Comparative Effectiveness of Customary Fit and Strong! vs. Fit and Strong! Plus

描述（由申请人提供）：本提案将比较习惯适合和强大的有效性！一项针对患有骨关节炎（OA）的老年人的循证体力活动/行为改变计划--该计划的增强版也涉及饮食和体重。OA是老年人残疾的主要原因（Hootman等人，2009），并且下肢（LE）OA是这种残疾发展的途径（Dunlop，Hughes等人，1998年）。健康和强壮！针对患有LE OA的老年人。在最近的一项随机试验中，为期8周的健康和强壮！该项目在18个月时显示出对身体活动维持的显著益处，伴随着LE僵硬、疼痛、功能、力量和步态速度的改善以及焦虑和抑郁的减少（Hughes等人，2010年）。然而，健康和强壮！目前没有解决方案参与者中存在的饮食/体重问题。这是一个重要的遗漏，因为与OA相关的LE症状由肥胖引起或加重。数据显示，10年内体重减轻5.1 kg可使发生膝关节OA的几率降低50%以上（Felson 1992）。2007年，60岁及以上的男性中有37%，女性中有48%肥胖（Flegal等人，2010年）。在2003-2009年期间，患有关节炎的成年人的肥胖患病率平均比没有关节炎的成年人高54%（Hootman等人，2011年a）。患有关节炎的肥胖者也有44%的可能是身体不活跃的（Hootman等人，2011年b）。肥胖患病率的上升可能解释了美国髋关节和膝关节置换手术的快速增长，2004年，这一数字达到91亿美元（Kim，2008）。重要的是，最近的一项Meta分析记录了缺乏证据支持干预措施在老年人中减轻体重的有效性（威瑟姆和Avenell，2010）。我们将通过开发和测试Fit and Strong来解决这一严重的科学差距！加-一个增强版的适合和强大！既能锻炼身体又能控制饮食我们将纳入ADAPT和ORBIT试验的共同元素，这些试验涉及体力活动和饮食/体重减轻。两项试验在18个月时都实现了约5%的体重减轻（Messier等人，2004年，Fitzgienic等人，2010年）。我们将比较习惯的适合和强大的有效性！适合和强大！加上超过24个月的使用RCT，在3个社区站点有400名参与者。两组都将接受逐渐减少的电话强化，以支持在3- 24个月期间维持行为改变。我们还将检查干预前后的医疗保健使用情况。我们假设健康和强壮！此外，参与者将在2、6、12、18和24个月时显示出饮食行为的差异性显著改善，并在6个月时出现显著体重减轻（e 5%），并将在24个月时保持。健康和强壮！此外，参与者还将在所有时间点显示出身体活动维持方面的差异性显著改善，伴随着LE疼痛，僵硬和功能以及抑郁和焦虑的改善。

DESCRIPTION (provided by applicant): This proposal will compare the effectiveness of customary Fit and Strong!-an evidence-based physical activity/behavior change program for older adults with osteoarthritis (OA)-to an enhanced version of the program that also addresses diet and weight. OA is the primary cause of disability among older adults (Hootman et al., 2009), and lower extremity (LE) OA is the pathway through which this disability develops (Dunlop, Hughes, et al., 1998). Fit and Strong! targets older adults with LE OA. In a recent randomized trial, the 8-week Fit and Strong! program demonstrated significant benefits on physical activity maintenance at 18 months accompanied by improved LE stiffness, pain, function, strength, and gait speed as well as reduced anxiety and depression (Hughes et al., 2010). However, Fit and Strong! does not currently address diet/ weight issues present among program participants. This is an important omission because LE symptoms related to OA are either caused by or exacerbated by obesity. Data show that a weight loss of 5.1 kg over a 10-year period decreases the odds of developing knee OA by more than 50% (Felson 1992). In 2007, 37% of men and 48% of women 60 years of age and older were obese (Flegal et al., 2010). Between 2003-2009 obesity prevalence, on average, was 54% higher among adults with arthritis compared to those without the condition (Hootman et al., 2011a). Obese persons with arthritis were also 44% more likely to be physically inactive (Hootman et al., 2011b). This rise in obesity prevalence may explain rapid increases in the use of hip and knee replacement surgery in the U.S., which totaled $9.1 billion in 2004 (Kim, 2008). Importantly, a recent meta- analysis has documented a dearth of evidence supporting the efficacy of interventions to decrease weight in older adults (Witham and Avenell, 2010). We will address this serious scientific gap by developing and testing Fit and Strong! Plus-an enhanced version of Fit and Strong! that addresses both physical activity and diet. We will incorporate common elements from the ADAPT and ORBIT trials that addressed physical activity and diet/ weight loss. Both trials achieved weight loss of approximately 5% at 18 months (Messier et al., 2004, Fitzgibbon et al., 2010). We will compare the effectiveness of customary Fit and Strong! to Fit and Strong! Plus over 24-months using an RCT with 400 participants at 3 community sites. Both groups will receive tapered telephone reinforcement to support maintenance of behavior change during months 3- 24. We will also examine health care use before and after the interventions. We hypothesize that Fit and Strong! Plus participants will show differential, significant improvement in diet behaviors at 2, 6, 12, 18 and 24 months accompanied by significant weight loss (e 5%) at 6 months that will be maintained at 24 months. Fit and Strong! Plus participants will also show differential statisticall significant improvements in physical activity maintenance accompanied by improved LE pain, stiffness, and function as well as depression and anxiety at all time points.