Community Exercise and Metabolic Syndrome in Black Families

描述(由申请人提供)：如果美国黑人有一个60岁的兄弟姐妹患有早发性冠状动脉疾病(CAD)，他们自己患冠心病的风险就会增加，而且所有心血管危险因素，特别是代谢综合征的患病率明显增加，这是这一高危人群中潜在的CAD先兆。久坐的生活方式与代谢综合征及其血管疾病底物有关。众所周知，在控制良好的研究环境中，中等强度的运动可以消除代谢综合征的风险因素。然而，在高风险的美国黑人中，习惯性的中等强度运动很难实现。我们建议以社区为基础的教练中介干预，以实现规律的阻力和足够强度的有氧运动，以改善危险因素，降低代谢综合征的患病率。我们将测试一种让参与者参与锻炼的策略，其基础是：1)有效性假设，即在社区提供并由来自社区的训练有素的教练实施的一年指导锻炼计划将导致身体健康和锻炼忠诚度的显著提高，以及2)。一种有效性假设，即社区干预将导致个体CAD危险因素，特别是代谢危险因素的显著减少，并将伴随着患有代谢综合征的美国黑人非CAD非糖尿病患者的“血管健康”的改善。我们将使用一项基于社区的运动干预(C-FIT)与自助运动(Self)对照干预的随机试验，使用文化敏感材料并转介到社区运动站点。样本将包括过去10年内积累的200名已确认的65岁未受影响的早产儿CAD患者的兄弟姐妹。6个月、1年和2年后的结果包括习惯性体力活动、有氧和力量健康、身体成分、胰岛素抵抗综合征、超敏C反应蛋白、血压和血脂水平的变化。终点还包括改善血管健康和将代谢综合征转化为正常的指标。分析将使用混合模型协方差分析(MM-ANCOVA)对因变量的基线水平进行回归调整。生物学和社会认知科学框架的整合允许将运动功效研究结果转化为“真实世界”，以实现足够的运动强度，以缓和在高危美国黑人家庭中普遍存在的代谢风险因素。这项研究旨在确定在一年的中等强度有氧健身和力量训练中，以社区为基础的私人教练模式对来自非裔美国人的早产儿冠心病高危人群代谢综合征及其组成部分的影响。结果将包括影响心血管风险的因素的变化。长期结果将在一年和两年内进行检查。

DESCRIPTION (provided by applicant): Black Americans who have a sibling < 60 years of age with premature coronary artery disease (CAD) have an increased risk of developing CAD themselves, and a marked excess prevalence of all cardiovascular risk factors, particularly the metabolic syndrome, which is a potent CAD precursor in this high-risk population. Sedentary lifestyle is associated with the metabolic syndrome and its vascular disease substrate. Moderate- intensity exercise is known to abolish metabolic syndrome risk factors in well-controlled research settings. However, habitual moderate intensity exercise is difficult to achieve among high-risk Black Americans. We propose a community-based coach-mediated intervention to achieve regular resistance and aerobic activity of sufficient intensity to ameliorate risk factors and reduce the prevalence of the metabolic syndrome. We will test a strategy to engage participants exercise based on: 1) an effectiveness hypothesis, that one year of a guided exercise program provided in the community and implemented by a trained coach from the community will result in a significant improvement in physical fitness and exercise adherence, and 2). an efficacy hypothesis that the community intervention will result in a significant reduction in individual CAD risk factors, particularly metabolic risk factors, and will be accompanied by improvement in "vascular health" in Black American non-CAD nondiabetic individuals with the metabolic syndrome. We will use a randomized trial of the community-based exercise intervention (C-FIT) compared to a self-help exercise (SELF) control intervention using culturally sensitive materials and referral to community exercise sites. The sample will be comprised of 200 already identified < 65 year old unaffected brothers and sisters of premature CAD patients accrued within the past 10 years. The outcomes at 6 months, 1- and 2-years include changes in habitual physical activity and aerobic and strength fitness, body composition, insulin resistance syndrome, high sensitivity C-reactive protein, blood pressure and lipids levels. Endpoints also include a proxy for improved vascular health and conversion from having the metabolic syndrome to normal. The analysis will use regression adjustment for the baseline level of the dependent variables using mixed-model analysis of covariance (MM-ANCOVA). The integration of biological and social cognitive science frameworks allows translation of exercise efficacy research findings to the "real world" to achieve exercise of sufficient intensity to moderate metabolic risk factors that are prevalent in high risk Black American families. This study is designed to determine the impact of a community-based personal trainer model over a year of moderate intensity aerobic fitness and strength training on the metabolic syndrome and its components in high risk people from African Americans with premature coronary disease. Outcomes will include changes in factors that affect cardiovascular risk. Long term-outcomes will be examined at 1 and 2 years.