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

描述(由申请人提供)：此申请是对NIH NHLBI K01促进生物医学研究教师多样性指导职业发展奖(RFA-HL-12-030)的回应。候选人：我是运动生理学家，科罗拉多大学丹佛分校(UCD)安舒茨医学院(AMC)心内科三年级博士后研究员。我目前是通过NHLBI F32个人博士后奖学金获得资助的，该奖学金基于我的试点项目，名为“外周动脉疾病患者血管内治疗后的社区锻炼计划”，为此我还获得了科罗拉多州临床和翻译科学研究所(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，以加强我提议的研究议程，即在社区环境中为PAD患者创建创新的锻炼计划。这是在我参加2010年在德克萨斯州帕克城举办的体育活动和公共卫生从业者(PAPH)课程时完成的。我还参加了科罗拉多州的社区参与沉浸式培训项目，美国印第安人赛道。作为切诺基民族的一名部落成员，我处于一个极好的地位，可以继续迈向独立研究员的地位，同时也根据我的传统和过去的培训为临床研究提供独特的视角。导师/环境：我的导师团队由PAD、CBPR方法论和建筑环境评估、心脏病学以及激励性访谈方面的国家级研究专家组成。朱迪·雷根斯坦纳博士是我的主要导师，在为PAD和糖尿病患者进行运动训练以及指导初级教职员工方面拥有丰富的经验。威廉·希亚特博士是PAD贴片临床试验的领导者，也是科罗拉多州预防中心的主席，科罗拉多州预防中心是临床试验设计研究机构。Deborah Main博士在社区卫生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。伊万·卡瑟利博士是一位学术心脏病专家，在外周血管干预领域处于领先地位。他将提供他在PAD患者护理方面的专业知识，以及帮助PAD患者加入我们的试验。保罗·库克博士是这项建议的顾问，负责设计的激励性采访方面。他发表了许多关于在不同患者群体中使用这项技术的出版物，并将帮助我继续接受励志访谈培训，以提高PAD患者在社区环境中对锻炼的接受和坚持。培训：我的计划是继续我的CBPR实践和激励性面试以及公共卫生方面的培训。这将通过参与社区和临床结果研究(例如，CCTSI和PAPH项目)初级教员的地方和国家层面的培训机会来实现。我期望在拟议的授权期内完成公共卫生硕士学位，特别是社区和行为健康专业。此外，在这次申请审查时，我将完成公共卫生科学证书。研究：尽管有监督的锻炼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。阻碍 接受和坚持监督锻炼计划的患者包括步行锻炼缺乏保险补偿，以及距离医院和诊所较近作为外部障碍。到目前为止，PAD的社区锻炼计划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，需要为基于社区环境的运动训练计划建立更一致和更有针对性的计划，该社区环境结合了受监督计划的优点，但也消除了与社区锻炼相关的障碍。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患者在社区锻炼之前的当地步行环境。然而，我们之前的试验方法是从研究人员的角度设计的，并没有正式接触实际的PAD患者，以获得他们关于如何创建有效干预的观点。让社区成员参与开发社区环境中使用的干预措施的研究计划可能：1)强调使用患者的经验知识行走的其他障碍；2)通过调整患者以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实践来改进我们的试点TMC干预组件，以努力提高PAD患者的运动表现。此外，证据支持基于运动的动机访谈作为一种有效的沟通策略，为运动中的问题提供直接的解决方案，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锻炼计划的效果，该计划包含通过CBPR实践和动机访谈(TMC)增强的训练、监测和指导(TMC)部分，以改善PAD患者的高峰步行时间(PWT)，这是本研究的主要结果。(摘要结束)

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)