RR&D Research Career Scientist Award Application

迈尔斯博士的研究计划的首要目标是将运动疗法和生活方式 干预，以帮助恢复功能，减少残疾，并减少慢性退伍军人的医疗保健费用 疾病这些领域包括心肺运动试验的诊断和预后应用， 以及多学科康复计划对慢性心力衰竭患者的生理影响， 冠状动脉疾病，腹主动脉瘤疾病，脊髓损伤，轻度认知障碍， 和慢性肾衰竭他目前是两个VA RR & D项目的PI，一个名为"PCI替代使用"， 持续运动（暂停），"和其他题为"运动，以防止肌肉质量和功能 老年透析患者的损失（完美）。PAUSE项目扩展了他在临床上的工作 康复在心血管疾病患者中的应用。心血管疾病仍然是 退伍军人死亡的主要原因，除了评估运动的生理效应， 生活方式干预作为冠状动脉疾病侵入性治疗的替代方法， 非侵入性（生活方式干预）与侵入性（冠状动脉支架）策略的成本效益。的 PERFECT试验关注运动疗法对慢性肾功能衰竭患者肌肉质量和功能的影响。 失败肾功能衰竭是VA的一个重要条件，因为它的成本（估计是第二个 VA中最昂贵的条件），其患病率（估计比一般人群高34%）， 及其对身体功能和残疾的毁灭性影响。迈尔斯博士目前的工作还包括三个 资助的项目涉及运动疗法对轻度认知障碍患者的影响。这些 研究旨在评估运动增强策略的有效性，沿着认知 训练干预，以改善轻度认知障碍的老年退伍军人的认知表现。 博士Myers发起并管理一个临床、血管造影和运动试验反应的关系数据库 可以追溯到1987年该数据库已成为回答许多流行病学问题的资源 影响退伍军人（称为退伍军人运动测试研究，或兽医）。兽医研究是一项正在进行的， 对因临床原因转诊进行运动试验的退伍军人受试者进行前瞻性评价，旨在 解决运动试验，临床和生活方式因素及其与健康结果的关联。研究从 VETS队列研究了与以下疾病相关的患病率、时间趋势和卫生保健费用： 他汀类药物使用、肥胖、慢性心力衰竭、心律异常和其他慢性疾病，以及如何 这些条件受健康和身体活动模式的影响。VETS队列分析 影响了主要健康组织的运动测试指南。他协调了另外两个 国家数据库，7个中心的心力衰竭心肺运动试验联盟，以及AHA/CDC- 健身注册和锻炼的重要性：国家数据库（FRIEND）。朋友 该倡议旨在建立一个全国健身登记册，以便更好地告知临床医生和公众 有关体育活动和健身的重要性及其在预防慢性病方面的作用。作为 他最近完成了一个为期6年的NIH资助的临床导向研究专业中心 （SCCOR）项目，题为"腹主动脉瘤疾病的运动疗法"。SCCOR计划 是由国家心脏，肺和血液研究所发起的，以促进临床上的多学科研究。 相关主题促进基础科学发现更快地应用于临床问题， 强调预防，诊断和治疗特定疾病。该项目特别 与退伍军人的相关性，因为它已被证明，腹主动脉粥样硬化疾病的患病率， > 60岁的退伍军人占14.3%，如果不治疗，可能会造成致命后果。

The overarching goals of Dr. Myers' research program are to apply exercise therapy and lifestyle intervention to help restore function, reduce disability, and reduce health care costs in Veterans with chronic disease. These areas include diagnostic and prognostic applications of cardiopulmonary exercise testing, and the physiologic effects of multidisciplinary rehabilitation programs in patients with chronic heart failure, coronary artery disease, abdominal aortic aneurysm disease, spinal cord injury, mild cognitive impairment, and chronic renal failure. He is currently PI on two VA RR&D projects, one entitled, “PCI Alternative using Sustained Exercise (PAUSE),” and the other entitled, “Exercise to Prevent Muscle Mass and Functional Loss in Elderly Dialysis Patients (PERFECT).” The PAUSE project extends his work on the clinical applications of rehabilitation in patients with cardiovascular disease. Cardiovascular disease remains the leading cause of mortality in Veterans, and in addition to assessing the physiologic effects of exercise and lifestyle intervention as an alternative to invasive treatment of coronary artery disease, the study addresses the cost effectiveness of non-invasive (lifestyle intervention) vs. invasive (coronary stenting) strategies. The PERFECT trial focuses on the effects of exercise therapy on muscle mass and function in chronic renal failure. Renal failure is an important condition in the VA because of its cost (estimated to be the second most costly condition in the VA), its prevalence (estimated to be 34% higher than the general population), and its devastating effects on physical function and disability. Dr. Myers current work also includes three funded projects involving the effects of exercise therapy in patients with mild cognitive impairment. These studies are designed to evaluate the effectiveness of exercise augmentation strategies along with cognitive training interventions to improve cognitive performance in older Veterans with mild cognitive impairment. Dr. Myers initiated and manages a relational database of clinical, angiographic, and exercise test responses dating back to 1987. This database has been a resource for answering many epidemiologic questions affecting Veterans (termed the Veterans Exercise Testing Study, or VETS). The VETS study is an ongoing, prospective evaluation of Veteran subjects referred for exercise testing for clinical reasons, designed to address exercise test, clinical, and lifestyle factors and their association with health outcomes. Studies from the VETS cohort have addressed the prevalence, temporal trends, and health care costs associated with statin use, obesity, chronic heart failure, cardiac rhythm abnormalities and other chronic conditions, and how these conditions are influenced by fitness and physical activity patterns. Analyses from the VETS cohort have influenced guidelines on exercise testing from major health organizations. He coordinates two other national data bases, a 7-center heart failure cardiopulmonary exercise test consortium, and the AHA/CDC- sponsored Fitness Registry and the Importance of Exercise: A National Data Base (FRIEND). The FRIEND initiative is designed to develop a national fitness registry in order to better inform clinicians and the public about the importance of physical activity and fitness and their role in the prevention of chronic disease. As Co-PI, he recently completed a 6-year NIH-funded Specialized Center of Clinically-Oriented Research (SCCOR) project entitled, “Exercise Therapy in Abdominal Aortic Aneurysm Disease.” The SCCOR program was initiated by the National Heart, Lung, and Blood Institute to foster multidisciplinary research on clinically relevant topics facilitating basic science findings to be more rapidly applied to clinical problems, with an emphasis on prevention, diagnosis, and treatment of a particular disease. This project has particular relevance to Veterans, since it has been shown that the prevalence of abdominal aortic aneurism disease in Veterans >60 years is 14.3%, with potentially lethal consequences if the disease is not treated.