Neurobiological Mediators of Self-Regulatory and Reward-Based Motivational Predictors of Exercise Maintenance in Chronic Pain and PTSD

慢性疼痛和创伤后应激障碍 (PTSD) 运动维持的自我调节和基于奖励的动机预测因子的神经生物学调节因素

• 批准号: 9767671
• 负责人: Erica Rose Checko
• 金额: $ 15.75万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9767671
• 关键词: Acute; American; Biological; Biological Factors; Boston; Cardiology; Cardiopulmonary; Clinic; Clinical; Clinical Research; Cognitive; Comorbidity; Complex; Data; Dependence; Development; Disease; Educational Intervention; Educational Status; Epigenetic Process; Exercise; Exercise stress test; Fostering; Foundations; Guidelines; Health; Health behavior change; Healthcare Systems; Heart Rate; Home environment; Individual; Informal Social Control; Intervention; Investigation; Laboratories; Lead; Maintenance; Mediating; Mediator of activation protein; Mental Depression; Modification; Monitor; Morbidity - disease rate; Motivation; Neurobiology; Neuropsychology; Pain; Pain interference; Participant; Pathogenesis; Pharmacologic Substance; Pharmacology; Plasma; Population; Post-Traumatic Stress Disorders; Predictive Factor; Prevalence; Problem Solving; Protocols documentation; Publishing; Research; Research Design; Research Personnel; Rest; Rewards; Running; Self Efficacy; Severities; Specialist; Standardization; Strenuous Exercise; Supervision; Swimming; Symptoms; System; Telephone; Testing; Therapeutic; Therapeutic Intervention; Training; Training Programs; Translational Research; Treatment Efficacy; United States National Institutes of Health; Veterans; Walking; Work; actigraphy; base; behavior change; chronic musculoskeletal pain; chronic pain; college; depressive symptoms; disability; effective therapy; exercise physiologist; exercise prescription; exercise program; exercise regimen; exercise training; extrinsic motivation; health administration; improved; innovation; intrinsic motivation; medical specialties; neurobiological mechanism; neuropeptide Y; pain sensitivity; prevent; reduce symptoms; response

This study will compare the effects of a 3-month, individually prescribed progressive exercise training program on: 1) chronic pain (CP), depression and PTSD symptoms, and 2) neurobiological and related neuropsychological mechanisms by which our exercise-training paradigm may foster exercise maintenance. More specifically, we will investigate hypothesized relationships between exercise-training associated augmentation of neuropeptide Y (NPY) system function and improved capacities for reward and self- regulation—neuropsychological capacities posited to underlie intrinsic motivation and self-efficacy, which in turn have been shown to predict exercise maintenance. This study will focus on Veterans and non-veterans with CP/PTSD. The study design includes a baseline, acute, cardiopulmonary exercise assessment (CPX) that will inform the exercise prescription for the 12-week “progressive exercise” training program, comprised of three 30-45 minute exercise sessions per week (walking, running, cycling or swimming, 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 VA Boston Healthcare System, and then transition into the home. Intermittent telephone calls by the researchers will provide additional motivational support and 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” CPX assessment will track changes in NPY system function and delineate their impact on pain, depression and PTSD symptoms, as well as the factors proposed to foster exercise maintenance. Both CPX tests will be performed in accordance with guidelines published by the American College of Cardiology. Among Veterans and non-veterans with CP/PTSD, we hypothesize that the capacity to release NPY in response to vigorous exercise (i.e., acute CPX testing) will be associated with improvements in pain, depression and PTSD symptoms, as well as the putative factors that predict exercise maintenance. To have sufficient power to test these hypotheses, 30 participants (15/year), will be engaged in exercise training. Data from this R21 will be used to demonstrate feasibility and inform the further development of individually prescribed, motivationally based exercise regimens that could be used as adjuncts to cognitive and other therapeutic PTSD, depression or chronic pain interventions to reduce chronic musculoskeletal pain, depression and PTSD, as well as the negative consequences of these disorders over the long-term.

这项研究将比较为期3个月的效果，个人规定的渐进式运动训练计划 1）慢性疼痛（CP），抑郁症和PTSD症状，2）神经生物学和相关 神经心理学机制，我们的运动训练模式可以促进运动的维持。 更具体地说，我们将调查运动训练相关的 增强神经肽Y（NPY）系统的功能，提高奖励和自我的能力， 调节-神经心理学能力被认为是内在动机和自我效能的基础， 已被证明可以预测运动维持。这项研究将侧重于退伍军人和非退伍军人 CP/PTSD研究设计包括基线、急性、心肺运动评估（CPX）， 将告知12周“渐进式运动”训练计划的运动处方，包括 每周三次30-45分钟的锻炼（步行，跑步，骑自行车或游泳，取决于 参与者的能力（capacity）。运动课程最初将由运动生理学家监督， VA波士顿医疗保健系统的临床研究单位（CSU），然后过渡到家庭。 研究人员的间歇性电话将提供额外的动机支持和解决问题。 规定的运动方案的实施也将通过使用心率和 活动记录仪监测器为受试者编程，以达到规定的心率范围（HRR）。最后， “终点”CPX评估将跟踪NPY系统功能的变化并描述它们对疼痛的影响， 抑郁症和创伤后应激障碍症状，以及促进运动维持的因素。两个CPX 测试将按照美国心脏病学会发布的指南进行。 在患有CP/PTSD的退伍军人和非退伍军人中，我们假设， 对剧烈运动的反应（即，急性CPX测试）将与疼痛的改善相关， 抑郁症和创伤后应激障碍症状，以及预测运动维持的假定因素。有 有足够的力量来检验这些假设，30名参与者（15人/年）将参加运动训练。数据 从这个R21将被用来证明可行性，并通知个别的进一步发展 处方，动机为基础的锻炼方案，可用作认知和其他 治疗性PTSD、抑郁或慢性疼痛干预，以减少慢性肌肉骨骼疼痛、抑郁 和创伤后应激障碍，以及这些疾病的长期负面影响。