Dynamic Treatment Regimens of Physical Activity for Persons with Osteoarthritis

骨关节炎患者体力活动的动态治疗方案

• 批准号: 9981661
• 负责人: S. Reza Jafarzadeh
• 金额: $ 21.63万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9981661
• 关键词: Accelerometer; Affect; American; Caring; Cartilage; Characteristics; Clinical; Cohort Studies; Conflict (Psychology); Data; Deceleration; Decision Making; Degenerative polyarthritis; Development; Diagnostic radiologic examination; Disease; Disease Progression; Elderly; Exercise; Exploratory/Developmental Grant; Goals; Image; Individual; Intervention; Joints; Knee; Knee Osteoarthritis; Knowledge; Longitudinal Studies; Malignant Neoplasms; Measures; Mechanical Stimulation; Mechanics; Medicine; Methods; Outcome; Pain; Patients; Performance; Persons; Pharmaceutical Preparations; Physical Function; Physical activity; Population; Prevention; Recommendation; Recording of previous events; Regimen; Reporting; Research; Risk; Stress; Structure; Testing; Time; Treatment Protocols; Uncertainty; United States National Institutes of Health; Walking; Weight Gain; Work; base; functional improvement; high reward; high risk; improved; insight; knee pain; novel; osteoarthritis pain; pain reduction; pain relief; performance based measurement; personalized approach; physical inactivity; response; sedentary

PROJECT SUMMARY/ABSTRACT Limited understanding of factors affecting the course of Osteoarthritis (OA) has hampered development and optimization of strategies that would lessen pain and slow disease progression. While OA is a mechanically- driven disease, important knowledge gaps remain regarding the effects of physical activity, the most common reason for mechanical stimulation of joint structures. OA pain is mainly activity-induced (e.g., stair climbing, walking), but paradoxically, walking regimens can reduce pain. Further, certain degrees of oscillating compressive stress cause trophic changes in cartilage, whereas static or high velocity stress causes catabolic responses. Given the contrasting effects of different types of activities on the joint, it is not surprising that studies of the effects of the amount of physical activity on OA have had conflicting results. Further, it is uncertain what types of activity could be beneficial for pain relief or function improvement without causing harm and accelerating disease progression. The long-term goal of this project is to facilitate decision making for clinicians and patients of a more optimal physical activity regimen for pain relief, maintaining functional performance, and decelerating structural damage in osteoarthritis. The central hypothesis of this proposal is that physical activity's influence on osteoarthritis outcomes differs depending on individual characteristics such as the stage of disease and that different types of activity have different effects on OA outcomes. Further, we hypothesize that the optimal activity regimen may evolve as the patient characteristics change. Therefore, a person-specific physical activity regimen that is adjustable and consistent with the patient's current characteristics is needed. We propose to take advantage of the Osteoarthritis Initiative (OAI) and Multicenter Osteoarthritis Study (MOST) cohorts, two large-scale longitudinal studies on OA with data on physical activity, measured objectively by accelerometer, in addition to extensive clinical, imaging, and medication history data. Our aims are: 1) to characterize the time-varying association of physical activity types with knee OA structural progression, 2) to examine a person-specific and dynamic physical activity regimen for pain reduction in persons with knee OA, and 3) to examine a person-specific and dynamic physical activity regimen for performance-based physical function in persons with knee OA. The contribution of this work is significant because a better understanding of how physical activity types and intensity may improve or worsen the outcomes of OA is urgently needed. Our novel analytic approach is a departure from the traditional approaches of physical activity recommendation based on average effect in the population. Unlike population-oriented approaches that were indifferent to an individual's unique characteristics, our person-specific approach will allow us to adjust the physical activity regimen as the disease evolves. Our work will provide new evidence about diverse types of physical activity and could inform better OA management.

项目总结/摘要 对影响骨关节炎（OA）病程的因素的有限理解阻碍了发展， 优化策略，减轻疼痛和减缓疾病进展。虽然OA是一种机械- 在疾病驱动下，关于身体活动的影响，最常见的 关节结构的机械刺激的原因。OA疼痛主要是活动诱导的（例如，爬楼梯， 步行），但矛盾的是，步行疗法可以减轻疼痛。此外，一定程度的振荡 压缩应力引起软骨的营养变化，而静态或高速应力引起分解代谢 应答考虑到不同类型的活动对关节的对比效应，研究表明， 关于身体活动量对OA的影响的研究结果相互矛盾。此外，不确定的是， 活动类型可能有利于缓解疼痛或改善功能，而不会造成伤害和加速 疾病进展。该项目的长期目标是促进临床医生和患者的决策 一个更优化的身体活动方案，以缓解疼痛，保持功能表现，并减速 骨关节炎的结构损伤。这项建议的核心假设是，身体活动对 骨关节炎的结果取决于个体特征，例如疾病的阶段， 不同类型的活动对OA结果有不同的影响。此外，我们假设最佳活性 治疗方案可以随着患者特征的改变而演变。因此，一个人特定的身体活动 需要可调节的并且与患者当前特征一致的方案。我们建议 利用骨关节炎倡议（OAI）和多中心骨关节炎研究（MOST）队列， 两项关于OA的大规模纵向研究，使用身体活动数据，通过 除了广泛的临床、成像和用药历史数据之外，还可以使用加速度计。我们的目标是：1） 描述体力活动类型与膝关节OA结构进展的时变关联，2） 检查用于减轻膝关节OA患者疼痛的个体特异性和动态体力活动方案， 和3）检查个人特定的和动态的身体活动方案，用于基于表现的身体活动。 膝关节OA患者的功能。这项工作的贡献是重大的，因为更好地了解 体力活动类型和强度如何改善或恶化OA的结果是迫切需要的。我们 一种新的分析方法是从传统的基于身体活动推荐的方法出发， 在人口中的平均影响。不像面向人群的方法， 独特的特点，我们的个人特定的方法将使我们能够调整身体活动方案， 疾病进化。我们的工作将提供有关不同类型的身体活动的新证据，并可能为 更好的OA管理。