Metabolic Syndrome and Fall Risk

 产品说明： 代谢综合征（MetS）是一组危险因素，包括腹部肥胖、高血压、高脂血症和高血糖，高血糖是心血管疾病和糖尿病的已知危险因素。然而，也有越来越多的文献支持MetS和神经病的关联。虽然众所周知糖尿病和前驱糖尿病通常与疼痛性感觉运动性小纤维神经病相关，但不太常见的是，患有MetS的个体也患有通常也涉及自主神经系统的类似疼痛性小纤维神经病。此外，有早期证据表明MetS是福尔斯的独立风险因素（1）。然而，目前尚不清楚有针对性的运动和平衡训练计划是否能成功降低该患者人群的跌倒风险。拟议的研究试点项目将评估具有MetS和自主神经病变证据的参与者的跌倒风险，通过四方形台阶测试（FSST）进行测量，这是一种有效且敏感的动态站立平衡测试（2）。将在该人群中首次评价的其他终点指标包括在仪器化步态垫（GaitRite）上进行的动态步态指数（DGI）。然后，参与者将被随机分配到标准护理组，并接受有关跌倒风险和预防的教育，或有针对性的平衡运动干预组。[Both小组将每周举行一次小组课程，并且运动干预组]将被指导进行家庭平衡运动计划，每周进行三次。在12周的干预期后，将对参与者进行重新评估，以确定与未参与平衡锻炼计划的标准护理组相比，平衡锻炼干预是否成功降低了跌倒风险。此外，参与者将在基线和干预后完成自我效能测量。不同的终点指标将作为该试点的一部分进行评估 研究以确定哪种是该人群平衡性能和跌倒风险的最合适评估工具。这些新信息将用于设计未来的临床试验。申请人林赛齐利奥克斯博士是巴尔的摩VAMC的神经学家，也是马里兰州大学神经病学系的助理教授，她最近完成了临床培训，并曾参与VA。这5年的CDA-2将使她获得临床研究的额外技能，以及通过与James Russell博士的持续指导来使用和解释BMPC测试，她曾与VA资助的研究试验合作，并发表了几篇同行评审的期刊文章。此外，她将与物理治疗和康复系的共同导师Mark Rogers博士合作，以补充她在周围神经疾病领域的知识，并研究平衡和运动的神经运动控制。她不仅将与罗杰斯博士和他的同事合作，但通过物理康复科学研究生院提供的课程和研讨会的参与。第三位导师Michael Terrin博士将提供临床试验方法方面的专业知识。这是一个新颖和独立的研究项目，经验将为她提供必要的工具，以建立自己作为一个独立的VA研究人员。

 DESCRIPTION: The metabolic syndrome (MetS) is a collection of risk factors including abdominal obesity, hypertension, hyperlipidemia, and hyperglycemia that is a known risk factor for cardiovascular disease and diabetes. However, there is also a growing body of literature that supports the association of the MetS and neuropathy. While it is well recognized that diabetes mellitus and pre-diabetes are commonly associated with a painful sensorimotor small fiber neuropathy it is less commonly known that individuals with the MetS also suffer from a similar painful small fiber neuropathy that often involves the autonomic nervous system as well. In addition, there is early evidence that the MetS is an independent risk factor for falls (1). However, it is not known if a targeted exercise and balance training program would be successful in reducing the fall risk in this patient population. The proposed research pilot project will assess participants with evidence of the MetS and autonomic neuropathy for fall risk as measured by the Four Square Step Test (FSST), which is a valid and sensitive test of dynamic standing balance (2). Additional endpoint measures that will be evaluated for the first time in this population include the Dynamic Gait Index (DGI) performed on an instrumented gait mat (GaitRite). The participants will then be randomized to either a standard care group and received education regarding fall risk and prevention or a targeted balance exercise intervention group. [Both groups will meet once a week for a group class and the exercise intervention group] will be instructed in a home balance exercise program to perform three times a week. After a 12 week intervention period the participants will be reassessed to determine if the balance exercise intervention was successful in reducing fall risk compared to the standard care group who did not participant in the balance exercise program. In addition the participants will complete self-efficacy measures at baseline and after the intervention. The different endpoint measures will be evaluated as part of this pilot study to determine which is the most appropriate assessment tool of balance performance and fall risk in this population. This new information will be used to design future clinical trials. Te applicant, Dr. Lindsay Zilliox, is a Neurologist at the Baltimore VAMC and an Assistant Professor in the Department of Neurology at the University of Maryland who recently completed her clinical training and has a history of involvement within the VA. This 5 year CDA-2 will allow her to gain additional skills in clinical research as well as the use and interpretation of autonomc testing through ongoing mentorship with Dr. James Russell, with whom she has worked on VA funded research trials and published several peer-reviewed journal articles with. In addition she will work with a co-mentor, Dr. Mark Rogers in the Department of Physical Therapy and Rehabilitation, to complement her knowledge in the field of peripheral nerve disease with research in neuromotor control of balance and locomotion. She will not only collaborate with Dr. Rogers and his colleagues, but participate in coursework and seminars that are offered through the Graduate School of Physical Rehabilitation Science. A third mentor, Dr. Michael Terrin, will provide expertise in clinical trial methodology. This is a novel and independent research project and the experience will provide her with the necessary tools to establish herself as an independent VA researcher.