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.

这项研究将比较一个3个月，单独规定的渐进式锻炼培训计划的影响 ON：1）慢性疼痛（CP），抑郁和PTSD症状以及2）​​神经生物学及其相关 我们的运动训练范式可以促进运动维护的神经心理学机制。 更具体地说，我们将研究与运动训练相关的假设关系 神经肽Y（NPY）系统功能的增强和提高能力的奖励和自我 监管 - 基于内在动机和自我有效的基础的神经心理能力，这 转弯已被证明可以预测锻炼。这项研究将集中于退伍军人和非退伍军人 使用CP/PTSD。研究设计包括基线，急性，心肺运动评估（CPX） 将为练习处方提供为期12周的“渐进式练习”培训计划的练习处方 每周进行三场30-45分钟的运动课程（步行，跑步，骑自行车或游泳，具体取决于 参与者的能力/能力）。锻炼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部门（CSU），然后过渡到房屋。 研究人员的间歇电话将提供额外的动机支持和解决问题。 使用心率和 Actigraph监视程序编程为参与以实现其处方心率范围（HRR）。最后， “端点” 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PTSD症状，以及提出促进运动维持的因素。两个CPX 测试将根据美国心脏病学院发布的指南进行。 在具有CP/PTSD的退伍军人和非退伍军人中，我们假设释放NPY的能力 对剧烈运动的反应（即急性CPX测试）将与疼痛的改善有关 抑郁症和PTSD症状以及预测维持运动的推定因素。拥有 有足够的能力来检验这些假设，30名参与者（15/年）将接受运动训练。数据 R21将用于证明可行性，并为单独的进一步发展提供信息 规定的，基于动机的运动方案，可以用作认知和其他的辅助 治疗性PTSD，抑郁或慢性疼痛干预措施，减轻慢性肌肉骨骼疼痛，抑郁症 和PTSD以及这些疾病的负面后果。