Executive Functioning and Physical Activity in Adolescents At-Risk for Type 2 Diabetes

项目摘要/摘要 预防青年发病的2型糖尿病（T2 D）至关重要。发病率正在上升，特别是在15岁的少女中。 颜色，和青年发病的T2 D是难以治疗的，并提出了一个更积极的过程比成人发病。 有效的T2 D预防需要更严格地了解潜在的作用机制， 促进行为改变。虽然体力活动可以防止胰岛素抵抗恶化，但关键是 在T2 D之前，运动训练对产生持续的身体变化的有效性不足。 肥胖青少年的活动、体重或代谢健康。母体研究的首要假设是， R 01 DK 111604 -01，抑郁症是许多处于T2 D风险中的青春期女孩遇到困难的驱动因素 开始/维持体力活动的经验。在母RCT中，我们正在检验以下假设： 提供一种心理支持的抑郁症干预，认知行为疗法（CBT），以减少 抑郁症，其次是运动训练，将提供一个有效的战略，增加身体 活性和改善胰岛素抵抗。在本行政补充文件（NOT-OD-22-140）中，我们的总体 我们的目标是阐明执行功能（EF）的维度，这些维度是减少抑郁和增加抑郁的基础。 体力活动。EF理论上是支持身体活动的认知/行为自我调节的核心 启动和维护。然而，在肥胖青少年中，大多数数据是关联的，方向性不清楚， 与身体活动相关的特定EF维度尚未完全理解。阐明动态，时间- 在为期12周的CBT/运动中，抑郁、EF和体力活动的有序变化可能会导致 促进未来针对有情绪问题的T2 D风险青少年的干预定制/优化。然而，在这方面， 对作用机制的严格测试需要密集的重复测量，以捕获时间顺序， 干预阶段，因此必须首先确定干预阶段的可行性/可接受性 密集的，反复的措施。利用母RCT，我们提出了一项可行性和概念验证研究 EF作为N=95例（样本子集）有抑郁升高的T2 D风险的青春期女孩的作用机制。 这份为期一年的补充材料的具体目的是：（1）测试密集重复措施的可行性/可接受性 抑郁症，EF，和身体活动在四个12周（6- 6周）序列的女孩在风险， T2 D：i）CBT运动训练，ii）运动训练CBT，iii）CBT运动训练CBT，iv）运动训练CBT;（2）描述纵向/ 抑郁、EF和体力活动的时间顺序变化和变化之间的关联 干预;以及（3）探索纵向/时间顺序变化与变化关联的组差异。这 补充促进与健康行为神经认知过程专家的新合作 （Goldschalle）和纵向、密集重复测量的高级统计（Aichele）。建立 EF在体力活动中作用的可行性/可接受性和概念验证将为未来的测试奠定基础 在未来的CBT/运动干预中，EF作为一种有待测试的作用机制，和/或作为一个目标得到加强。

Project Abstract/Summary Prevention of youth-onset type 2 diabetes (T2D) is critical. Rates are escalating, especially in adolescent girls of color, and youth-onset T2D is difficult to treat and presents with a more aggressive course than adult-onset. Efficacious T2D prevention requires a more rigorous understanding of the underlying mechanisms of action that facilitate behavior change. Although physical activity is protective against worsening insulin resistance, a key antecedent of T2D, exercise training shows insufficient effectiveness for producing sustained change in physical activity, weight, or metabolic health in adolescents with obesity. The overarching hypothesis of the parent study, R01DK111604-01, is that depression is a driver of the difficulties that many adolescent girls at risk for T2D experience in initiating/sustaining physical activity. In the parent RCT, we are testing the hypothesis that delivering an empirically-supported depression intervention, cognitive-behavioral therapy (CBT), to decrease depression, followed sequentially by exercise training, will offer an efficacious strategy for increasing physical activity and improving insulin resistance. In this administrative supplement (NOT-OD-22-140), our overarching goal is to illuminate executive functioning (EF) dimensions that underlie decreasing depression and increasing physical activity. EF is theoretically central to self-regulation of cognitions/behaviors that support physical activity initiation and maintenance. Yet, in adolescents with obesity, most data are associational, directionality is unclear, and specific EF dimensions relevant to physical activity are not entirely understood. Elucidating dynamic, time- ordered changes that unfold in depression, EF, and physical activity throughout 12-week CBT/exercise could facilitate future intervention tailoring/optimization for adolescents at risk for T2D with mood concerns. However, rigorous tests of mechanisms of action require intensive repeated measures to capture temporal ordering during the intervention phase, making it essential to first establish feasibility/acceptability of intervention-phase intensive, repeated measures. Leveraging the parent RCT, we propose a feasibility and proof-of-concept study of EF as mechanism of action in N=95 (sample subset) adolescent girls at risk for T2D with elevated depression. Specific aims of this 1-year supplement are to: (1) Test feasibility/acceptability of intensive repeated measures of depression, EF, and physical activity across four 12-week (6-week6-week) sequences in girls at risk for T2D: i) CBTexercise, ii) exerciseCBT, iii) CBTCBT, and iv) exerciseexercise; (2) Describe longitudinal/ time-ordered changes and change-to-change associations for depression, EF, and physical activity across the intervention; and (3) Explore group differences in longitudinal/time-ordered change-to-change associations. This supplement fosters new collaborations with experts in neurocognitive processes in health behavior (Goldschmidt) and advanced statistics for longitudinal, intensive repeated measures (Aichele). Establishing feasibility/acceptability and proof-of-concept of EF's role in physical activity would lay a foundation for future tests of EF as a mechanism of action to be tested, and/or enhanced as a target, in future CBT/exercise interventions.