老人肥満者への食事・運動療法介入にて骨代謝・骨密度改善

老人肥満者への食事・運動療法介入にて1年間のRCT、結果、骨代謝・骨密度改善をみたとのこと

Effect of Weight Loss and Exercise Therapy on Bone Metabolism and Mass in Obese Older Adults: a One-Year Randomized Controlled Trial
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2007-1473
【背景】肥満老人に対して、体重減少と・運動は脆弱性を改善し、心臓リスク要因を改善するが、ライフスタイル介入の骨代謝・骨量への長期効果は不明

【目的】肥満老人の骨代謝・骨稜への運動と食事による体重減少の影響を評価する目的

【デザイン・セッティング】大学ベースの研究センターでの1年のランダム化対照臨床トライアル

【参加者】 27のfrail, obese (BMI: 39±5 kg/m2) older (age: 70±5 years) adults

【介入】 ランダムに食事・運動療法(治療群:n=17)と無治療群(対照群:n=10)

【アウトカム測定結果】
・ 治療群の体重減少 (-10±2% vs. +1±1%, P<.001)

・対照群に比べ、治療群は骨量、骨マーカー、ホルモンの変化大きい
内容としては、1) 骨密度 (BMD): total hip (0.1±2.1% vs. -2.4±2.5%), 転子 (0.2±3.3% vs. -3.3±3.1%), 転子間稜 (0.3±2.7% vs. -2.7±.3.0%)
2) C-terminal telopeptide (12±35% vs. 101±79%) と osteocalcin (-5±15% vs. 66±61%)
3) leptin (2±12% vs. -30±25%) と estradiol (0.1±14% vs. -14±21%) (all P<0.05)

体重変化 (r=0.55)、 骨マーカー(r=-0.54)、 leptin (r=0.61) はhip BMDと相関 (all P<0.05)


【介入方法】(pdf)

Treatment group intervention: The treatment group intervention involved a combination of an energy-deficit diet, behavior therapy, and a multi-component exercise therapy.
Subjects met weekly as a group with a study dietitian, who was experienced in group behavioral therapy.

Standard behavioral techniques were used to change eating habits . Participants were prescribed a balanced diet to provide an energy deficit of 500-750 kcal/d, which contained ~30% of energy as fat, 50% as carbohydrate, and 20% as protein.

In addition, subjects were given a daily multivitamin supplement and were counseled to consume adequate dietary calcium and Vitamin D (1200-1500 mg Ca/d and 1000 IU vitamin D/d).

Total calorie intake was adjusted to prevent more than a 1.5% loss of body weight per week.
The goal was to achieve a 10% weight loss at 6 months, followed by weight maintenance for an additional 6 months.

The exercise program focused on improving endurance, strength, and balance.

Exercisetraining sessions were conducted as a group on three nonconsecutive days each week at our exercise facility.
Each session lasted ~90 min: 15 min of flexibility exercises, 30 min of endurance exercise, 30 min of strength training, and 15 min of balance exercises.

Endurance exercises included walking on a treadmill, step-ups, stair climbing, stationary cycling, and Stairmaster exercise. Subjects exercised at moderate intensity, (~75% of peak heart rate), and the intensity of exercise was gradually increased over several weeks to between 80% and 90% of peak heart rate. Resistance exercises were performed by using weight-lifting machines and freeweights.

One-repetition maximums (1-RMs), which is the maximal amount of weight subjects lifted one time, were used to adjust resistance exercises. Weight lifting sessions consisted of 1-2 sets performed at a resistance of ~65% of 1-RM, which allowed the completion of 8-12 repetitions. The volume of exercise was gradually increased to 2-3 sets at a resistance of ~80% 6 of 1RM, which allowed the completion of 6-8 repetitions. These sessions were supervised by a physical therapist



ちかくの体育大学が当方の地域をフィールドにして、同様なことを検討しているらしいが、やってることが中途半端な上に、医療機関への連携もなく、勝手な指導を始める始末。自治体の長がトップダウンで決めてるらしく、地元の医療機関の意見など無視。最近ではアルコールを飲んでないヒトにまでアルコールを推奨するような指導を受けたと、複数から問合当方にあり・・・いいかげんにしろ・・・と、のど元まで・・・(以下略)

プロトコールを抜き出した理由は・・・そういう私的事情による・・・

by internalmedicine | 2008-03-28 10:32 | 運動系  

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