Influence of exercise training and intensity on cerebral blood flow regulation and cognitive function in mid-life adults with cardiovascular disease.

运动训练和强度对患有心血管疾病的中年成年人脑血流调节和认知功能的影响。

• 批准号: 10641959
• 负责人: BRUCE D JOHNSON
• 金额: $ 15.9万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10641959
• 关键词: Acceleration; Adult; Attenuated; Award; Biological Markers; Blood Pressure; Blood Vessels; Brain; Cardiac; Cardiac rehabilitation; Cardiometabolic Disease; Cardiovascular Diseases; Cerebrovascular Circulation; Characteristics; Clinical Trials; Control Groups; Data; Dementia; Development; Disease; Event; Exercise; Grant; Health; Impaired cognition; Impairment; Incidence; Interval training; Life; Modification; Outcome; Patients; Population; Prevention Research; Prevention strategy; Randomized, Controlled Trials; Regulation; Research; Research Project Grants; Rest; Risk; Risk Factors; Secondary to; Structure; Time; Training; Translating; United States National Institutes of Health; Vascular Diseases; Ventricular; cardiorespiratory fitness; cardiovascular disorder risk; cerebral atrophy; cerebral hypoperfusion; cerebrovascular; cognitive enhancement; cognitive function; design; exercise intensity; exercise prescription; exercise training; follow-up; gray matter; high risk; improved; indexing; middle age; modifiable risk; programs; response

PROJECT SUMMARY Rates of cognitive impairment and dementia are on the rise with incidence set to triple by 2050. Mid-life is an important time for prevention strategies, as around 30% of cognitive impairment has been attributed to modifiable risk factors at this life stage. Furthermore, adults with cardiovascular disease (CVD) are at even higher risk of cognitive decline, which is further accelerated by a cardiac-related event. Cerebral hypoperfusion (reduced brain blood flow) appears to be a significant contributor to cognitive decline, which can occur as a result of vascular dysfunction and impairment of cerebral blood flow (CBF) regulation. In contrast, higher cardiorespiratory fitness shows protection against cognitive decline, brain atrophy, and reductions in CBF. Therefore, strategies that improve vascular function, cardiorespiratory fitness, and other modifiable CVD risk factors, such as exercise, should be further investigated as prevention strategies in mid-life adults at high risk of cognitive decline. Cardiac rehabilitation (exercise and risk factor modification program) may provide an ideal preventative strategy to attenuate the cognitive decline in mid-life adults who have had a cardiac-related event. Furthermore, in patients attending cardiac rehabilitation, high intensity interval training (HIIT) has been shown to double improvements in cardiorespiratory fitness and vascular function, compared with moderate intensity continuous training (MICT). Whether these greater improvements translate into greater improvements for cerebrovascular function, CBF regulation, and cognitive function is unknown. This randomized controlled trial involving mid-life adults with CVD, will investigate the effect of exercise intensity (HIIT compared with MICT) during a 12-week cardiac rehabilitation (3 sessions/week) on CBF regulation and cognitive function. We hypothesize that HIIT during cardiac rehabilitation will lead to greater improvements in CBF regulation (as cerebrovascular reactivity) than MICT, and as a result we hypothesize that HIIT will lead to greater improvements in cognitive function compared with MICT. Furthermore, this study will include an observational control group of patients who decline cardiac rehabilitation, to investigate the potential benefit for exercise-based cardiac rehabilitation compared with no cardiac rehabilitation. We hypothesize that patients attending exercise-based cardiac rehabilitation will have greater improvements in CBF regulation (as cerebrovascular reactivity) and cognitive function, compared with patients who do not attend cardiac rehabilitation. We will also explore changes in resting CBF, brain structure, neurotrophic biomarkers, and ambulatory blood pressure, as well as other indices of CBF regulation. This exploratory study will help to generate pilot data that will aid in the design of ongoing research and proposals for larger grants investigating 1) specific exercise prescription to enhance cognitive health in mid- life adults, and 2) potential benefits for cardiac rehabilitation participation in this population.

项目摘要 认知障碍和痴呆症的发病率正在上升，到2050年发病率将增加两倍。中年是 这是预防策略的重要时机，因为大约30%的认知障碍归因于 可改变的危险因素。此外，患有心血管疾病（CVD）的成年人 认知能力下降的风险更高，心脏相关事件会进一步加速认知能力下降。脑 灌注不足（脑血流量减少）似乎是认知能力下降的一个重要因素， 可由于血管功能障碍和脑血流（CBF）调节受损而发生。在 相比之下，较高的心肺适应性显示出对认知能力下降、脑萎缩和 CBF的减少。因此，改善血管功能、心肺适应性和其他功能的策略， 可改变的心血管疾病风险因素，如运动，应进一步研究作为预防策略， 中年人有认知能力下降的高风险。 心脏康复（运动和危险因素修正计划）可能提供理想的预防措施， 缓解发生心脏相关事件的中年人认知能力下降的策略。 此外，在参加心脏康复的患者中，高强度间歇训练（HIIT）已被用于治疗心脏病。 与中度相比， 强度持续训练（MICT）。这些更大的改进是否会转化为更大的 脑血管功能、CBF调节和认知功能的改善尚不清楚。 这项随机对照试验涉及中年心血管疾病患者，将调查运动的影响 在12周的CBF心脏康复（3次/周）期间的强度（HIIT与MICT相比） 调节和认知功能。我们假设心脏康复期间的HIIT将导致更大的 改善CBF调节（脑血管反应性）比MICT，因此，我们假设 HIIT与MICT相比将导致认知功能的更大改善。此外，这项研究 将包括一个观察性对照组的患者谁拒绝心脏康复，调查 与无心脏康复相比，运动心脏康复的潜在获益。我们 假设参加运动心脏康复的患者在以下方面会有更大的改善： CBF调节（如脑血管反应性）和认知功能，与不调节的患者相比 参加心脏康复治疗我们还将探讨静息CBF，脑结构，神经营养 生物标志物和动态血压，以及CBF调节的其他指标。 这项探索性研究将有助于产生试点数据，有助于设计正在进行的研究， 建议更大的赠款调查1）具体的运动处方，以提高中期认知健康， 终身成年人，和2）在该人群中参与心脏康复的潜在益处。

项目成果

Practical guidelines for exercise prescription in patients with chronic heart failure.

慢性心力衰竭患者运动处方实用指南。

• DOI: 10.1007/s10741-023-10310-9
• 发表时间: 2023
• 期刊: Heart failure reviews
• 影响因子: 4.6
• 作者: Taylor,JennaL;Myers,Jonathan;Bonikowske,AmandaR
• 通讯作者: Bonikowske,AmandaR