Weight management for adults with mobility related disabilities

项目摘要/摘要 与行动能力相关的残疾(MRD)在美国成年人中占相当大的比例，而且还在不断增长 人口肥胖率高，成功控制体重的选择有限。成年人患有 MRD在体重管理方面面临许多障碍，包括缺乏负担得起的、可获得的 参加现场会议或从事体力活动(PA)的交通工具，缺乏无障碍锻炼 设施有无障碍的健身设备，以及购买食物和准备食物的困难。的确有 几乎没有关于体重管理的交付方法的比较有效性的信息 在患有MRDS的成年人身上。我们之前评估了一个增强版的停车灯节食法(ESLD= SLD+部分受控主食和低卡路里奶昔)对既有智力又有智力的成年人进行体重管理 核磁共振检查。当处方与个人每月进行的行为干预相结合时， 家访形式，ESLD在6个月和12个月时导致显著更大的体重减轻。与之相比 MRDS成人的饮食计划。尽管这些结果令人鼓舞，但替代战略可以提供 对更多患有MRD的成年人进行体重管理，潜在地改善结果，降低成本， 都是有根据的。因此，我们提出了一项双臂随机试验来比较体重与体重的关系。 损失(6个月)和维护(18个月)在通过群组视频远程提供的干预之间 在平板电脑上与参与者在家中(GR)或在个人家访(IH)期间进行会议。 这两个干预机构都将使用ESLD，并使用电子秤自我监测体重。GR臂将 包括在平板电脑上通过视频会议远程提供团体行为咨询和团体PA 计算机，并使用商业上可用的基于Web的应用程序进行自我 监控/参与者对饮食和PA的反馈。IH部门将包括在以下期间提供的行为咨询 个人家访，自我指导PA的处方，以及使用常规饮食和PA的自我监测 纸和笔的自我报告。主要目标将是比较体重减轻(0-6个月)。在这两者之间 干预措施。我们预计，与IH ARM相比，GR的体重减轻幅度要大得多。其次，我们会 比较0-18个月的平均体重减轻，参与者从以下方面达到≥5%体重减轻的比例 基线、心血管危险因素和生活质量的变化，并进行成本分析。此外，我们 将探讨行为课出席率、饮食依从性的影响 (能量摄入，主菜/奶昔的数量，水果/蔬菜的服务)，PA(最低限度的中等强度PA， 最小静坐时间)，以及饮食和PA的自我监控，饮食变化和PA的自我效能，饮食自我 在6个月和18个月时，对饮食/PA的管理、对饮食/PA的社会支持、PA的障碍、睡眠和关于减肥的药物。

Project Summary/Abstract Individuals with mobility related disabilities (MRDs) represent a sizeable and growing segment of the US adult population, with high rates of obesity, and limited options for successful weight management. Adults with MRDs face numerous barriers to weight management including the lack of affordable, accessible transportation to attend on-site meetings or engage in physical activity (PA), lack of accessible exercise facilities with accessible fitness equipment, and difficulty with food shopping and meal preparation. There is virtually no information regarding the comparative effectiveness of methods of delivery for weight management in adults with MRDs. We previously evaluated an enhanced version of the Stop Light Diet (eSLD = SLD+portion controlled entrées and low calorie shakes) for weight management in adults with both intellectual with MRDs. When prescribed in conjunction with a monthly behavioral intervention, delivered in an individual, home visit format, the eSLD resulted in significantly greater weight loss at 6 and 12 mos. when compared with a meal plan diet in adults with MRDs. Although these results are encouraging, alternative strategies to provide weight management to larger numbers of adults with MRDs, potentially improve outcomes, and reduce costs, are warranted. Therefore, we propose a two-arm randomized trial to compare body weight following weight loss (6 mos.) and maintenance (18 mos.) between interventions delivered either remotely via group video conferencing on a tablet computer to participants in their homes (GR), or during individual home visits (IH). Both intervention arms will use an eSLD and self-monitor body weight using electronic scales. The GR arm will include group behavioral counseling and group PA delivered remotely via video conferencing on a tablet computer to participants in their homes, and use commercially available web-based applications for self- monitoring/participant feedback for diet and PA. The IH arm will include behavioral counseling delivered during individual home visits, a prescription for self-directed PA, and self-monitoring of diet and PA using conventional paper and pencil self-reports. The primary aim will be to compare weight loss (0-6 mos.) between the two interventions. We expect significantly greater weight loss in the GR compared with IH arm. Secondarily we will compare mean weight loss from 0-18 mos., the proportion of participants achieving ≥ 5% weight loss from baseline, changes in cardiovascular risk factors and quality of life, and conduct a cost analysis. In addition, we will explore the influence of behavioral session attendance, compliance with the recommendations for diet (energy intake, number of entrées /shakes, servings of fruits/vegetables), PA (min of moderate-vigorous PA, min sedentary time), and self-monitoring of diet and PA, self-efficacy for dietary change and PA, dietary self- regulation, social support for diet/PA, barriers to PA, sleep, and medications on weight loss at 6 and 18 mos.