Community Exercise and Metabolic Syndrome in Black Families

描述（由申请人提供）：兄弟姐妹年龄< 60岁患有过早冠状动脉疾病（CAD）的美国黑人自身患CAD的风险增加，并且所有心血管危险因素的患病率明显过高，特别是代谢综合征，这是这一高危人群中CAD的有力前兆。久坐不动的生活方式与代谢综合征及其血管疾病基质有关。在控制良好的研究环境中，中等强度的运动被认为可以消除代谢综合征的危险因素。然而，在高风险的美国黑人中，很难实现习惯性的中等强度运动。我们建议以社区为基础的教练介导的干预，以实现有规律的抵抗和足够强度的有氧运动，以改善危险因素并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，基于：1)有效性假设，即在社区提供并由社区训练有素的教练实施一年的有指导的运动计划，将导致身体健康和运动依从性的显着改善。2)有效性假设，即社区干预将导致个体CAD风险因素，特别是代谢风险因素的显着降低。同时伴有代谢综合征的美国黑人非冠心病非糖尿病患者的“血管健康”改善。我们将使用一项随机试验，将社区运动干预（C-FIT）与使用文化敏感材料和转介到社区运动场所的自助运动（SELF）控制干预进行比较。样本将由200名已经确定的< 65岁的未受影响的兄弟姐妹组成，这些兄弟姐妹是过去10年内积累的过早CAD患者。6个月、1年和2年的结果包括习惯性体育活动、有氧和力量健身、身体成分、胰岛素抵抗综合征、高敏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从代谢综合征到正常转换的代理。分析将使用协方差混合模型分析（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，使运动功效研究成果转化为“现实世界”，实现足够强度的运动，以调节在美国黑人高风险家庭中普遍存在的代谢危险因素。本研究旨在确定基于社区的私人教练模式一年以上中等强度有氧健身和力量训练对非裔美国人早发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因素的变化。长期结果将在1年和2年进行检查。

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.