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

促进身体活动以改善接受造血细胞移植 (HCT) 的老年人的认知功能

基本信息

批准号：
10298917
负责人：
Thuy Koll
金额：
$ 19.02万
依托单位：
UNIVERSITY OF NEBRASKA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-30 至 2026-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10298917
关键词：
Address Adoption Adult Affect Age Age-Years Attention Behavioral Sciences Brain Cancer Survivor Cancer Survivorship Chronic Clinical Cognition Cognition Disorders Cognitive aging Collaborations Communities Community Health Data Dissemination and Implementation Distress Effectiveness Elderly Evaluation Exercise Exercise Test Feedback Future Geriatrics Guidelines Health Hematologic Neoplasms Hospitalization Immune system Immunosuppression Impaired cognition Individual Inflammation Infusion procedures Intervention Interview K-Series Research Career Programs Knowledge Leadership Life Light Malignant Neoplasms Measures Memory Mentors Mentorship Methods Modeling Neuropsychological Tests Oncology Outcome Pathway interactions Patient Care Patients Perception Performance Physical Function Physical activity Population Positioning Attribute Process Quality of life Radiation therapy Reach, Effectiveness, Adoption, Implementation, and Maintenance Research Research Personnel Risk Role Severities Structure Survivors Target Populations Testing Toxic effect Training Translations Transplant Recipients Transplantation Vulnerable Populations Work active control base cancer therapy cardiorespiratory fitness chemotherapy clinical practice clinical trial implementation cognitive benefits cognitive change cognitive function collaborative approach design disability effectiveness evaluation effectiveness implementation design effectiveness implementation study effectiveness research evidence base executive function exercise intervention exercise training experience functional outcomes hematopoietic cell transplantation high risk implementation determinants implementation intervention implementation research implementation science implementation strategy improved innovation member novel older patient preservation prevent primary outcome programs secondary outcome sedentary activity skills stem cells translational study trial design

项目摘要

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.

项目概要癌症和治疗相关的认知变化会导致痛苦，阻碍正常生活和角色的恢复，并恶化生活质量。造血细胞移植（HCT）是一种潜在的延长生命的治疗方法患有血液系统恶性肿瘤的患者。 HCT 不同于其他癌症环境中的化疗由于化疗的强度和毒性的严重程度。过去是为年轻患者保留的十年来，越来越多的 60 岁及以上成年人接受了这种强化治疗。我们的初步数据显示，HCT 后，35% 的老年患者出现明显的认知障碍相比之下，HCT 前为 19%。体育活动可以改善老年人和其他幸存者的认知功能癌症。虽然未经在接受 HCT 的老年人中进行测试，但我们假设增加体力活动可以还可以改善这一弱势群体的认知功能。该提案的目的是适应和测试基于证据的身体活动干预措施，老年人社区健康活动模式计划 II (CHAMPS II)，在 HCT 环境中改善 60 岁及以上成年人的认知功能。这个程序是有效增加患有多种慢性病的社区久坐老年人的身体活动状况。我们将分三波迭代调整和实施CHAMPS-II。每波期间，2-4 患者/护理伙伴二人组将参加多阶段、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以下项目的初步有效性：与主动控制条件相比，调整后的干预措施可改善认知功能（每组 N = 34）。这种新颖的试验设计涵盖了有效性和实施研究，以加速转化对患有癌症的老年人进行身体活动干预。身体活动的翻译尽管有希望的证据表明，在癌症生存方面对临床实践进行干预仍然具有挑战性改善功能结果和生活质量的功效。成为一名独立研究员制定、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的结果，科尔博士需要额外的培训和经验：1）身体活动运动训练的推广及原则； 2）混合有效性实施的设计和实施临床试验； 3) 执行转化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为此提供支持具有老年病学（Fisher）、行为和实施科学（Estabrooks）、临床专业知识的提案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能够成为少数在老年人认知和认知增强干预方面拥有专业知识的老年科医生之一患有癌症的成年人。