A Novel Mobile Health Exercise Intervention in Aging: Brain Perfusion and Cognition

 描述(申请人提供)：鉴于美国65岁以上人口的数量将从2010年的4020万增加到2050年的8850万，预测AD患病率为1380万，专注于在老龄化过程中保持大脑和认知健康的研究努力已成为一个关键的公共卫生问题。对于卫生专业人员来说，制定行为干预措施以防止健康老年人的认知能力下降是至关重要的。心血管危险因素与认知能力下降有关，脑血管改变在正常衰老中非常常见，这表明针对心血管危险因素可能有助于维持脑血管和认知健康。在有监督的环境(实验室和小组环境)中对老年人进行的体力活动干预一直显示出心脑血管健康和认知功能的改善。缺乏的是在现实世界环境中发生的干预措施的开发，这些干预措施利用新技术来帮助客观跟踪实时体力活动行为。现实世界的体育活动干预措施有可能惠及更大一部分人口，并在干预期结束后加强维护。这项拟议的研究项目将开发一种新的、为期6个月的体育活动干预措施，利用移动健康技术，在65-75岁认知正常的老年人中，提高可能影响现实世界环境中脑血流和认知的体育活动水平。这项干预的目标是将用于中等到剧烈体力活动的时间增加到每周150分钟，这是美国心脏协会建议的心血管益处。为此，将进行随机对照试验，30名参与者被分配到流动健康体力活动条件下，另外30名参与者被分配到教育控制条件下，为期6个月。根据健康测试，体力活动处方的目标是每个人最大心率的60%-75%，并将在现实环境中独立进行。此外，我们将调查这种新的干预是否具有增加脑血流量和改善认知的潜力，正如之前在受控环境中的研究所表明的那样。这项为期五年的K23申请旨在为申请者提供必要的培训，使其成为一名独立的临床科学家，专注于开发改善大脑和认知老化的行为干预措施。本项目以申请人以前在认知神经科学、衰老、脑成像和神经心理学方面的经验为基础，以实现下列培训目标：1)获得使用移动健康技术制定和实施针对老年人的体力活动干预措施的广泛培训；2)学习如何收集、处理和分析脑血流和静息状态连接性脑成像数据；3)发展设计和实施随机对照试验(包括高级统计学)方面的专业知识；以及4)获得科学写作和授权方面的经验。该项目和相关培训目标的完成将确保申请者获得必要的技能和经验，以过渡到独立调查员的角色，该调查员整合了运动科学、现实世界行为干预、认知增强和老年人群脑成像等领域。

 DESCRIPTION (provided by applicant): Research efforts focusing on maintaining brain and cognitive health in aging have become a critical public health concern given that the number of people over 65 will increase from 40.2 million in 2010 to 88.5 million by 2050 in the United States, with a forecasted AD prevalence of 13.8 million. It is crucial for health professionals to develop behavioral interventions that prevent cognitive decline in healthy older adults. Cardiovascular risk factors have been associated with cognitive decline, and cerebrovascular changes are very common in normal aging, suggesting that targeting cardiovascular risk factors could potentially help to maintain cerebrovascular and cognitive health. Physical activity interventions conducted in supervised settings (laboratories and group settings) with older adults have consistently shown improved cardiovascular and cerebrovascular health and improved cognitive function. What is lacking is the development of interventions that take place in real world environments and that take advantage of new technologies to help objectively track real time physical activity behaviors. Real world physical activity interventions have the potentia to reach a larger segment of the population and to enhance maintenance after the intervention period ends. The proposed research project will develop a novel, 6-month physical activity intervention using mobile health technologies to promote physical activity levels likely to affect cerebral blood flow and cognition in real world environments in cognitively normal older adults aged 65-75. The goal of this intervention is to increase time spent in moderate to vigorous physical activity to 150 min/week, which is recommended by the American Heart Association for cardiovascular benefits. For this purpose, a randomized controlled trial will be conducted with 30 participants being assigned to the mobile health physical activity condition and another 30 to an education control condition for 6 months. Physical activity prescriptions will target 60-75% of each individual's maximum heart rate based on fitness testing and will be conducted independently in real world environments. Moreover, we will investigate if this novel intervention has the potential to increase cerebral blood flow and improve cognition as has been shown by previous research in controlled environments. This five year K23 application is designed to provide the applicant with the necessary training to become an independent clinical scientist focusing on developing behavioral interventions to improve brain and cognitive aging. This project builds on the applicant's previous experience with cognitive neuroscience of aging, brain imaging, and neuropsychology to achieve the following training goals: 1) Obtain extensive training in the development and implementation of physical activity interventions with older adults using mobile health technology; 2) learn how to collect, process and analyze cerebral blood flow and resting state connectivity brain imaging data; 3) develop expertise in the design and implementation of randomized controlled trials (including advanced statistics); and 4) obtain experience with scientific writing and grantsmanship. Completion of this project and associated training goals will ensure the applicant obtains the necessary skills and experience to transition into the role of an independent investigator who integrates the fields of exercise science, real world behavioral interventions, cognitive enhancement, and brain imaging with older adult populations.