NIDDM, EXERCISE REFERRAL, & OLDER AFRICAN AMERICAN WOMEN

描述（改编自申请人的摘要）： 总成本为900亿美元（仅医疗保健费用就为125亿美元）， 总体患病率约为6%，糖尿病对 医疗保健系统。 在所有糖尿病病例中，90%至95%由以下组成： 2型糖尿病 非裔美国人中2型糖尿病患病率 妇女的比例特别高，估计至少有30%的人 55岁以上的人 非洲裔美国人不仅面临更大的风险， 患2型糖尿病，但患肾病的几率是2倍， 视网膜病变、截肢和与截肢相关的住院死亡率。 运动、饮食和体重控制代表了已知的和潜在的可修改的 2型糖尿病并发症的危险因素。 然而，对于许多2型糖尿病患者来说，中等体重是非常重要的。 难以维持，减轻体重的干预措施有限， 成功 从理论上讲，运动可以提高代谢控制独立 减肥的效果，一些小型干预研究已经证实， 中等强度的运动（最大心率55至70）可以改善 HbA1c在8 - 12周内降低至少15%，体重几乎没有或没有减轻。 此外，运动对心血管健康非常重要， 整体生活质量。 绝大多数（即至少80%）人 2型糖尿病患者不运动。 因此，医生 市民普遍建议转介病人作运动。 其有效性 很少被测试，但一个小的未发表的研究使用医生发起的， 推荐一个精心设计的基于团体的锻炼计划，产生了36% 22名50岁以上的非洲裔美国妇女和7名 8名收养者参加了18个多月的活动。 本研究的主要目的是实施、支持和评估一项 务实的医生发起的运动转诊计划长达24个月 在三个不同的社区初级保健诊所。 主 结果将是基于组的运动采用率和维持率， 整体身体活动水平的变化。 次要目标是 确定运动采用和维持的基线预测因子， 干预期间的总体身体活动水平 并评估运动对健康和临床结果的影响。 措施 次要目的包括HbA1c、胰岛素和口服降糖剂量， 静息时和设定工作负荷时的血压和心率， 渐进式运动测试，体重，人体测量，皮褶厚度， 自评健康和功能以及运动自我效能。

DESCRIPTION (Adapted from the Applicant's Abstract): With an estimated total cost of $90 billion ($12.5 Billion for medical care alone) and an overall prevalence of about 6%, diabetes has an impressive impact on the health care system. Between 90 and 95% of all diabetes cases consist of type 2 diabetes. the prevalence of type 2 diabetes among African-American women is particularly high and is estimated to be at least 30% for those over the age of 55. African-Americans are not only at greater risk of developing type 2 diabetes, but experience twice the rate of nephropathy, retinopathy, amputation, and in-hospital mortality related to amputations. Exercise, diet and weight control represent known and potentially modifiable risk factors for the management of complications related to type 2 diabetes. For many type 2 diabetes patients, however, moderate weight is very difficult to maintain and interventions to reduce weight have had limited success. Theoretically, exercise can improve metabolic control independent of weight loss, and a few small intervention studies have confirmed that moderate-intensity exercise (55 to 70& of maximum heart rate) can improve HbA1c by at least 15% within 8 to 12 weeks with little or no weight loss. in addition, exercise holds great importance for cardiovascular health and overall quality of life. The vast majority (i.e. at least 80%) of persons with type 2 diabetes, however, do not exercise. for this reason, physician referral for exercise has been widely recommended. Its effectiveness has rarely been tested, but a small unpublished study using physician-initiated referral to a carefully designed group-based exercise program produced a 36% adoption rate among 22 African-American women over 50 years of age, and 7 of the 8 who adopted have participated for over 18 months. The primary aim of this study is to implement, support and evaluate a pragmatic physician-initiated exercise referral program for up to 24 months in three separate community based primary care clinics. The primary outcomes will be rates of group-based exercise adoption and maintenance and changes in overall physical activity level. The secondary aims will be to identify baseline predictors of exercise adoption and maintenance and overall physical activity level over the course of the intervention period and assess the effect of exercise on health and clinical outcomes. Measures for secondary aims include HbA1c, insulin and oral hypoglycemic dosages, blood pressure and heart rate at rest and at set workloads during progressive exercise testing, weight, anthropometrics, skinfold thicknesses, self-rated health and function and exercise self-efficacy.