Neurobiological and Psychological Benefits of Exercise in Chronic Pain and PTSD

描述 这项研究将明确比较为期12周的渐进运动训练计划对患有慢性疼痛/创伤后应激障碍的退伍军人1)慢性疼痛和创伤后应激障碍的临床症状，2)痛阈值和耐受性，以及3)抗应激、抗伤害神经激素，如神经肽Y(NPY)和别孕酮/孕酮(Allo)的影响。修订后的研究设计包括一项基线心肺运动评估(CPX)，该评估将为为期12周的“渐进运动”训练计划提供运动处方，该计划包括每周三次30-45分钟的运动(步行或跑步，取决于参与者的能力/能力)。运动课程最初将由退伍军人管理局波士顿医疗系统临床研究部(CSU)的运动生理学家监督，然后每个参与者都将过渡到家里。PI每周的电话将提供额外的激励支持和解决问题的帮助。还将通过使用心率和活动监测器来支持指定运动方案的实施，这些监测器为参与者设置了程序，以达到他们指定的心率范围(HRR)。最后，将在第13周进行“终点”最大负荷运动评估，以跟踪心理和神经生物学因素的可测量变化，并描绘它们对疼痛指数和创伤后应激障碍症状的影响。这两项最大负荷运动测试都将根据美国心脏病学会发布的指南进行。疼痛、疼痛耐受性的测量(通过冷加压测试)将在运动测试前30分钟和运动测试后30分钟进行，并在中点“登记”，在那里也将重复自我报告问卷。基于PI的早期研究，运动动机和自我效能感在感知疼痛和疼痛耐受性变化中的作用将与运动前后NPY和Allo水平的变化相关。预计健康参与者和慢性疼痛/创伤后应激障碍患者对有氧运动和无氧运动的生物反应的差异将预示有氧运动和无氧运动在心理和减轻疼痛方面的差异。一旦确定，可以通过修改运动方案来增加这些因素，以帮助提高疼痛/创伤后应激障碍人群的抗应激激素水平，并在临床上显著减少他们的症状。为了获得足够的能量以及 由于预计辍学率为18%-20%，建议的招聘人数为每个条件30人(共60人)。这项试点工作的数据将被用来计算效果大小，以支持未来结合个人处方运动方案的临床试验 以及一项基于动机的运动行为改变干预措施，旨在减少退伍军人的疼痛和创伤后应激障碍症状。这位CDA-2奖项的申请者寻求在四个广泛领域进行高级教育和培训：1)慢性疼痛和创伤后应激障碍的心理生理学，重点关注性别差异；2)慢性应激、创伤后应激障碍和疼痛的神经生物学；3)运动生理学；4)创伤性脑损伤的神经心理学和神经生物学。这些领域的授课和体验式培训相结合将服务于PI的长期目标 作为退伍军人事务部的一名独立科学家/实践者，他专注于为与创伤后应激障碍并存的健康状况开发改进的治疗方法，如慢性疼痛和轻度创伤性脑损伤。在短期内，这一CDA-2将允许PI开发一种更有效的、基于动机的运动行为改变方案，以培养慢性疼痛/创伤后应激障碍患者的长期运动依从性。这一干预措施将作为认知干预措施的补充，通过退伍军人事务部、国立卫生研究院或国防部资助的更大规模的拨款，在CDA2的第4-5年申请PI，以进一步开发和研究这些障碍。

DESCRIPTION This study will explicitly compare the effects of a 12-week progressive exercise training program on 1) the clinical symptoms of chronic pain and PTSD, 2) pain threshold and tolerance, and 3) anti-stress, anti- nociceptive neurohormones such as neuropeptide Y (NPY) and allopregnanolone/pregnanolone (ALLO) in veterans with chronic pain/PTSD compared to healthy comparison participants. The revised study design includes a baseline cardiopulmonary exercise assessment (CPX) that will inform the exercise prescription for a 12-week "progressive exercise" training program, comprised of three 30-45 minute exercise sessions per week (walking or running, depending on the ability/capacity of the participant). Exercise sessions will be initially supervised by an exercise physiologist in the Clinical Studies Unit (CSU) at the VA Boston Healthcare System and then each participant will transition into the home. Weekly telephone calls by the PI will provide additional motivational support and assistance with problem solving. Implementation of the prescribed exercise regimen will also be supported by the use of heart rate and actigraph monitors programmed for the participant to achieve their prescribed heart rate range (HRR). Finally, an "endpoint" maximum load exercise assessment will occur at week 13 in order to track measurable change for both psychological and neurobiological factors and to delineate their impact on pain indices and PTSD symptomatology. Both maximum load exercise tests will be performed in accordance with guidelines published by the American College of Cardiology. Measures of pain, pain tolerance (via the cold pressor test) will be implemented 30 minutes before and 30 minutes after exercise testing as well as at a midpoint "check-in" at which self-report questionnaires will also be repeated. Based on the PI's earlier research, the role of exercise motivation and self-efficacy on changes in perceived pain and pain tolerance will be correlated with changes in NPY and ALLO levels, pre and post exercise. It is anticipated that differences in biological responses to aerobic and anaerobic exercise between healthy participants and those with chronic pain/PTSD will predict differences in the psychological and pain-reducing benefits of aerobic and anaerobic exercise. Once identified, such factors could be augmented by modification of the exercise regimen in order to help enhance the ant-stress hormone levels for the pain/PTSD population and experience clinically significant reductions in their symptoms. In order to obtain sufficient power as well as accounting for an expected drop-out rate of 18-20%, the proposed recruitment is 30 participants per condition (total of 60 participants). Data from this pilot work will be used to compute effect sizes in support of a future clinical trial incorporating individually prescribed exercise regimens and a motivationally based exercise behavior change intervention aimed at reducing pain and PTSD symptoms in our Veterans. Advanced education and training is sought by this CDA-2 award applicant in four broad areas: 1) psychophysiology of chronic pain and PTSD with a sub-focus on sex differences, 2) the neurobiology of chronic stress, PTSD, and pain, 3) exercise physiology and 4) the neuropsychology and neurobiology of traumatic brain injury (TBI). The combination of didactic and experiential training in these areas will serve the PI's long-term goal of becoming an independent scientist/practitioner in the VA focused on development of improved treatments for health conditions co-morbid with PTSD such as chronic pain and mild TBI. In the shorter-term, this CDA-2 will allow the PI to develop a more effective, motivationally based, exercise behavior change protocol that fosters long- term exercise compliance in patients with chronic pain/PTSD. This intervention will be used as an adjunct to cognitive interventions for these disorders to be further developed and studied via a larger VA, NIH, or DOD- funded grant for which the PI will apply in years 4-5 of the CDA2.