The Effect of Interval Exercise on Functional Outcomes in Veterans with COPD and OSA

间歇运动对患有慢性阻塞性肺病和阻塞性睡眠呼吸暂停的退伍军人功能结果的影响

• 批准号: 10424722
• 负责人: Madalina Macrea
• 金额: --
• 依托单位: SALEM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10424722
• 关键词: Accelerometer; Address; Behavioral; C-reactive protein; Chronic Obstructive Pulmonary Disease; Chronic lung disease; Classification; Complex; Continuous Positive Airway Pressure; Data; Disease; Drowsiness; Dyspnea; Economic Burden; Educational Intervention; Endothelium; Excessive Daytime Sleepiness; Exercise; Exhibits; Experimental Designs; Feedback; Future; General Population; Glucose; Goals; Health; Health Benefit; Home; Individual; International; Interval training; Knowledge; Life; Life Style; Lipids; Literature; Lung diseases; Measures; Mediating; Morbidity - disease rate; Obstructive Sleep Apnea; Outcome; Patients; Phenotype; Physical activity; Pilot Projects; Premature aging syndrome; Psyche structure; Quality of life; Reporting; Risk; Scientist; Self Efficacy; Serum; Surveys; Syndrome; Techniques; Testing; Time; Training; Translations; Veterans; base; behavioral study; cardiorespiratory fitness; cardiovascular health; career; clinical phenotype; common symptom; design; disability; exercise intervention; exercise rehabilitation; exercise training; functional decline; functional outcomes; functional status; healthy lifestyle; high risk; implementation barriers; improved; mortality; novel; optimal treatments; patient population; preference; randomized trial; rehabilitation research; response; standard of care; translational barrier; treatment as usual

The term "Overlap Syndrome" (OS) is used to describe the presence of both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) in a single patient. Due to premature aging, patients with OS are prone to developing functional decline up to 20 years earlier than the general population. The International Classification of Functioning, Disability and Health (ICF) evaluates functional status in chronic pulmonary disease globally in 5 domains. We propose to study validated outcomes in 3 of these domains: 1) participation in life situations, measured by the 36-item Short Form Survey (SF-36); 2) physical activity (PA), measured by daily step counts; and 3) cardiovascular health, measured by cardiorespiratory fitness (CRF), flow-mediated endothelial dilation (FMD) and serum hs-CRP, lipids and glucose. Our long-term goal is to develop an exercise strategy tailored to Veterans with OS which will reduce their risk of functional decline through increased PA. Excessive daytime sleepiness (EDS) is a common symptom of OSA that persists in a third of patients despite optimal treatment with continuous positive airway pressure (CPAP). EDS is associated with decreased quality of life and daily activity and increased risk of CVD and further, improves with exercise. Understanding the relationship of EDS with these domains of functional status within the context of an exercise intervention provides an opportunity to tailor exercise strategies to this complex patient population. We propose to investigate Veterans with EDS-OS because they are at highest risk for functional decline yet have the greatest barriers to exercise. Exercise trials performed in patients with COPD or OSA show that moderate intensity continuous training (MICT) decreased EDS and increased SF-36, PA, CRF and hs-CRP. MICT remains underutilized despite its well-established benefits. Thus, we propose to test moderate intensity interval training (MIIT), a novel 5-minute interval-based exercise intervention that meets the individual needs and capacities of Veterans with OS. In addition, we will study behavioral barriers to exercise using the self-efficacy for exercise (SEE) Scale and Brainwriting Premortem, an efficient stakeholder feedback technique, to facilitate the design of a future home- based MIIT intervention and its successful translation into bouts of daily PA (future Merit Application). We propose a randomized trial of MIIT (5-minute intervals at 50% VO2peak 3 times weekly for 12 weeks) in Veterans with OS vs. standard of care controls. The Epworth Sleepiness Scale (ESS) will be assessed at baseline. Veterans with the EDS-OS phenotype (ESS >10) will enter the MIIT trial. The specific aims are: 1) To determine the effect of MIIT on participation in life situations compared to usual care control Hypothesis 1: MIIT improves: a) SF-36 physical and mental scores; and b) Epworth Sleepiness Scale. Hypothesis 2. The EDS-OS phenotype will be associated with poor SF-36 scores and will exhibit improvement with MIIT that is mediated by improved Epworth Sleepiness Scale. 2) To determine the effect of MIIT on physical activity compared to usual care control Hypothesis 3: MIIT increases daily step count as measured by accelerometry. Hypothesis 4. The EDS-OS phenotype will be associated with greater limitations in baseline step count and will exhibit improvement with MIIT that is mediated by improved Epworth Sleepiness Scale. 3) To determine the effect of MIIT on cardiovascular health compared to usual care control Hypothesis 5: MIIT a) increases CRF (VO2peak) and FMD; and b) decreases serum hs-CRP, lipids and glucose Hypothesis 6: The EDS-OS phenotype will be associated with greater limitations in baseline cardiovascular health and will exhibit improvement with MIIT that is mediated by improved Epworth Sleepiness Scale. 4) To explore behavioral barriers to translation of MIIT into sustainable healthy lifestyle change Hypothesis 7: Low self-efficacy for exercise is associated with poor compliance to MIIT. Hypothesis 8: Brainwriting Premortem will identify pre-implementation barriers to a future home-based MIIT.

术语“重叠综合征”（OS）用于描述慢性阻塞性肺疾病和慢性阻塞性肺疾病两者的存在。 阻塞性睡眠呼吸暂停（OSA）和慢性阻塞性肺疾病（COPD）。由于过早老化，OS患者 比一般人早20年出现功能衰退。国际 功能、残疾和健康分类（ICF）评估慢性肺疾病的功能状态 在全球5个领域。我们建议在这些领域中的3个领域研究有效的结果：1）参与生活 情况，通过36项简明量表（SF-36）测量; 2）身体活动（PA），通过每日步数测量 计数;和3）心血管健康，通过心肺适应性（CRF）、流量介导的内皮细胞（内皮细胞）和/或血管内皮细胞（内皮细胞）测量。 扩张（FMD）和血清hs-CRP、血脂和血糖。我们的长期目标是制定一个锻炼策略 专为患有OS的退伍军人量身定制，通过增加PA降低其功能下降的风险。 白天过度嗜睡（EDS）是OSA的常见症状，三分之一的患者会持续存在 尽管使用持续气道正压通气（CPAP）进行了最佳治疗。EDS与减少 生活质量和日常活动，增加心血管疾病的风险，并进一步改善运动。了解 在运动干预的背景下，EDS与这些功能状态域的关系提供了 这是一个为这个复杂的患者群体量身定制锻炼策略的机会。我们建议调查退伍军人 EDS-OS是因为他们的功能下降风险最高，但运动障碍最大。 在COPD或OSA患者中进行的运动试验表明，中等强度的持续训练 （MICT）降低EDS，升高SF-36、PA、CRF和hs-CRP。尽管其技术能力得到了充分利用， 完善的福利。因此，我们建议测试中等强度间歇训练（MIIT），一种新的5分钟 基于间隔的运动干预，满足退伍军人的个人需求和能力与OS。 此外，我们还将使用运动自我效能量表（SEE）研究运动的行为障碍， 大脑写作事前分析，一种有效的利益相关者反馈技术，以促进未来住宅的设计- 基于MIIT的干预及其成功转化为每日PA（未来的Merit应用）。 我们提出了一项MIIT的随机试验（以50%VO2peak间隔5分钟，每周3次，持续12周） 在有OS的退伍军人与标准治疗对照中的比较。埃普沃思嗜睡量表（ESS）将在 基线。具有EDS-OS表型（ESS >10）的退伍军人将进入MIIT试验。具体目标是： 1)确定与常规护理对照相比，MIIT对参与生活状况的影响 假设1：MIIT改善：a）SF-36身体和精神评分;和B）埃普沃思嗜睡量表。 假设2. EDS-OS表型将与SF-36评分较差相关，并将显示改善 通过改良的埃普沃思嗜睡量表介导的MIIT。 2)确定与常规护理对照相比，MIIT对体力活动的影响 假设3：工信部增加了加速度计测量的每日步数。 假设4. EDS-OS表型将与基线步数的更大限制相关， 通过改善的埃普沃思嗜睡量表介导的MIIT改善。 3)确定与常规护理对照相比，MIIT对心血管健康的影响 假设5：MIIT a）增加CRF（VO 2峰值）和FMD;和B）降低血清hs-CRP、脂质和葡萄糖 假设6：EDS-OS表型将与基线心血管疾病的更大限制相关。 健康，并将表现出MIIT的改善，这是由改进的埃普沃思嗜睡量表介导的。 4)探索将MIIT转化为可持续健康生活方式改变的行为障碍 假设7：运动自我效能低与对MIIT的依从性差相关。 假设8：大脑写作事前分析将识别未来基于家庭的工业和信息化部的实施前障碍。