Promoting Physical Activity to Improve Cognitive Function in Older Adults Undergoing Hematopoietic Cell Transplantation (HCT)

项目摘要 癌症和治疗相关的认知变化会导致痛苦，阻碍恢复正常的日常生活和角色， 生活质量下降。造血细胞移植（HCT）是一种潜在的延长生命的治疗方法， 血液恶性肿瘤患者。HCT不同于其他癌症背景下的化疗 因为化疗的强度和毒性的严重性。以前专供年轻患者使用， 十年来，越来越多的60岁及以上的成年人接受了这种强化治疗。我们 初步数据显示，HCT后，35%的老年患者经历了显著的认知障碍 而HCT前为19%。体力活动改善老年人和其他疾病幸存者的认知功能 癌的虽然未在接受HCT的老年人中进行测试，但我们假设增加体力活动可以 还能改善这一弱势群体的认知功能。本提案的目的是适应和测试 一项以证据为基础的身体活动干预，老年人社区健康活动模式计划II （CHAMPS II），在HCT环境中改善60岁及以上成人的认知功能。这个程序是 有效增加患有多种慢性疾病的久坐社区老年人的身体活动 条件我们将迭代地适应和实施CHAMPS-II分三波。在每一波中，2-4 患者/护理伙伴二人组将参与多阶段、轻至中等强度的身体活动计划。 我们将使用类型1混合有效性-实施设计来确定 与主动控制条件相比，适应性干预改善认知功能（每组N = 34）。 这种新颖的试验设计跨越了有效性和实施研究，以加速 为老年癌症患者实施身体活动干预措施。身体活动的翻译 临床实践中的干预措施在癌症生存率方面仍然具有挑战性，尽管有令人鼓舞的证据表明， 在改善功能结局和生活质量方面的疗效。成为一名独立的研究者， 开发，实施和传播预防认知能力下降和改善功能的干预措施 对于老年癌症患者，Koll博士需要额外的培训和经验：1）体力活动 运动训练的促进和原则; 2）混合有效性的设计和实施 临床试验;和3）执行翻译研究所需的领导和项目管理技能， 研究人员和临床医生之间的合作。优秀的导师和顾问团队支持这一点 具有老年医学（Fisher），行为和实施科学（Estabrooks），临床 老年人和癌症人群的运动试验（Ehlers）、老年肿瘤学（Wildes）、认知障碍和 认知老化（Murman）和混合方法（Jones）。培训和研究计划将使科尔博士 成为为数不多的老年医学专家在认知和认知增强干预老年人之一， 患有癌症的成年人。

PROJECT SUMMARY Cancer and treatment-related cognitive changes cause distress, hinder resumption of normal routine and roles, and worsen quality of life. Hematopoietic cell transplantation (HCT) is a potentially life-prolonging treatment for patients with hematological malignancies. HCT differs from the delivery of chemotherapy in other cancer settings due to the intensity of chemotherapy and severity of toxicity. Previously reserved for younger patients, in the past decade a growing number of adults 60 years of age and older have received this intense treatment. Our preliminary data shows that post-HCT, 35% of older patients experience significant cognitive impairment compared to 19% pre-HCT. Physical activity improves cognitive function in older adults and survivors of other cancers. While untested in older adults undergoing HCT, we hypothesize that increasing physical activity can also improve cognitive function in this vulnerable population. The objective of this proposal is to adapt and test an evidence-based physical activity intervention, The Community Health Activities Model Program for Seniors II (CHAMPS II), in the HCT setting to improve cognitive function for adults 60 years and older. This program is effective in increasing physical activity for sedentary community-dwelling older adults with multiple chronic health conditions. We will iteratively adapt and implement CHAMPS-II in three waves. During each wave, 2-4 patient/care-partner dyads will participate in a multi-phase, light- to moderate-intensity physical activity program. We will use a Type 1 hybrid effectiveness-implementation design to determine the preliminary effectiveness of the adapted intervention to improve cognitive function compared to an active control condition (N = 34 per group). This novel trial design spans the effectiveness and implementation research to accelerate the translation of physical activity interventions into practice for older adults with cancer. The translation of physical activity interventions into clinical practice remains challenging within cancer survivorship, despite promising evidence of efficacy in improving functional outcomes and quality of life. To become an independent researcher who develops, implements, and disseminates interventions that prevent cognitive decline and improve functional outcomes for older patients with cancer, Dr. Koll requires additional training and experience in: 1) physical activity promotion and principles of exercise training; 2) design and conduct of hybrid effectiveness-implementation clinical trials; and 3) leadership and project management skills needed to execute translational studies requiring collaboration between researchers and clinicians. An outstanding team of mentors and advisors support this proposal with expertise in geriatrics (Fisher), behavioral and implementation science (Estabrooks), clinical exercise trials in older adult and cancer populations (Ehlers), geriatric oncology (Wildes), cognitive disorders and cognitive aging (Murman), and mixed methods (Jones). The training and research plan will position Dr. Koll to become one of the few geriatricians with expertise in cognition and cognition-enhancing interventions in older adults with cancer.