群本身在行为改变方面是一个具有挑战性的群体，因此，这一人群可能会发现很难发起和遵守锻炼计划。因此，本研究计划的目的是：1)探讨以行为改变的自我决定理论(SDT)为基础的个体化家庭锻炼计划与动机咨询相结合的可行性；2)确定其在改善中心性肥胖HOA患者的身体功能、身体成分和运动相关心理介质方面的潜在疗效。我们建议通过随机对照临床试验对干预措施进行初步测试。中心性肥胖的HoA将被随机分配，要么维持他们的日常活动，要么接受基于行为改变SDT的动机咨询的家庭锻炼计划。从这项可行性研究中获得的初步数据将被用来计算正确的样本量，以进行更大的有效性随机对照试验，潜在的R01调查。这项研究的总体目标是确定一种可行的干预措施，可以转化为HOA社区，以减轻功能衰退，从而改善健康和生活质量。研究设计和执行拟议研究的经验对我的职业发展和向独立调查员的过渡将是无价的。

DESCRIPTION (provided by applicant): As a geriatrician and a junior investigator, I am committed to an academic career in patient-oriented research. This K23 will lay the foundation for me to become an independent investigator, where I can lead translational interventions to attenuate functional decline in HIV-infected older adults (HOA). Aside from specific coursework and didactic readings, my growth in HIV and Aging will be enhanced from a mentoring panel who will contribute to my career growth. The career development plan features a strong, established, multi-disciplinary mentoring panel with experts in aging, HIV disease, behavior and motivation, clinical trials, body composition, physical frailty and exercise physiology. Additional key resources include University of Rochester's Clinical and Translational Science Institute and its Developmental Center for AIDS Research. The targeted training will not only improve my knowledge in HIV and Aging, but also will put me in a competitive position to apply for a NIH R01 that supports a clinical trial designed to ameliorate frailty in HOA. The improved survival of HOA has significant implications with respect to their functional status and quality of life (QOL). Further, HOA with central obesity are at increased risk of frailty and accelerated functional decline. While it is known that exercise can improve physical function in the general older population, the HIV-infected population, itself, is a challenging cohort with respect to behavior change, and consequently this population may find it difficult to initiate and comply with an exercise program. Consequently, the aims of the research plan herein is 1) to investigate the feasibility of an individually tailored home-based exercise program in combination with motivational counseling based on the self determination theory (SDT) of behavior change and 2) to determine its potential efficacy in improving physical function, body composition and exercise-related psychological mediators in HOA with central obesity. We propose to pilot test the intervention with a randomized controlled clinical trial. HOA with central obesity will be randomized to either maintain their usual activities or to receive the home-based exercise program in combination with motivation counseling based on SDT of behavior change. The preliminary data obtained from this feasibility study will be used to calculate the correct sample size to conduct a larger efficacy RCT, a potential R01 investigation. The overall goal of this research is to identify a feasible intervention that can be translated into the HOA community to attenuate functional decline and thereby improving health and QOL. The experience in study design and execution of the proposed research will be invaluable to my career growth and my transition to an independent investigator.