Profiling the Heterogeneous Response of Exercise therapy in HF patients

描述(申请人提供)：个人国家研究服务奖(NRSA)申请的目的是为护士提供研究培训，使其成为独立的调查者，重点关注持续至少8周的运动疗法如何在心力衰竭(HF)患者群体中影响生理和症状变化的平行过程，并影响HF患者的预后。除了支持学术课程，获得方法和统计技能，以及学习在弱势群体中进行符合伦理道德的研究外，NRSA培训赠款还将支持解释心力衰竭患者群体对运动疗法的不同反应的研究。从临床角度来看，运动疗法有巨大的潜力，可以更好地纳入患者护理计划，并由联邦医疗保险报销。首先需要进一步了解谁受益最大。我假设，在心力衰竭患者群体中，对运动治疗有共同和独特的反应，可以根据健康结果进行识别、预测和量化。我将使用心力衰竭患者的子组和一项调查运动训练(HF-ACTION)结果的对照试验数据集对这一假设进行实证研究。我已经获得了使用该数据集的特别许可，包括该研究的主要研究人员Christopher O‘Connor博士和David Whellan博士提供的生物标记物、症状和结果数据。我的研究培训将由我的赞助商和共同赞助商指导，他们是两位国际知名的心衰科学家，著名的心衰护理专家和领导者芭芭拉·里格尔博士，以及备受赞誉的心衰移植专家肯尼斯·马古利斯博士。该项目还将得到克里斯托弗·李博士的大量投入，他是 护士科学家、高级方法学家和这个项目的顾问。这项研究训练的长期影响很重要，因为运动训练是一种自我管理行为，受到强烈鼓励，但在心力衰竭患者群体中使用不足。这项研究与国家护理研究所的优先事项密切相关，该研究所明确需要调查健康的多种决定因素及其对患者自我管理疾病、管理症状和提高与健康相关的生活质量的能力的影响。这项工作将导致了解针对哪些人进行特定的量身定制的运动干预。本申请中提出的具体研究和方法方法对许多利益相关者具有广泛的适用性，包括专业人员、护理人员和心力衰竭患者。

DESCRIPTION (provided by applicant): The purpose of this individual National Research Service Award (NRSA) application is to provide research training for a nurse to become an independent investigator focusing on how exercise therapy, defined as routine exercise lasting at least 8 weeks, in the heart failure (HF) patient population impacts the parallel processes of physiologic and symptom changes and influences HF patients' outcomes. In addition to supporting scholarly coursework, acquiring methodological and statistical skills, and learning to conduct ethically sound research with vulnerable populations, this NRSA training grant will also support research to explain the heterogeneous response to exercise therapy in the HF patient population. From a clinical perspective, there is huge potential for exercise therapy to be better integrated into patient care plans and be reimbursed by Medicare. Further understanding of who benefits most is first needed. I hypothesize that there are common and distinct responses to exercise therapy in the HF patient population that can be identified, predicted, and quantified in association with health outcomes. I will investigate this hypothesis empirically using a subgroup of patients from the Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing (HF-ACTION) dataset. I have received special permission to use the dataset, including biomarker, symptom and outcome data from the principal investigators of the study: Dr. Christopher O'Connor and Dr. David Whellan. My research training will be guided by my sponsor and co- sponsor who are two internationally known HF scientists, Dr. Barbara Riegel, a well-known HF nurse expert and leader, and Dr. Kenneth Margulies, a highly acclaimed HF transplant specialist. This project will also receive significant input from Dr. Christopher Lee, a nurse scientist, advanced methodologist and consultant on this project. The long-term impact of this research training is important because exercise training is a self-management behavior strongly encouraged but under-used in the HF patient population. This research is closely assigned with the priorities of the National Institute of Nursing Research, which specify the need to investigate multiple determinants of health and the impact they have on patients' ability to self-manage their disease, manage their symptoms and improve their health-related quality of life. This work will lead to knowledge of whom to target with specific tailored exercise interventions. The specific research and methodological approach proposed in this application has wide applicability to many stakeholders, including professionals, caregivers and patients with HF.