Tai Chi for Obesity: A Randomized Controlled Pilot Trial

描述(申请人提供)：在过去的40年里，美国肥胖症的流行率增加了两倍多，达到31%，目前有超过6100万人受到影响。肥胖症是全世界死亡和残疾的一个重要风险因素，尽管其在所有人口部分中的流行率有所增加，但有证据表明，这一负担并不是所有人都平等地承担。夏威夷原住民和太平洋岛民(NHPI)的肥胖率是世界上最高的(高达60%)，随之而来的是与肥胖相关的疾病的沉重负担，包括心血管疾病、糖尿病、高血压、呼吸系统疾病和癌症。事实上，数据表明，肥胖受试者具有与心力衰竭患者相似的健康相关生活质量(HRQOL)和功能能力。 这项先导性研究的主要目标是评估为期12周的低强度太极(TC)身心锻炼计划的安全性和有效性，这些人群主要是有II-III级肥胖(BMI&GT；35 kg/m2)和至少一种冠状动脉疾病危险因素的NHPI。具体地说，我们的主要目标是1)确定随机接受TC计划的肥胖者是否表现出更好的功能状态和运动耐力，通过6分钟步行测试和心肺压力测试来衡量；以及2)确定为期12周的TC计划是否根据Duke活动量表指数和SF-36来衡量是否改善了HRQOL。其他目的是检查TC对肥胖特有的HRQOL(IWQOL-Lite)、自主神经张力(心率变异性)、心血管疾病风险因素(空腹血糖、糖化血红蛋白、血脂、胰岛素抵抗)和肥胖指标(瘦素、体重、体脂百分比)的影响。此外，我们计划评估如果受试者继续每天在家独立练习TC，在为期12周的TC干预结束时观察到的变化是否保持在24周。对照受试者将以与TC组相似的持续时间和频率进行社交会面。 我们的研究建立在女王医疗中心和国防部合作开发的基础设施上。夏威夷大学的土著夏威夷健康教授正在研究NHPI中心力衰竭的差异。我们预计，这项初步研究的结果将使我们能够计划一项针对肥胖的太极身心锻炼计划的有效性和作用机制的最终研究。 公共卫生相关性：这项研究将评估太极锻炼计划与针对非常肥胖的患者(包括很大比例的夏威夷原住民/太平洋岛民)的信息性团体计划相比是否具有有益的影响。我们将评估步行能力、生活质量以及心脏和血管疾病的危险因素，包括体重、胆固醇、血糖、血压和运动量。

DESCRIPTION (provided by applicant): Over the past 4 decades, the prevalence of obesity in the U.S. has more than tripled to 31%, with over 61 million people currently affected. Obesity is a significant risk factor for death and disability worldwide and, although its prevalence has increased among all segments of the population, there is evidence that this burden is not borne equally by all. Native Hawaiians and Pacific Islanders (NHPI) have rates of obesity that are among the highest in the world (as high as 60%) and, with it, they carry a heavy burden of obesity-related conditions, including cardiovascular disease, diabetes, hypertension, respiratory ailments and cancer. Indeed, data suggest that obese subjects have a health-related quality of life (HRQOL) and functional capacity similar to patients with heart failure. The main goal for this pilot study is to evaluate the safety and efficacy of a low-intensity 12- week Tai Chi (TC) mind-body exercise program in a population of predominantly NHPIs with class II-III obesity (BMI>35 kg/m2) and at least one coronary artery disease risk factors. Specifically, our primary aims are to 1) Determine if individuals with obesity randomized to a TC program demonstrate better functional status and exercise tolerance, as measured by the six- minute walk test and cardiopulmonary stress test; and 2) Determine if a 12-week TC program improves HRQOL as measured by the Duke Activity Scale Index and SF-36. Additional aims are to examine the impact of TC on obesity-specific HRQOL (IWQOL-Lite), autonomic tone (heart rate variability), cardiovascular disease risk factors (fasting glucose, HbA1c, lipids, insulin resistance) and measures of obesity (leptin, weight, percent body fat). In addition, we plan to assess if changes observed at the end of the 12-week TC intervention are maintained at 24- weeks if subjects continue to independently practice TC at home daily. Control subjects will meet socially with a duration and frequency similar to the TC group. Our study builds on the infrastructure developed by a collaboration between The Queen's Medical Center and the Dept. of Native Hawaiian Health at the University of Hawaii, which is examining heart failure disparities among NHPI. We anticipate that results from this pilot study will enable us to plan a definitive study of the effectiveness and mechanism of action of a Tai Chi mind-body exercise program for obesity. Public Health Relevance: This study will evaluate whether a Tai Chi exercise program has beneficial effects compared to a informational group program for very obese patients, including a large percentage of Native Hawaiians/Pacific Islanders. We will evaluate ability to walk, quality of life, and risk factors for heart and vascular diseases, including weight, cholesterol, blood sugar, blood pressure, and exercise capacity.