Momentary Biobehavioral Effects on Physical Activity in Adults with T2 Diabetes

描述（由申请人提供）：这个独立之路奖的候选人是辛西娅·弗里奇，博士，注册护士，她最近在伊利诺伊大学芝加哥护理学院（UIC CON）完成了她的博士学业。Fritschi博士将由艾琳·柯林斯博士指导，艾琳·柯林斯博士是UIC CON的终身副教授，也是爱德华·海恩斯退伍军人事务部医院康复研究与发展的研究职业科学家。这个应用程序的目标是帮助Fritschi博士建立一个独立的项目，研究2型糖尿病患者的身体活动。本文提出的独立研究将扩展我们对阻碍或促进体育活动行为的多层次生物、心理和社会因素的认识。长期目标是帮助久坐不动的2型糖尿病患者通过增加身体活动来保持最佳的健康和功能。这将通过在自然环境中使用新颖的实时干预措施来实现。候选人的短期职业目标是获得必要的技能和经验，以开发与这个非常重要的主题相关的研究项目。在她的研究“疲劳运动和糖尿病”（F31 NR009751）中，Fritschi博士在横断面生物学和自我报告数据收集方法以及多元回归分析方面积累了丰富的经验。她探讨了患者报告的一个重要结果（疲劳）及其对2型糖尿病女性患者的相关性和影响。然而，这些研究的结果受到使用横截面设计和召回数据收集方法的限制。现在，新的实时数据收集方法，包括连续血糖监测（CGM）和活动监测（actigraphy），结合生态瞬时评估方法，使有效研究生物行为因素与身体活动之间复杂的多层次关系成为可能。在她提出的K99指导研究中，Fritschi博士将评估连续6天使用实时技术测量2型糖尿病成人身体活动（手腕活动记录仪）、疲劳（自我报告）、血糖水平（CGM）和相关自我护理行为（夜间日记）的可行性，同时对与身体活动相关的其他因素进行回顾性测量。可行性包括：(1)参与者的可接受性；（二）易用性；(3)侵入日常活动；(4)数据质量。可行性研究的结果将指导独立研究的修订，并加强候选人对实现其短期和长期职业目标所必需的分析方法的学习。独立阶段（R00）的主要目的是使用最先进的生态瞬时评估方法来检查选定的基线特征（健康/身体状况、一般疲劳、身体成分、抑郁和人口统计学因素）和实时生物行为因素（疲劳和血糖水平）对110名2型糖尿病成年人PA的影响。通过对身体活动与葡萄糖水平和疲劳发作的生态瞬时评估，Fritschi博士和她的团队将能够检查自然环境中的实时共变和时间关联。到目前为止，还没有其他研究在2型糖尿病患者中实时检测这些关系。通过发现他们的身体活动水平与疲劳和其他身体活动的生物行为决定因素之间的关系，本研究的发现将指导针对增加身体活动的量身定制干预措施的开发，从而降低久坐的2型糖尿病成年人的残疾风险。K99培训阶段的目标是加强Fritschi博士作为一名独立临床护理研究员的能力。培训计划的首要目标是增加Fritschi博士在运动能力、实时身体活动监测和运动行为的现场和实验室测试方面的知识。她还将接受纵向和干预研究设计和分析方面的指导。第二个培训目标是提高她使用生态瞬时评估数据收集方法和分析的知识和技能，特别是与身体活动和相关健康行为相关的知识和技能。

DESCRIPTION (provided by applicant): The candidate for this Pathway to Independence award is Cynthia Fritschi, PhD, RN, who recently completed her doctoral studies at the University of Illinois at Chicago College of Nursing (UIC CON). Dr. Fritschi will be mentored by Eileen Collins, PhD, RN, a tenured Associate Professor at the UIC CON and a Research Career Scientist in Rehabilitation Research and Development at the Edward Hines Jr. Department of Veterans Affairs Hospital. The goal of this application is to assist Dr. Fritschi to build an independent program of research in physical activity for people with type 2 diabetes. The independent research proposed herein will expand our knowledge of multilevel biological, psychological, and social factors that impede or foster physical activity behavior. The long-term goal is to assist sedentary adults with type 2 diabetes to maintain optimal health and functioning by helping them to increase physical activity behaviors. This will be accomplished through use of novel, real-time interventions in the natural environment. The candidate's short-term career goal is to acquire the skills and experience necessary to develop a program of research related to this very important topic. In her study, "Fatigue Exercise, and Diabetes" (F31 NR009751) as a predoctoral fellow, Dr. Fritschi developed extensive experience in cross-sectional biological and self-report data collection methods and multivariate regression analyses. She explored an important patient-reported outcome (fatigue) and its correlates and impact on women with type 2 diabetes. However, findings from these studies were limited by use of a cross-sectional design in combination with recall data collection methods. Now, novel, real-time data collection methods, including continuous glucose monitoring (CGM) and activity monitors (actigraphy) in combination with ecological momentary assessment methods have made it possible to effectively study the complex multilevel relationships between biobehavioral factors and physical activity. In her proposed K99 mentored research, Dr. Fritschi will evaluate the feasibility of using real-time technology continuously over 6 days to measure physical activity (wrist actigraphy), fatigue (self-report), blood glucose levels (CGM), and related self-care behaviors (nightly diary), alongside retrospective measures of other factors associated with physical activity in adults with type 2 diabetes. Feasibility includes: (1) acceptability to participants; (2) ease of use; (3) invasiveness into daily activities; and (4) data quality. Findings from the feasibility study will guide revision of the independent research and enhance candidate learning of the analytical methods necessary to achieve her short- and long-term career goals. The primary aim of the independent phase (R00) is to use state-of-the-science ecological momentary assessment methods to examine the influence of selected baseline characteristics (health/physical status, general fatigue, body composition, depression, and demographic factors) and real-time biobehavioral factors (fatigue and blood glucose levels) on PA in 110 adults with type 2 diabetes. Through ecological momentary assessment of physical activity in relation to glucose levels and fatigue episodes, Dr. Fritschi and her team will be able to examine real-time covariation and temporal associations in the natural environment. To date, no other study has examined these relationships in real time among people with type 2 diabetes. By discovering how their physical activity levels relate to fatigue and other biobehavioral determinants of physical activity, findings from this study will guide development of tailored interventions targeted at increasing physical activity and thus reducing the risks for disability in sedentary adults with type 2 diabetes. The goal of the K99 training phase is to strengthen Dr. Fritschi's ability to excel as an independent clinical nurse researcher. The first and primary goal of the training plan is to increase Dr. Fritschi's knowledge in field and laboratory tests of exercise capacity, real-time physical activity monitoring, and exercise behavior. She will also be mentored in longitudinal and intervention research design and analysis. The second training goal is to advance her knowledge and skills in the use of ecological momentary assessment data collection methods and analysis, especially related to physical activity and related health behaviors. PUBLIC HEALTH RELEVANCE: Physical activity is an essential component of therapy for adults with type 2 diabetes and vital in reducing the risks for the devastating long-term complications and disability associated with type 2 diabetes. Physical activity is a relatively simple self-management activity that has been shown to be able to ameliorate some of the many well-known deleterious effects of diabetes. Despite their heightened risk for heart disease, disability, and shorter life span, most adults with type 2 diabetes are physically inactive and report lower levels of PA than their non-diabetic counterparts. Improvement in physical activity levels of people with type 2 diabetes could result in immense gains in their quality of life and lessen the burdens on their family, society, and the medical system.