Self Regulation and Physical Activity Adherence in Type 2 Diabetes Mellitus

描述(由申请人提供)：该项目旨在通过模拟自我效能、自我调节和认知功能如何随时间影响身体活动行为来检验2型糖尿病(T2 DM)患者的身体活动行为。其目的是阐明特定人群中身体活动行为的心理社会决定因素和机制。其次，该项目将测试以家庭为基础的锻炼计划和基于社会认知理论的行为改变干预(SCT；Bandura，2004)的有效性。流行病学证据表明，尽管体力活动被认为是可以显著改善病程的一线治疗方法，但受T2 DM影响的人坚持锻炼的比率极低。这项建议将从神经科学和社会认知的角度研究目标人群中身体活动依从性的机制。假设自律策略使用，这可能是 被认为包括认知控制，会通过自我效能感间接影响身体活动行为。由于与糖调节失调相关的认知障碍可能会干扰成功操纵自我调节和行为坚持所需的挑战的能力，因此假设专门关注自我调节策略和自我效能增强的体力活动干预可能有效地改善坚持，其次是代谢健康参数。此外，假设参加为期四周的特别设计的体力活动行为改变干预措施将改善T2 DM患者的体力活动行为，并且观察到的差异将持续六个月的随访。招募将包括80名来自伊利诺伊州中东部的确诊为T2 DM的男性和女性(年龄40-70岁)，他们将被随机分配到干预或常规护理组。干预参与者将在开始干预的1个月内在小组研讨会上多次会面，在那里将提供基于社会认知的运动行为干预课程。将教导和鼓励干预参与者定期跟踪家里的活动。测量将包括身体活动行为(通过加速度计)；空腹血糖；自我效能；自我调节策略的使用，包括自我监控和目标设定；以及认知功能。将在基线、M1和M7处采取措施。在这一特定人群中提高锻炼依从性可以显著改善健康状况，并将减轻个人和社会的健康负担。拟议的项目将加深对目标人群坚持体育活动的机制的了解。 公共卫生相关性：拟议项目的公共卫生相关性很大，因为它解决了一个突出的公共卫生负担，目标人群主要是不活跃的人，因此面临更大的疾病负担风险。导致2型糖尿病发展和疾病进展的因素包括饮食不良和体力活动不足。有规律的有氧运动已被反复证明能有效改善2型糖尿病患者的胰岛素敏感性和血糖调节。然而，大多数美国人没有达到推荐的常规有氧运动量。更少的2型糖尿病患者达到推荐的有益于健康的体力活动量。对于我们社会中的大多数人来说，坚持长期的体力活动是相当困难的，特别是患有代谢性疾病的人，这些代谢性疾病可能涉及其他合并症。目前尚不清楚为什么在这一人群中坚持体育锻炼特别困难。这个项目将根据可能是坚持的必要因素来检查身体活动行为：自信、自我监控和执行认知功能。解决这一人群的运动依从性问题可以显著改善T2 DM患者目前和未来的健康状况，并减轻社会负担。

DESCRIPTION (provided by applicant): The proposed project aims to examine physical activity behavior in persons with type 2 diabetes mellitus (T2DM) by modeling how self-efficacy, self-regulation and cognitive function impact physical activity behavior over time. The goal is to elucidate psychosocial determinants and mechanisms of physical activity behaviors in the specified population. Secondly, the project will test the effectiveness of a home-based exercise program coupled with a behavior change intervention based in Social Cognitive Theory (SCT; Bandura, 2004). Epidemiological evidence indicate that persons affected by T2DM have extremely low rates of exercise adherence despite the fact that physical activity is considered a first line treatment that can significantly improve disease course. This proposal will examine mechanisms of physical activity adherence in the target population from a neuroscience and social cognitive perspective. It is hypothesized that self-regulatory strategy use, which could be argued to include cognitive control, will indirectly influence physical activity behavior through self-efficacy. As cognitive impairments related to glucose dysregulation may interfere with the ability to successfully maneuver challenges required for self-regulation and behavioral adherence, it is hypothesized that a physical activity intervention specifically focusing on self- regulatory strategies and self-efficacy enhancement may be effective to improve adherence and, secondarily, metabolic health parameters. Additionally, it is hypothesized that participation in the four week, specifically designed physical activity behavior change intervention will improve physical activity behavior in individuals with T2DM compared to a usual care group, and that observed differences will be sustained for a six month follow-up. Recruitment will include 80 men and women (ages 40-70 years) with diagnosed T2DM from east central Illinois who will be randomly assigned into the intervention or usual care group. Intervention participants will meet several times, within 1 month of beginning the intervention, in group workshops where a social-cognitive based exercise behavior intervention curriculum will be delivered. Intervention participants will be taught and encouraged to regularly track at home activity. Measures will include physical activity behavior (via accelerometry); fasting blood glucose; self-efficacy; self-regulatory strategy use, which include self-monitoring and goal-setting; and cognitive function. Measures will be taken at baseline, m1, and m7. Improving exercise adherence in this specific population promises significant health improvement and would lessen individual and society health burdens. The proposed project will deepen understanding concerning mechanisms of physical activity adherence in the target population. PUBLIC HEALTH RELEVANCE: The public health relevance of the proposed project is considerable as it addresses a prominent public health burden and targets a population that is primarily inactive and is thereby at greater risk for experiencing further disease burden. Contributing factors to the development and disease progression of T2DM include poor diet and inadequate physical activity. Regular aerobic physical activity has been repeatedly shown to be effective in improving insulin sensitivity and glucose regulation for those who has T2DM. However, most Americans do not meet the recommended amount of regular aerobic exercise. Even fewer with T2DM meet the recommended amount of physical activity for health benefits. Adhering to long-term physical activity is quite difficult for most people in our society, especialy individuals with metabolic disease which may involve other comorbidities. It remains unclear why physical activity adherence is especially difficult in this population. This project will examie physical activity behavior in light of factors which may be necessary for adherence: confidence, self-monitoring and executive cognitive function. Addressing the problem of exercise adherence in this population could significantly improve the current and future health status of individuals with T2DM as well as reduce the societal burden.