Effects of Adding Home-based Power Training to a Multidisciplinary Weight Management Service: A Randomised Clinical Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 38
- 主要终点
- Lower-limb power (W)
研究概览
简要总结
This study evaluates whether adding home-based resistance training to a multidisciplinary specialist weight management service can promote weight loss and improve physical function, strength, power and quality of life in adults with severe obesity. The study also investigated whether performing resistance exercises as fast as possible can yield further improvements in physical function compared with traditional slow-speed resistance training.
All recruited participants completed a 3-month home-based resistance training programme with behavioural support; half of the participants performed resistance exercises in a slow and controlled manner, whereas the other half performed resistance exercises with maximal intentional velocity.
详细描述
Severe obesity reduces muscle contractile function, which manifests as a diminished ability to perform activities of daily living. These functional impairments often lead to pain during movement and a decreased motivation to exercise.
In the United Kingdom (UK), specialist Tier 3 weight management services are provisioned for adults with severe obesity. Tier 3 services comprise a multidisciplinary team (MDT) of specialists and mainly adopt an educational approach, focusing on psychological therapy, dietary modification, pharmacotherapy and physical activity advice. However, current Tier 3 programmes do not specifically address the functional impairments imposed by obesity, which predisposes adults with severe obesity to musculoskeletal pain and pathology.
Adding supervised resistance training to MDT weight management programmes has been shown to improve functional capacity in adults with severe obesity. However, supervised interventions place considerable time and resource burdens on the service provider and patient, which may not be conducive to sustained participation. Obese individuals often report feeling too embarrassed to exercise in front of others and feel uncomfortable appearing in public wearing exercise clothing. Home-based exercise is a convenient alternative to supervised interventions and may promote similar functional adaptations.
Traditional resistance training typically involves sustained contractions at low to moderate velocities. While this method of training is effective for augmenting maximal strength production, which is executed at slow velocities, it may neglect the development of muscle power. This is problematic because lower-limb power has recently emerged as a critical determinant of function in adults with severe obesity.
Power training integrates a high-speed component into conventional resistance training exercises. Research in older adults has consistently shown that power training is superior to conventional slow-speed strength training for improving functionality. Preliminary evidence also exists supporting the superiority of power training in sarcopenic obese adults. Nevertheless, it is unknown whether home-based power training is feasible or effective when added to an MDT weight management programme.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Care Provider)
盲法说明
The investigator and outcome assessors were not blind to group allocation. It was also not possible to blind participants to the intervention, however, patients were unaware of the study hypotheses.
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Currently enrolled in a Tier 3 specialist weight management service in the United Kingdom
- •Body mass index of ≥ 40 kg/m2 or between 35 and 40 kg/m2 with a serious co-morbidity (such as type 2 diabetes or obstructive sleep apnoea).
- •Aged ≥ 18 years
- •Willing and able to give written informed consent.
- •Understand written and verbal instructions in English
排除标准
- •Unstable chronic disease state
- •Prior myocardial infarction or heart failure
- •Poorly controlled hypertension (≥ 180/110 mmHg)
- •Uncontrolled supraventricular tachycardia (≥ 100 bpm)
- •Absolute contraindications to exercise testing and training as defined by the American College of Sports Medicine
- •Current participation in a structured exercise regime (≥ 2x/week for the last 3 months)
- •Body mass ≥ 200 kg
- •Any pre-existing musculoskeletal or neurological condition that could affect their ability to complete the training and testing
结局指标
主要结局
Lower-limb power (W)
时间窗: 3-month endpoint
Mean power was measured in the sit-to-stand transfer with a wearable inertial sensor (PUSH, PUSH Inc., Toronto, Canada). The device is worn on the participant's forearm and measures acceleration in the upwards phase of the movement. Power is then calculated as velocity x force, where velocity is the integral of acceleration, and force is the product of mass and acceleration. The test was administered in a firm bariatric chair (height, 48 cm; depth, 56 cm; width, 69 cm). From a seated position, participants were instructed to maintain their arms crossed against their chest and stand up as quickly as possible (legs straight), before returning back to the initial seated position in a controlled manner (full weight on chair). Two warm-up trials were performed, followed by three repetitions separated by 60 seconds of rest. Additional trials were performed if the arms moved away from the chest.
次要结局
- Number of adverse events(During the 3-month intervention period)
- Body mass (kg)(3-month and 6-month endpoints)
- Waist and hip circumference (cm)(3-month and 6-month endpoints)
- Number of recruited participants(During the 13-month recruitment period)
- Attrition rate(During the 3-month intervention period)
- Six-minute walk test (m)(3-month and 6-month endpoints)
- EuroQol 5-level questionnaire (EQ-5D-5L)(3-month and 6-month endpoints)
- Weight-related symptom measure (WRSM)(3-month and 6-month endpoints)
- Timed up-and-go (s)(3-month and 6-month endpoints)
- Obesity and Weight Loss Quality of Life Instrument (OWLQOL)(3-month and 6-month endpoints)
- Sessional heart rate (%)(During the 3-month intervention period)
- Total number of repetitions during each resistance training session(During the 3-month intervention period)
- Isometric mid-thigh pull (kg)(3-month and 6-month endpoints)
- Number of patients lost to follow-up(3-month and 6-month endpoints)
- Number of exercise sessions completed(During the 3-month intervention period)
- Waist to hip ratio(3-month and 6-month endpoints)
- 30-s chair sit-to-stand test (s)(3-month and 6-month endpoints)
- Shoulder press and seated row one repetition maximums (kg)(3-month and 6-month endpoints)
- Shoulder press velocity (m/s)(3-month and 6-month endpoints)
- Shoulder press power (W)(3-month and 6-month endpoints)
- EuroQoL visual analogue scale (EQ-VAS)(3-month and 6-month endpoints)
- Session duration (minutes)(During the 3-month intervention period)
- Step count(During the 3-month intervention period)
- Lower-limb power (W)(6-month endpoint)
- Lower-limb movement velocity (m/s)(3-month and 6-month endpoints)