Froehlich-Grobe Katherine, Betts Andrea C, Driver Simon J, Carlton Danielle N, Lopez Amber Merfeld, Lee Jaehoon, Kramer M Kaye
Baylor Scott & White Institute for Rehabilitation, Dallas, Texas.
Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, School of Public Health, Dallas, Texas.
Am J Prev Med. 2020 Dec;59(6):805-817. doi: 10.1016/j.amepre.2020.06.023. Epub 2020 Nov 5.
This study examines the feasibility and effectiveness of an intensive lifestyle intervention adapted for people with impaired mobility.
This was a randomized, wait-list controlled trial. The experimental group immediately received the 12-month weight loss program; the wait-list control group received it after a 6-month delay. Between-group comparisons were conducted for the 6-month RCT study design. Repeated measures were conducted for both groups combined after receiving the 12-month intervention. Data were collected August 2015-February 2017 and analyzed in 2017.
SETTING/PARTICIPANTS: A community-based sample received 23, group-based sessions via a mix of telephone and in-person sessions in a hospital-based setting. Participants with impaired mobility (n=66) were middle-aged (49.80 [SD=11.37] years), mostly White (66.7%), female (66.7%), and most commonly had spinal cord injury (47.0%).
The 12-month intervention delivered 23 group-based sessions that promoted weight loss through reducing caloric intake and increasing physical activity.
Primary outcomes were effectiveness measured as change in weight and time spent in moderate physical activity. Feasibility was assessed in 12-month combined group analyses, measured as retention, attendance, and dietary self-monitoring.
The 6-month RCT results showed that the immediate and delayed groups differed significantly (p<0.05) in weight (-1.66 [SD=4.42] kg loss vs 0.05 [SD=4.15] kg gain) and moderate physical activity (52.93 [SD=90.74] minutes/week increase vs -14.22 [SD=96.02] minutes/week decrease), accounting for baseline weight, time with disability, and age of onset. The 12-month results with groups combined demonstrated 74.2% retention and 77.7% core session attendance. Self-monitoring was higher in the delayed group (77.3%), who used a smartphone app, than the immediate group (47.3%), who mostly used paper trackers. Participants achieved significant 12-month weight loss of 3.31 (SD=10.13) kg (d=0.33) in mixed modeling analyses with groups combined yet did not significantly increase moderate physical activity.
Group Lifestyle Balance Adapted for Individuals with Impaired Mobility is a feasible, effective approach to teach healthy lifestyle skills to individuals with mobility impairment, yielding modest weight loss and enhanced self-efficacy.
This study is registered at www.clinicaltrials.gov NCT03307187.
本研究探讨了针对行动不便者的强化生活方式干预措施的可行性和有效性。
这是一项随机、等待列表对照试验。实验组立即接受为期12个月的减肥计划；等待列表对照组在延迟6个月后接受该计划。针对6个月的随机对照试验研究设计进行组间比较。在接受12个月干预后，对两组进行重复测量。数据收集于2015年8月至2017年2月，并于2017年进行分析。
设置/参与者：一个基于社区的样本在医院环境中通过电话和面对面相结合的方式接受了23次小组课程。行动不便的参与者（n = 66）为中年人（49.80 [标准差 = 11.37]岁），大多为白人（66.7%），女性（66.7%），最常见的是脊髓损伤（47.0%）。
为期12个月的干预提供了23次小组课程，通过减少热量摄入和增加身体活动来促进减肥。
主要结局指标为减肥效果，以体重变化和中等强度身体活动时间来衡量。在12个月的合并组分析中评估可行性，以留存率、出勤率和饮食自我监测来衡量。
6个月随机对照试验的结果显示，即时组和延迟组在体重（-1.66 [标准差 = 4.42] kg与0.05 [标准差 = 4.15] kg）和中等强度身体活动（每周增加52.93 [标准差 = 90.74]分钟与每周减少14.22 [标准差 = 96.02]分钟）方面存在显著差异（p < 0.05），同时考虑了基线体重、残疾时间和发病年龄。两组合并后的12个月结果显示留存率为74.2%，核心课程出勤率为77.7%。使用智能手机应用程序的延迟组（77.3%）的自我监测情况高于主要使用纸质追踪器的即时组（47.3%）。在合并组的混合模型分析中，参与者在12个月内实现了显著的体重减轻，为3.31（标准差 = 10.13）kg（d = 0.33），但中等强度身体活动并未显著增加。
针对行动不便个体的“团体生活方式平衡”是一种可行且有效的方法，可向行动不便的个体传授健康的生活方式技能，实现适度的体重减轻并提高自我效能感。
