Enhanced Home-Based Exercise Therapy for Peripheral Arterial Disease through Mobile Health and Remote Monitoring

通过移动健康和远程监控增强外周动脉疾病的家庭运动疗法

• 批准号: 10508514
• 负责人: Arash Harzand
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-10-01 至 2026-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10508514
• 关键词: Accelerometer; Activities of Daily Living; Adherence; Adult; Affect; American; Amputation; Behavioral; Body Weight decreased; COVID-19 pandemic; Cardiac rehabilitation; Cellular Phone; Clinical; Complex; Coronary Arteriosclerosis; Data; Devices; Diabetes Mellitus; Elements; Enhancement Technology; Enrollment; Exercise; Exercise Therapy; Face; Goals; Gold; Guidelines; Health; Health Technology; Home; Hospitals; Hypertension; Impairment; Income; Indirect Calorimetry; Intervention; Interview; Leadership; Leg; Life Style; Life Style Modification; Light; Measurement; Monitor; Myocardial Infarction; Oxygen Consumption; Pain in lower limb; Patient Education; Patients; Peripheral arterial disease; Physical activity; Physicians; Population; Provider; Quality of Care; Quality of life; Rehabilitation Centers; Rehabilitation therapy; Reproducibility; Resolution; Risk; Risk Factors; Safety; Scientist; Smoking; Stroke; Structure; Supervision; Symptoms; Technology; Testing; Time; Training; Travel; Treatment outcome; Vertebral column; Veterans; Walking; aged; base; behavior change; claudication; cost; design; evidence base; exercise prescription; exercise program; exercise regimen; exercise rehabilitation; experience; functional independence; functional loss; functional outcomes; high risk; improved; improved mobility; informant; innovation; mHealth; mortality risk; multi-component intervention; novel; patient oriented; primary outcome; programs; randomized trial; remote monitoring; rural area; satisfaction; success; symptomatic improvement; tool

An estimated 8.5 million Americans (or 7% of US adults) and nearly 10% of veterans are estimated to have peripheral arterial disease (PAD). Significantly debilitating and negatively impacting quality of life, the primary symptom of PAD is claudication (reproducible leg pain with ambulation) that leads to impaired mobility, loss of functional independence, and a heightened risk for amputation. Veterans are at an increased risk of developing symptomatic PAD due to their disproportionately high rates of PAD risk factors such as diabetes, smoking, and hypertension, the most prominent PAD risk factors. Supervised exercise therapy is proven to decrease claudication and enhance mobility in PAD; however, fewer than 25% of eligible patients enroll. Participation in this facility-based program requires travel to a rehabilitation center 3 times per week for 12-weeks, which can be burdensome and costly for Veterans, many of whom live in rural areas and on fixed incomes. There is, therefore, a need to develop a convenient and effective alternative exercise rehabilitation program for Veterans with PAD, particularly in light of safety considerations now associated with this population’s travel to group facilities in the current COVID pandemic. A promising approach to increase access to exercise rehabilitation for PAD is remote, home-based exercise therapy (HBET). Our group has successfully delivered a smartphone-enabled HBET program to Veterans with coronary artery disease with a 3-fold increase in participation and high satisfaction (80%). To this end, we are committed to utilizing technology innovations to implement HBET for Veterans with PAD successfully. HBET programs combine self-led walking exercises with health coaching and exercise tracking with a wearable activity monitor. Adapting HBET to PAD is difficult, however, due to the added complexity of an exercise prescription that requires the patient to walk until they experience near-maximal leg pain. Even with active coaching, successfully implementing HBET for PAD with long-term adherence has been difficult in the past. Our goal, therefore, is to leverage newer mobile health (mHealth) tools to adapt HBET for PAD. We propose to test our technology-enhanced approach for HBET by partnering with a successful VA lifestyle program, MOVE!, which has demonstrated success in achieving sustained weight loss and reduced diabetes onset through lifestyle modification. As increased physical activity is a core element of MOVE!, participation may help increase adherence with HBET for PAD. Our newly proposed program, Smart MOVE!, will be a multi-component program featuring a tailored version of MOVE! and a novel mHealth device called the LifeQ to improve convenience, access, and adherence to HBET for PAD. Aim 1 (Years 1-2): Identify barriers and facilitators to MOVE! participation among Veterans with PAD. Aim 2 (Years 1-2): Evaluate the feasibility of the LifeQ device to monitor exercise during HBET Aim 3 (Years 2-5): Determine the feasibility of proceeding with Smart MOVE! through a pilot randomized trial. As a VA physician actively treating Veterans with PAD, I have seen first-hand the challenges they face in accessing guideline-directed treatments such as supervised exercise. This study will lay the groundwork and provide evidence to proceed with Smart MOVE!, a much-needed patient-centered exercise rehabilitation program for PAD. Additionally, the proposed training plan will support my progress towards becoming an independent VA rehabilitation clinician-scientist focused on improving care quality and treatment outcomes for Veterans with PAD.

据估计，850万美国人（占美国成年人的7%）和近10%的退伍军人 患有外周动脉疾病（PAD）。严重削弱和负面影响生活质量， PAD的主要症状是导致活动性受损的跛行（伴随截肢的可再现的腿部疼痛）， 丧失功能独立性，截肢的风险增加。退伍军人面临的风险增加 由于其PAD风险因素（如糖尿病）的比例过高而出现症状性PAD， 吸烟和高血压是最突出的PAD危险因素。 监督下的运动疗法被证明可以减少PAD患者的跛行并增强其活动能力;然而， 只有不到25%的合格患者参加。参加这项基于设施的计划需要前往 康复中心每周3次，持续12周，这对退伍军人来说可能是负担和昂贵的，许多 他们中的大多数生活在农村地区，收入固定。因此，需要开发一种方便且 有效的替代运动康复计划，为退伍军人与PAD，特别是鉴于安全 在当前的COVID大流行中，与该人群前往集团设施相关的考虑因素。 一个有希望的方法，以增加获得运动康复的PAD是远程，以家庭为基础 运动疗法（HBET）。我们的团队已经成功地交付了一个支持智能手机的HBET计划， 患有冠状动脉疾病的退伍军人的参与率提高了3倍，满意度高（80%）。到 为此，我们致力于利用技术创新，为患有PAD的退伍军人实施HBET 成功地HBET计划将联合收割机自我引导的步行锻炼与健康指导和锻炼跟踪相结合 一个可穿戴的活动监测器然而，由于增加的复杂性， 运动处方，要求患者步行，直到他们经历接近最大的腿部疼痛。即使有 积极的辅导，成功地实施HBET为PAD与长期坚持一直是困难的， 过去因此，我们的目标是利用更新的移动的健康（mHealth）工具，使HBET适应PAD。 我们建议通过与成功的VA合作来测试我们的HBET技术增强方法 生活方式节目，MOVE！，它已经证明成功地实现了持续减肥和减少 糖尿病的发病是通过改变生活方式。由于增加体力活动是MOVE！的核心要素， 参与可能有助于增加PAD患者对HBET的依从性。我们新提出的计划，智能移动！， 将是一个多组件的计划，具有一个量身定制的版本移动！和一种新型的移动健康设备， LifeQ，以改善PAD的HBET的便利性、可及性和依从性。 目标1（1-2年级）：确定移动的障碍和促进因素！参与PAD的退伍军人。 目标2（1-2年）：评价LifeQ器械在HBET期间监测运动的可行性 目标3（2-5年级）：确定继续进行Smart MOVE的可行性！通过一个试点 随机试验 作为一名积极治疗PAD退伍军人的VA医生，我亲眼目睹了他们面临的挑战 在获得指南指导的治疗，如监督运动。这项研究将奠定基础， 提供证据以继续Smart MOVE！，以病人为中心的运动康复 计划PAD。此外，拟议的培训计划将支持我成为一名 独立的VA康复临床医生-科学家专注于提高护理质量和治疗结果， 有PAD的退伍军人