Intervening on sedentary behavior to prevent weight regain in older adults

 描述(申请人提供)：老年人(65岁以上)中与肥胖相关的慢性病和流动性下降强调迫切需要在这一人群中确定基于证据的、长期有效的、可能针对特定年龄的肥胖治疗方法。最新的针对所有年龄段的肥胖治疗指南建议进行密集的干预，包括行为咨询、卡路里限制和增加体力活动以实现减肥。然而，停止治疗后体重恢复非常常见，特别是在老年人中，目前推荐的继续进行200-300分钟/周的大容量有组织运动的策略可能不太可行和有效。体重回升的一个关键因素是体重减轻后能量消耗的减少，这主要是由于非锻炼或自发体力活动(SPA)的减少，而SPA是久坐行为(SB)增加或坐着或仰卧的时间增加的直接结果。 我们的试验数据显示，SPA的下降预示着体重回升的幅度。由于老年人在醒着的一天中有65%-80%的时间是坐着或俯卧的，我们假设，在这个年龄段，对SB进行干预将是一种比干预运动行为的传统方法更有效的预防体重回升的方法。这项拟议的研究将测试一种新颖的、可接受的行为干预(SitLess)的有效性，该干预侧重于提高人们对全天使用基于加速度计的自我监控的SB的认识。我们的初步数据显示，这种干预改善了强化治疗阶段的体重减轻，并防止了在短时间(5个月)的随访阶段体重回升。这项研究的主要目的是确定在常规减肥的基础上增加这种针对某人的干预措施 针对EX的干预导致老年肥胖者的长期体重减少较少。这将通过对225名肥胖(BMI=30-40公斤/平方米)年龄较大(65-79岁)的成年人进行为期24个月的试验来实现，他们被随机分成三种治疗方法(n=75)之一，所有治疗方法都是限制饮食卡路里，外加以下任一种：1)中等强度有氧运动(WL+EX)；2)干预SB(WL+SitLess)；或3)(WL+EX+SitLess)。基本假设是：WL+EX+SitLess的24个月体重将低于WL+EX或WL+SitLess。次要结果，包括休息和体力活动能量消耗、SB、饮食摄入量、身体成分、身体健康和功能、心脏代谢风险和干预过程措施，也将被审查。这些结果将提供第一个关于自我监测对体重减轻的适应性生热反应的关键贡献者的有效性的随机对照试验数据。提高人们对减肥导致的SPA减少的认识，并通过行为促进减少SB来抵消这些减少，可能会提供一种更有效、安全、非药物和可持续的策略来减少老年人减肥后的体重回升。

 DESCRIPTION (provided by applicant): Chronic disease and decreased mobility associated with obesity in older (65+ yrs) adults emphasize the urgent need to identify obesity treatments in this population that are evidenced-based, effective in the long-term, and perhaps age-specific. The latest obesity treatment guidelines for all ages recommend an intensive intervention involving behavioral counseling, caloric restriction, and increased physical activity to achieve weight loss. However weight regain after treatment cessation is very common, especially in older adults in whom the currently recommended strategy of continued performance of high-volume structured exercise of 200-300 min/wk may be less feasible and effective. A key factor contributing to weight regain is the decrease in energy expenditure that occurs in response to weight loss, due mainly to a decline in non-exercise or spontaneous physical activity (SPA) that is the direct result of an increase in sedentary behavior (SB), or time spent sitting or reclining. Our pilot data show that decreases in SPA predict magnitude of weight regain. Since older adults spend 65-80% of their waking day sitting or prone, we hypothesize that intervening on SB will be a more effective method for preventing weight regain than the conventional approach of intervening on exercise behavior in this age group. The proposed research will test the efficacy of a novel, acceptable, behavioral intervention (SitLess) that focuses on increased awareness of SB employing accelerometry-based self-monitoring throughout the day. Our preliminary data show that this intervention improves weight loss during the intensive phase of treatment and prevents weight regain during a short (5-month) follow-up phase. The primary aim of this study is to determine whether addition of this intervention that targets SB to a conventional weight loss intervention that targets EX results in lower long-term reduction in body weight in older, obese adults. This will be accomplished with a 24-month trial in 225 obese (BMI=30-40 kg/m2) older (65-79 yrs) adults randomized to one of three treatments (n=75), all with dietary caloric restriction plus either: 1) moderate- intensity aerobic exercise (WL+EX); 2) intervening on SB (WL+SitLess); or 3) (WL+EX+SitLess). The primary hypothesis is that: WL+EX+SitLess will have lower 24-month body weight than either WL+EX or WL+SitLess. Secondary outcomes, including resting and physical activity energy expenditure, SB, dietary intake, body composition, physical fitness and function, cardiometabolic risk and intervention process measures, will also be examined. The results will provide the first randomized, controlled trial data on the efficacy o self-monitoring of a key contributor to the adaptive thermogenic response to weight loss. Increasing awareness of weight loss-induced reductions in SPA, and behavioral promotion of decreasing SB to counteract these reductions, may provide for a more effective, safe, non- pharmacologic, and sustainable strategy to reduce weight regain after weight loss in older adults.