A community-based exercise program to improve walking outcomes in patients with p

一项基于社区的锻炼计划，旨在改善 p 患者的步行结果

• 批准号: 8724550
• 负责人: Ryan J. Mays
• 金额: $ 13.42万
• 依托单位: UNIVERSITY OF MONTANA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2017-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8724550
• 关键词: Ache; Adherence; Adopted; Adoption; Adult; Age; American Indians; Arterial Fatty Streak; Arteries; Award; Behavior; Behavioral; Biomedical Research; Blood Vessels; Blood flow; Buttocks; Cardiology; Cherokee Indian; Cities; Clinic; Clinical; Clinical Research; Clinical Sciences; Clinical Trials; Clinical Trials Design; Clinics and Hospitals; Colorado; Communication; Communities; Community Health; Counseling; Development; Diabetes Mellitus; Disease; Educational Status; Effectiveness; Elements; Environment; Evaluation; Exercise; Exertion; Faculty; Failure; Fellowship; Funding; Grant; Health; Health Sciences; Health care facility; Heart Diseases; Home environment; Immersion Investigative Technique; Impairment; Individual; Institutes; Insurance; Insurance Coverage; Intermittent Claudication; Intervention; K-Series Research Career Programs; Knowledge; Leg; Master of Public Health; Medical; Mentors; Methods; Modeling; Monitor; Motivation; Muscle Cramp; National Heart, Lung, and Blood Institute; Outcome; Outcome Study; Outcomes Research; Oxygen Consumption; Pain; Pain in lower limb; Patient Care; Patient Education; Patient Outcomes Assessments; Patients; Perception; Performance; Peripheral; Peripheral arterial disease; Personal Satisfaction; Phase; Physical activity; Physical therapy exercises; Pilot Projects; Play; Positioning Attribute; Postdoctoral Fellow; Prevalence; Prevention; Process; Public Health; Publications; Questionnaires; Randomized; Reliance; Research; Research Methodology; Research Personnel; Resolution; Role; SF-36; Self Efficacy; Stroke; Structure; Supervision; Techniques; Testing; Thigh structure; Time; Training; Training Programs; Translational Research; Transportation; United States National Institutes of Health; Universities; Walking; abstracting; base; behavioral health; claudication; community based participatory research; community setting; compliance behavior; cooking; design; effective intervention; effective therapy; experience; follow-up; improved; innovation; insight; meetings; member; motivational enhancement therapy; novel; patient population; pilot trial; prevent; primary outcome; programs; response; secondary outcome; sedentary; standard of care; tribal member

DESCRIPTION (provided by applicant): This application is in response to an NIH NHLBI K01 Mentored Career Development Award to Promote Faculty Diversity in Biomedical Research (RFA-HL-12-030). Candidate: I am an exercise physiologist and 3rd year postdoctoral fellow within the Division of Cardiology at the University of Colorado Denver (UCD) Anschutz Medical Campus (AMC). I am currently funded through an NHLBI F32 individual postdoctoral fellowship based on my pilot project titled "A community-based exercise program following endovascular therapy for patients with peripheral artery disease" for which I also received a Colorado Clinical and Translational Sciences Institute (CCTSI) grant (project support). I have begun the process of receiving training in community-based participatory research (CBPR) methods to enhance my proposed research agenda of creating innovative exercise programs in community settings for patients with PAD. This was accomplished when I attended the 2010 Physical Activity and Public Health Practitioners (PAPH) course held in Park City, UT. I also participated in the Colorado Immersion Training in Community Engagement program, American Indian track. As a Tribal member of the Cherokee Nation, I am in an excellent position to continuing moving toward independent investigator status while also providing a unique perspective to clinical research based on my heritage and past training. Mentors/Environment: My mentor team is composed of national level research experts in PAD, CBPR methodology and built environment evaluation, cardiology as well as motivational interviewing. Dr. Judy Regensteiner is my primary mentor and has extensive experience in exercise training for patients with PAD and diabetes as well as in mentoring junior faculty. Dr. William Hiatt is a leader in clinical trials for PAD patiets and is the President of the Colorado Prevention Center which is a clinical trial design research organization. Dr. Deborah Main has expertise in community-based health research and has played a critical role in the CBPR methods of the proposal. Dr. Ivan Casserly is an academic cardiologist who is a leader in the field of peripheral vascular intervention. He will provide his expertise with regard to PAD patient care as well as aid in recruitment of PAD patients into our trial. Dr. Paul Cook is a consultant on this proposal for the motivational interviewing aspects of the design. He has a number of publications in using this technique in a variety of patient populations and will aid me in my continued training in motivational interviewing to improve PAD patients' adoption and adherence to exercise in community settings. Training: My plans are to continue my training in CBPR practices and motivational interviewing as well as in public health. This will be accomplished by participating in local and national level training opportunities for junior faculty in community-based and clinical outcomes research (e.g., CCTSI and PAPH programs). I anticipate completing a Master of Public Health degree during the proposed award period, specifically in the Community and Behavioral Health concentration. Additionally, I will be completing a Certificate in Public Health Sciences at the time of this application review. Research: Although supervised exercise programs for peripheral arterial disease (PAD) are highly effective, few people are able to successfully utilize these programs. Barriers that prevent patients from adopting and adhering to supervised exercise programs include lack of insurance reimbursement for walking exercise and poor proximity to hospitals and clinics as external barriers. Community-based exercise programs for PAD have to date met with inconsistent results possibly due to lack of training and follow-up. Thus, more consistent and directed programs need to be established for exercise training programs based in community settings that incorporate the strengths of supervised programs but also remove the barriers associated with exercise in the community. Our pilot project used novel training, monitoring and coaching (TMC) components in community settings that have been implemented successfully in supervised settings. We also evaluated the local walking environment for each PAD patient prior to community-based exercise. However, our previous pilot methods were designed from the researcher perspective and did not formally engage the actual PAD patients to gain their perspective on how to create effective interventions. Research programs that involve community members in developing the intervention to be used in the community setting may: 1) highlight additional barriers to walking using experiential knowledge of patients and 2) improve compliance by adjusting exercise prescription components that patients may have previously resisted completing. Thus, our project will use CBPR practices in the early design phase of the intervention to improve our piloted TMC intervention components in an effort to increase PAD patients' exercise performance. In addition, evidence supports exercise based motivational interviewing as an effective communication strategy for providing directed resolutions to problems while exercising and may improve self-efficacy of PAD patients. Thus, the primary aim of the proposed study is to determine the effect of a community-based exercise program with training, monitoring and coaching (TMC) components that are enhanced by CBPR practices and motivational interviewing (TMC+) to improve peak walking time (PWT) in PAD patients, which is the primary outcome of the study. (End of Abstract)

描述（由申请人提供）：本申请是为了响应NIH NHLBI K 01指导职业发展奖，以促进生物医学研究（RFA-HL-12-030）的教师多样性。 候选人：我是一名运动生理学家，在科罗拉多丹佛大学（UCD）安舒茨医学院（AMC）心脏病学系从事博士后研究。 我目前通过NHLBI F32个人博士后奖学金获得资助，该奖学金基于我的试点项目“外周动脉疾病患者血管内治疗后基于社区的锻炼计划”，为此我还获得了科罗拉多临床和转化科学研究所（CCTSI）的资助（项目支持）。我已经开始接受基于社区的参与性研究（CBPR）方法的培训，以加强我提出的在社区环境中为PAD患者创建创新运动计划的研究议程。这是当我参加了2010年体育活动和公共卫生从业人员（PAPH）在公园城举行的课程，UT。我还参加了科罗拉多沉浸式社区参与培训计划，美国印第安人的轨道。作为切罗基民族的部落成员，我处于一个极好的位置，继续走向独立的研究者地位，同时也提供了一个独特的视角，临床研究的基础上，我的遗产和过去的培训。 导师/环境：我的导师团队由PAD，CBPR方法和建筑环境评估，心脏病学以及动机访谈的国家级研究专家组成。Judy Regensteiner博士是我的主要导师，在PAD和糖尿病患者的运动训练以及指导初级教师方面拥有丰富的经验。William Hiatt博士是PAD患者临床试验的领导者，也是科罗拉多预防中心的主席，该中心是一个临床试验设计研究组织。Deborah Main博士在以社区为基础的健康研究方面具有专业知识，并在该提案的CBPR方法中发挥了关键作用。Ivan Casserly博士是一位学术心脏病专家，是外周血管介入领域的领导者。他将提供关于PAD患者护理的专业知识，并帮助招募PAD患者参加我们的试验。保罗·库克博士是这份提案的顾问，负责设计中的动机性面试方面。他有一些出版物在使用这种技术在各种患者人群，并将帮助我在我的动机访谈，以提高PAD患者的采用和坚持在社区环境中锻炼的继续培训。 培训：我的计划是继续我在CBPR实践和动机面试以及公共卫生方面的培训。这将通过参加地方和国家一级的培训机会，为初级教师在社区为基础的和临床成果的研究（例如，CCTSI和PAPH程序）。我预计在拟议的奖励期间完成公共卫生硕士学位，特别是在社区和行为健康浓度。此外，我将在此申请审查时完成公共卫生科学证书。 调研：虽然有监督的运动计划对外周动脉疾病（PAD）非常有效，但很少有人能够成功地利用这些计划。障碍阻挠 患者接受和坚持监督锻炼计划的障碍包括缺乏步行锻炼的保险报销以及医院和诊所的距离不近等外部障碍。以社区为基础的PAD锻炼计划迄今为止遇到了不一致的结果，可能是由于缺乏培训和后续行动。因此，更一致和有针对性的计划需要建立基于社区设置的运动训练计划，结合监督计划的优势，但也消除了与社区运动相关的障碍。我们的试点项目在社区环境中使用了新的培训，监测和指导（TMC）组件，这些组件已在监督环境中成功实施。我们还评估了每个PAD患者在社区锻炼前的当地步行环境。然而，我们以前的试点方法是从研究人员的角度设计的，并没有正式参与实际的PAD患者，以获得他们对如何创建有效干预措施的看法。让社区成员参与制定社区环境中使用的干预措施的研究计划可能：1）使用患者的经验知识突出步行的其他障碍，2）通过调整患者先前可能拒绝完成的运动处方成分来提高依从性。因此，我们的项目将在干预的早期设计阶段使用CBPR实践，以改善我们的试点TMC干预组件，努力提高PAD患者的运动表现。此外，有证据支持基于运动的动机访谈作为一种有效的沟通策略，在运动时提供直接解决问题的方法，并可能提高PAD患者的自我效能。因此，拟议研究的主要目的是确定以社区为基础的运动计划的效果，其中包括通过CBPR实践和动机访谈（TMC+）增强的培训，监测和指导（TMC）组件，以改善PAD患者的峰值步行时间（PWT），这是研究的主要结局。 (End摘要）