Neuromodulation for Exercise Adherence in Older Veterans

老年退伍军人坚持运动的神经调节

• 批准号: 9910072
• 负责人: Kalpana P. Padala
• 金额: --
• 依托单位: CENTRAL ARKANSAS VETERANS HLTHCARE SYS
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9910072
• 关键词: Adherence; Attention; Behavior Control; Behavior Therapy; Biological; Brain; Cognitive; Communities; Complex; Data; Diabetes Mellitus; Dose; Double-Blind Method; Elderly; Equilibrium; Executive Dysfunction; Exercise; Fall prevention; Gait; Home environment; Hospitalization; Incidence; Individual; Injury; Intervention; Knowledge; Learning; Link; Magnetism; Measures; Memory; Methods; Morbidity - disease rate; Motivation; Motor Cortex; Outcome Measure; Parkinson Disease; Patient Self-Report; Patients; Phase; Pilot Projects; Placebos; Prefrontal Cortex; Prevention program; Psyche structure; Randomized; Rewards; Role; Safety; Schedule; Self Efficacy; Supervision; Techniques; Testing; Time; Training; Translations; Travel; Veterans; base; clinical practice; cost; design; discounting; evidence base; executive function; exercise adherence; exercise program; exercise training; exergame; falls; fear of falling; flexibility; human old age (65+); improved; mortality; neural network; neuroregulation; novel; overtreatment; performance tests; post stroke; primary outcome; problems and exercises; processing speed; programs; repetitive transcranial magnetic stimulation; response; safety assessment; sedentary; treatment comparison

Background: Fall-related hospitalizations and consequent morbidity and mortality continue to rise despite the availability for over two decades of evidence-based fall-prevention programs. This is a major problem since more than 2.5 million older adults are treated annually for fall-related injuries in the US. Fall-prevention programs focusing on strength and balance exercises have been successful in facility settings but exercise programs are ineffective at home due to lack of adherence. Estimates indicate that only 1 in 5 individuals adhere to home exercise programs for fall prevention. Thus, there is an urgent need to improve adherence to exercise performed at home by older adults seeking to improve balance for the sake of fall prevention. Behavioral interventions have failed to consistently improve adherence to exercise. Biological reasons for poor exercise adherence, such as executive dysfunction, have not been explored. Adherence to long-term exercise is dependent on executive function (EF), which is controlled by the [dorsolateral prefrontal cortex (DLPFC)] of the brain. EF influences choices in scheduling, forgoing competing activities, enduring subtle costs of time and inconvenience, and the ability to delay gratification. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation increasingly used for neural network specific interventions. rTMS of the DLPFC improves EF, memory, motivation, and mental flexibility. rTMS studies to date have stimulated the motor cortex for gait and balance improvements. The role of DLPFC in exercise adherence has not been explored. The proposed study will be the first to test DLPFC stimulation for improving exercise adherence. Objective: The study objective is to determine the effects of rTMS treatment of the dorsolateral prefrontal cortex compared to sham on: [1. Short-term (2-wk) changes in executive function;] 2. Long-term (24-wk) adherence to a home-based exercise program; 3. Long-term (24-wk) changes in balance and gait; and [4. Short-term (2-wk) changes in self-efficacy and delay discounting.] Methods: Sedentary community-dwelling older Veterans (age ≥ 65 years, [N=106]) will participate in a double- blind randomized sham-controlled three-phase study. The proposed study will use Nintendo Wii-Fit exercises. Phase I will include two weeks of facility-based exercise for safety assessment and learning the program, followed by 12 weeks of home-based exercises. [Subjects with poor adherence and those with good adherence with low EF] will then be randomized to rTMS or sham treatments. Phase II will include ten consecutive weekdays of rTMS or sham treatment along with exercise training for subjects with poor adherence [and for those with good adherence and low EF] and continuation of home-based exercises for those with good adherence and EF. Phase III includes 24-weeks of a home-based exercise program. All subjects will exercise for 45 minutes five days/week. [Objective measure of adherence collected from Wii-Fit console and Conner’s continuous performance test for EF will be the primary outcome measures.] Balance and gait will be assessed. [Self-efficacy, delay discounting along with fear of falls, and falls incidence will be assessed. Outcome measures will be assessed at baseline, and at 14, 16, and 40 weeks.] Significance: This project will have a major impact in improving adherence to an exercise program and in turn, improve balance in sedentary community-dwelling older Veterans. At the end of the proposed project, we will gain knowledge about the efficacy of rTMS in improving EF and exercise adherence. Knowledge gained about the adherence to home-based exercises would be applicable to multiple conditions such as diabetes. Since Wii-Fit and rTMS are readily available, translation of the study results to clinical practice would be expeditious.

背景：跌倒相关的住院治疗和随之而来的发病率和死亡率持续上升，尽管 提供了超过二十年的循证跌倒预防计划。这是一个大问题，因为 在美国，每年有超过250万老年人因跌倒相关损伤而接受治疗。防坠落 专注于力量和平衡练习的项目在设施设置中取得了成功， 由于缺乏坚持，这些计划在国内是无效的。据估计，只有五分之一的人 坚持家庭锻炼计划以预防跌倒。因此，迫切需要加强对 老年人在家中进行的运动，旨在改善平衡，以防止跌倒。 行为干预未能持续改善坚持锻炼。贫困的生物学原因 诸如执行功能障碍的锻炼坚持性尚未被探索。坚持长期锻炼 依赖于执行功能（EF），而执行功能是由背外侧前额叶皮层（DLPFC）控制的。 大脑执行功能会影响日程安排的选择，放弃竞争性活动，忍受微妙的时间成本， 不方便，以及延迟满足的能力。重复经颅磁刺激（rTMS）是一种 非侵入性神经调节越来越多地用于神经网络特定干预。DLPFC的rTMS 改善EF，记忆力，动机和心理灵活性。迄今为止的rTMS研究已经刺激了运动皮层 改善步态和平衡DLPFC在运动坚持性中的作用尚未探讨。的 拟议的研究将是第一个测试DLPFC刺激改善运动坚持性。 目的：研究经颅磁刺激（rTMS）对前额叶背外侧区的影响 与假手术相比，皮质：[1.执行功能的短期（2周）变化;] 2。长期（24周） 坚持以家庭为基础的锻炼计划; 3.长期（24周）平衡和步态变化;以及[4]。 自我效能和延迟折扣的短期（2周）变化。 方法：久坐不动的社区居住老年退伍军人（年龄≥ 65岁，[N=106]）将参加一项双 盲法、随机、假手术对照的三阶段研究。拟议的研究将使用任天堂Wii-Fit练习。 第一阶段将包括为期两周的基于设施的安全评估和学习计划的演习， 接下来是12周的家庭训练[依从性差和依从性好的受试者 低EF的依从性]然后将随机分配至rTMS或假治疗。第二阶段将包括10个 对于较差的受试者，连续工作日进行rTMS或假治疗，沿着进行运动训练 坚持[和那些坚持良好和低EF]和继续以家庭为基础的练习， 那些坚持和EF良好的人。第三阶段包括24周的家庭锻炼计划。所有 受试者将每周五天锻炼45分钟。[从Wii-Fit收集的依从性的客观测量 控制台和Conner的EF连续性能测试将是主要结局指标。平衡 将对步态进行评估。[自我效能感、延迟折扣沿着对福尔斯的恐惧，以及福尔斯的发生率 评估。将在基线以及第14、16和40周时评估结局指标。] 意义：该项目将对提高锻炼计划的依从性产生重大影响， 改善久坐社区居住的老年退伍军人的平衡。在拟议项目结束时，我们将 获得有关rTMS在改善EF和运动依从性方面的疗效的知识。获得的知识 坚持家庭锻炼可适用于多种情况，例如糖尿病。以来 Wii-Fit和rTMS是现成的，研究结果转化为临床实践将是迅速的。