Physical Activity and Sedentary Behavior Change; Impact on Lifestyle Intervention Effects for Diabetes Translation

描述（由申请人提供）：基于成功的糖尿病预防计划（DPP）的翻译工作表明，这种行为生活方式干预模式在各种不同的社区环境中有效。尽管身体活动伊萨DPP生活方式干预的关键部分，作为两个干预目标之一， DPP，和/或由此产生的翻译研究仿照它，从来没有得到验证与准确的客观措施。此外，先前的研究表明，在一般人群的许多亚组中，不存在中度/剧烈（中度+）体力活动。由于功能受限或缺乏动力，这些人可能很难提高中等强度以上的体力活动水平。对于这些人来说，试图增加中等强度活动计划的干预可能不如试图减少坐着的时间那么有效或有益。这个目标 建议是了解运动的影响，特别是身体活动和坐着的时间，在社区生活方式干预工作。目标1解决了预防文献中的一个重要空白;客观测量的活动是否由于在基于DPP的翻译工作中使用的现有干预措施而改善，活动的这种变化是否对体重变化产生影响？目标#2检查了将增加计划的和相对短暂的中度+体力活动的传统体力活动目标替换为专注于减少久坐时间的传统体力活动目标的影响，该目标是在改编自DPP的成功翻译生活方式干预框架内，即团体生活方式平衡（GLB）计划。该研究设计是一项前瞻性的、为期6个月的延迟对照干预研究，（年龄50岁及以上，BMI为e24 kg/m2，患有前驱糖尿病和/或代谢综合征）将从社区中心招募，并随机分配到三组之一：标准的GLB计划，包括常规的中等+活动目标（GLB-MOD），GLB计划，重点是减少久坐行为（GLB-SED）或延迟干预。分配至GLB-MOD组和GLB-SED组的受试者将在6个月时与延迟对照组进行比较，此后，延迟组将被随机分配至GLB-MOD组或GLB-SED组。参与者将完成基线、6个月和12个月评估访视。体重变化、客观测量的活动和久坐时间是主要结局，次要结局包括自我报告的体力活动、HbA 1c、空腹血糖、血脂、血压、腰围、生活质量和身体功能的变化。假设在GLB-MOD中通过加速度测量法评估的身体活动将显著增加（大多数是中等强度的活动），并且体重将显著降低，这将部分与活动水平的变化相关。第二个假设是GLB-SED干预将显著减少通过加速度计测量的坐着的时间，并且这种变化也与体重的显著降低有关。从整个努力中获得的信息是重要的，创新的，并将使我们能够全面准确地了解身体活动/不活动频谱的两端及其在社区预防干预计划中的影响。如果被证明是有效的，创新的，修改后的专注于久坐的翻译干预计划将提供一个有价值的未来翻译选择。

DESCRIPTION (provided by applicant): Translation efforts based upon the successful Diabetes Prevention Program (DPP) have shown that this behavioral lifestyle intervention model is effective in a variety of diverse community settings. Despite the fact that physical activity isa key part of the DPP lifestyle intervention as one of the two intervention goals, activity change in the DPP, and/or the resulting translation studies modeled after it, has never been verified with an accurate objective measure. In addition, previous research has shown that, in many subgroups of the general population, moderate/vigorous (moderate+) physical activity is non-existent. These same individuals may have a difficult time increasing their levels of moderate+ intensity physical activity due to either limited function or lack of motivation. For these individuals, interventions attempting to increase planned bouts of moderate+ intensity activity may not be as effective or as beneficial as trying to decrease time spent sitting. The goal of this proposal is to understand the impact of movement, specifically physical activity and sitting time, in community lifestyle intervention efforts. Aim #1 addresses an important remaining gap in the prevention literature; does objectively measured activity improve as a result of the existing intervention that is being used in DPP-based translation efforts and does this change in activity have an impact on weight change? Aim #2 examines the impact of replacing the conventional physical activity goal of increasing planned and relatively brief bouts of moderate+ physical activity with one focusing on decreasing sedentary time within the framework of a successful translation lifestyle intervention adapted from the DPP, the Group Lifestyle Balance (GLB) program. The study design is a prospective, six month delayed-control intervention in which 321 subjects (age 50 and older with a BMI of e24 kg/m2 and with prediabetes and/or metabolic syndrome) will be recruited from community centers and randomly assigned to one of three groups: the standard GLB program which includes the conventional moderate+ activity goal (GLB-MOD), the GLB program with a focus on decreasing sedentary behavior (GLB-SED), or delayed intervention. Subjects assigned to GLB-MOD and GLB-SED will each be compared at 6 months to the delayed-control group after which time, the delayed group will be randomly assigned to either GLB-MOD or GLB-SED. Participants will complete baseline, 6, and 12 month assessment visits. Change in weight, objectively measured activity, and time spent sedentary are the primary outcomes with secondary outcomes including change in self-reported physical activity, HbA1c, fasting glucose, lipids, blood pressure, waist circumference, quality of life and physical function. It is hypothesized that physical activity assessed by accelerometry in GLB-MOD will significantly increase (mostly moderate intense activity) and that there will be a significant decrease in weight, which will partly be related to change in activity levels. The 2nd hypothesis is that the GLB-SED intervention will significantly decrease time spent sitting as measured by accelerometry and that this change will also be related to a significant decrease in weight. The information that will be gained from this entire effort is important, innovative, and wll allow us to obtain a complete and accurate understanding of both ends of the physical activity/inactivity spectrum and their impact in community prevention intervention programs. If shown to be effective, the innovative, modified sedentary-focused translation intervention program would provide a valuable future translation option.