Weight management for adults with mobility related disabilities

项目总结/摘要 与行动有关的残疾（MRD）的个人代表了美国成年人的一个相当大的和不断增长的部分 肥胖率高，成功控制体重的选择有限。成人 MRD在体重管理方面面临着许多障碍，包括缺乏负担得起的，可获得的 参加现场会议或参加体育活动（PA）的交通，缺乏无障碍锻炼 无障碍健身设施，以及购买食品和准备膳食的困难。有 几乎没有关于体重管理方法的比较有效性的信息 在患有MRD的成年人中。我们以前评估了一个加强版的停止轻饮食（eSLD = SLD+部分控制主菜和低热量奶昔）用于成人体重管理， 关于MRD当与每月一次的行为干预结合使用时， 家庭访视形式，eSLD在6个月和12个月时导致显著更大的体重减轻。较 MRD患者的膳食计划饮食。尽管这些结果令人鼓舞，但提供 对大量患有MRD的成年人进行体重管理，可能会改善结局，并降低成本， 都是正当的因此，我们提出了一个双臂随机试验，比较体重以下的体重 丢失（6个月）和维护（18个月）在通过远程视频或小组视频 在平板电脑上与参与者在他们的家中（GR）或在个人家访（IH）期间进行会议。 两个干预组都将使用eSLD，并使用电子秤自我监测体重。GR臂将 包括团体行为咨询和通过平板电脑上视频会议远程提供的团体PA 计算机到参与者在他们的家中，并使用商业上可获得的基于网络的应用程序， 监测/参与者对饮食和PA的反馈。IH手臂将包括行为咨询提供期间 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。 纸和铅笔的自我报告。主要目的是比较体重减轻（0-6个月）两 干预措施。与IH组相比，我们预计GR组的体重减轻明显更大。其次， 比较0-18个月的平均体重减轻，体重减轻≥ 5%的受试者比例 基线、心血管危险因素和生活质量的变化，并进行成本分析。另外我们 将探讨行为会议出席的影响，遵守饮食建议， （能量摄入，主菜/奶昔的数量，水果/蔬菜的份量），PA（中等强度PA的分钟， 静坐时间），饮食和PA的自我监测，饮食改变和PA的自我效能，饮食自我监测， 在6个月和18个月时，对饮食/PA的社会支持、PA障碍、睡眠和药物减肥。

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.