Prehabilitation of Veterans with Exercise and Nutrition (PREVENT)

通过运动和营养对退伍军人进行康复训练（预防）

• 批准号: 10311096
• 负责人: Atilio Barbeito
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2023-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10311096
• 关键词: Accelerometer; Activities of Daily Living; Adherence; Adverse event; Aerobic; Anxiety; Aortic Aneurysm; Caring; Clinical; Counseling; Country; Cystectomy; Data; Dietary Intervention; Elements; Enrollment; Ensure; Exercise; Future; Goals; Home; Hospitals; Institution; Intervention; Measures; Mental Depression; Monitor; Multivitamin; Nutritional; Nutritional Support; Nutritional status; Operative Surgical Procedures; Outcome; Participant; Patients; Perioperative; Perioperative complication; Physical Fitness; Physical Function; Physical Medicine; Physical Rehabilitation; Physical activity; Pilot Projects; Population; Postoperative Complications; Postoperative Period; Preparation; Proteins; Protocols documentation; Publishing; Quality of life; Recovery of Function; Rehabilitation therapy; Reporting; Research; Risk; Safety; Services; Socialization; Stress; Supervision; Supplementation; System; Technology; Testing; Text Messaging; Time; Training; Transportation; Travel; Veterans; Visit; Vitamin D supplementation; Whey Protein; Work; base; cohort; design; exercise intensity; exercise intervention; exercise program; exercise training; fitness; follow-up; functional status; health related quality of life; high risk; high risk population; hospital readmission; improved; improved outcome; innovation; interest; multimodality; muscle form; novel; nutrition; operation; patient oriented; physiologic stressor; programs; randomized trial; remote delivery; repaired; rural area; surgery outcome; surgical risk; telehealth

Approximately half a million operations are performed each year in VA hospitals across the country.4 Veterans undergoing high-risk surgery have a 1 in 5 chance of suffering complications, a 1 in 10 chance of being readmitted to the hospital within 30 days, and a 1 in 50 chance of dying within 30 days.4 Long-term survival is significantly reduced for those patients who have perioperative complications, even if they survive to leave the hospital.5 Low fitness and poor functional status are among the strongest predictors of postsurgical complications.1,2 Prehabilitation takes advantage of the weeks leading up to surgery in order to improve fitness, mobility and nutrition in preparation for the upcoming surgical stress.13 Indeed, prehabilitation has been shown to improve fitness and reduce complications and quality of life in high-risk surgical patients.7,9,12 The most effective prehabilitation programs combine exercise plus nutritional support (are multimodal), and provide exercise that is supervised and individualized, ensuring the appropriate exercise intensity and increasing it gradually according to improvements in fitness and strength. Most supervised prehabilitation programs are facility-based, but travel time, distance, and transportation limit participation.10 Unfortunately, home-based prehabilitation programs have shown small effect sizes and low compliance rates, likely because adequate training intensity is required in programs of such short duration, which is often not achieved with unsupervised home-based programs.14-16 [[A prehabilitation program that is delivered using telehealth would be ideal, because it combines accessibility with supervision, encouraging compliance and ensuring adequate training intensity, but such programs do not currently exit within the VA]]. [[We aim to determine the feasibility, acceptability, safety, and effect size estimates for outcomes of interest of a short-term (3-4 week) multimodal prehabilitation intervention that is supervised and individualized, yet is delivered at home using telehealth technology.]] The exercise program will consist of 3 days of supervised telehealth exercise sessions per week consisting of moderate intensity aerobic training and resistive and functional training. Nutritional support will consist of tailored nutritional advice, whey protein supplementation and multivitamin and vitamin D supplementation during prehabilitation and following hospital discharge for [[6 weeks]]. Compliance with the interventions will be enhanced by daily automated text messages using the VA Annie App. In addition, participants will be contacted weekly in order to identify problems with compliance and to provide counseling. [[Post-operative exercise sessions will resume as early as 1 week postoperatively and progressed as allowed according to the type of surgery. Text messages and weekly calls will also resume postoperatively until the 6-week follow-up visit to encourage progressive increases in unsupervised physical activity and nutritional support. Objective physical activity data will be collected using physical activity trackers, which patients will wear from the time of enrollment until the 6-week postoperative follow-up visit. Follow-up will continue for a total of 6 months postoperatively.]] The main outcomes of interest include feasibility (acceptance rates), acceptability (compliance rates), and safety (number of adverse events). We will also measure changes in fitness, nutritional state, anxiety and depression, and health-related quality of life throughout the study period in order to estimate effect sizes, which will inform a future randomized trial. The proposed work combines several innovations in the delivery of exercise and nutrition and applies them to the perioperative high-risk population for the first time. It constitutes the first step toward the study of a multimodal “tele-prehabilitation” program on postoperative and long-term outcomes following high-risk surgery.

全国各地的退伍军人医院每年进行约50万例手术。4退伍军人 接受高风险手术的人有五分之一的机会出现并发症，十分之一的机会再次入院， 在30天内送到医院，在30天内死亡的几率为1/50。 对于那些有围手术期并发症的患者，即使他们存活下来离开医院，也会减少。 低体能和功能状态差是术后最强的预测因素之一。 并发症。1，2 Prehadrit利用手术前几周的时间来改善健康， 为即将到来的手术压力做准备。13事实上， 改善高危手术患者的健康状况并减少并发症和生活质量。7，9，12最 有效早产计划结合了联合收割机运动和营养支持（是多模式的）， 有监督的个性化锻炼，确保适当的锻炼强度，并增加锻炼强度。 逐渐根据健身和力量的改善。大多数有监督的学前教育项目都是 基于设施，但旅行时间，距离和交通限制了参与。 学前教育项目的效果较小，依从率较低，这可能是因为 在如此短的时间内，训练强度是必需的，这通常是在无人监督的情况下无法实现的。 14 -16 [[使用远程保健提供的产前保健方案是理想的， 因为它将无障碍与监督相结合，鼓励遵守并确保充分的培训 强度，但这样的程序目前不退出VA]]。 [[We旨在确定以下关注结局的可行性、可接受性、安全性和效应量估计值： 短期（3-4周）多模式早产干预，是监督和个性化，但 使用远程保健技术在家中提供。]]锻炼计划将包括3天的监督 每周的远程保健运动课程，包括中等强度的有氧训练和阻力训练， 功能训练。营养支持将包括量身定制的营养建议，乳清蛋白 在产前和产后补充多种维生素和维生素D 出院[6周]。将通过每日自动发送文本，加强对干预措施的遵守 使用VA Annie应用程序发送消息。此外，将每周与参与者联系，以确定 问题，并提供咨询。[[术后锻炼会议将尽早恢复， 术后1周，根据手术类型，进展情况允许。短信和每周 在术后6周随访访视前，还将恢复电话，以鼓励 无监督的体力活动和营养支持。客观的身体活动数据将使用 体力活动追踪器，患者将从入组时佩戴至术后6周 后续访问。术后随访将持续6个月。]] 关注的主要结果包括可行性（接受率）、可接受性（依从率）和安全性 （不良事件数量）。我们还将测量健康、营养状态、焦虑和抑郁的变化， 以及整个研究期间与健康相关的生活质量，以估计效应量， 未来的随机试验拟议的工作结合了几个创新的交付行使和 并首次将其应用于围手术期高危人群。这是第一步 旨在研究多模式“远程妊娠”计划对术后和长期结局的影响 在高风险手术后