Improving Cognition Through Telehealth Aerobic Exercise and Cognitive Training After a First Schizophrenia Episode

在首次精神分裂症发作后通过远程医疗有氧运动和认知训练提高认知能力

• 批准号: 10647268
• 负责人: KEITH H NUECHTERLEIN
• 金额: $ 125.44万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-01 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10647268
• 关键词: Address; Advocate; Aerobic Exercise; Applications Grants; Brain-Derived Neurotrophic Factor; Chronic; Clinic; Clinical Trials; Cognition; Cognitive; Cognitive deficits; Combined Modality Therapy; Communities; Data; Disease; Educational Intervention; Educational process of instructing; Exercise; Future; Individual; Intervention; Investigational Therapies; Measures; Methods; Motivation; National Institute of Mental Health; Neuronal Plasticity; Online Systems; Outcome; Outpatients; Persons; Physical Exercise; Public Health; Research; Research Priority; Schizophrenia; Schools; Signal Transduction; Synaptic plasticity; Testing; Text Messaging; Time; Training; Training Programs; Treatment Efficacy; United States National Institutes of Health; Videoconferencing; Work; Wrist; cognitive function; cognitive training; computerized; confirmatory clinical trial; cost; design; disability; efficacy validation; exercise program; exercise training; first episode schizophrenia; fitbit; fitness; functional outcomes; improved; innovation; intrinsic motivation; neurotrophic factor; novel; portability; primary outcome; programs; psychotic; severe mental illness; telehealth; videoconference

ABSTRACT This R01 confirmatory efficacy clinical trial application involves telehealth delivery of a treatment approach to improving core cognitive deficits in schizophrenia, using an experimental therapeutic design that NIMH has advocated. Our telehealth intervention approach combines neurotrophin-releasing aerobic exercise training with neuroplasticity-based cognitive training to enhance the impact of cognitive training on cognition. Telehealth cognitive training and telehealth physical exercise training address the NIMH strategic research priorities for creating innovative interventions that can be “disseminated broadly” and “readily taught to the existing workforce with minimal cost.” Cognitive training and physical exercise have each been shown separately to improve cognitive deficits in schizophrenia to some degree, and our previous research has shown that when combined they show promise of improving cognition and work/school functioning more than either treatment alone. In our preliminary studies, comparing the combined treatment with cognitive training without aerobic exercise, we find evidence of brain-derived neurotrophic factor (BDNF) target engagement, differential improvement in cognition, and prediction of later cognitive outcome from initial BDNF gain. The portability of the proposed intervention outside of academic research programs will be demonstrated by providing the interventions via videoconferencing. The proposed study will incorporate additional methods, such as Fitbit wrist-worn fitness trackers, web-based motivational support, and personalized text messages to encourage motivation and to maximize participation in the exercise condition. We will use Mature BDNF as our primary target and cognition as our primary outcome. We hypothesize that the increases in Mature BDNF associated with regular aerobic exercise provide a platform which allows neuroplasticity-based cognitive training to enhance cognition more quickly than is typically observed in studies of cognitive training alone. We hypothesize that combining aerobic exercise with cognitive training will produce larger cognitive improvements, relative to cognitive training without exercise, with all interventions conducted remotely via videoconferencing. Further, we hypothesize that a greater proportion of exercise sessions completed will be associated with greater cognitive improvement. The research will also test whether intrinsic motivation at baseline and increases in intrinsic motivation over time predict the extent of participation in the telehealth physical exercise program. Cognitive deficits in persons with schizophrenia are a major influence on their everyday functioning in the community. We target the period shortly after a first episode of schizophrenia to maximize the generalization of cognitive improvement to real-world functional outcome, before chronic disability is established. This telehealth cognitive training plus aerobic exercise clinical trial has the potential to test a hypothesized mechanism of action and to make a meaningful difference in the lives of individuals with severe mental illness.

摘要 此R01确认疗效临床试验应用涉及远程医疗提供治疗 一种改善精神分裂症核心认知缺陷的方法，使用一种实验性治疗设计 NIMH一直主张。我们的远程健康干预方法结合了释放神经营养素的有氧运动 训练以神经可塑性为基础的认知训练，增强认知训练对认知的影响。 远程保健认知训练和远程保健体育锻炼训练解决了NIMH的战略研究 优先创造可“广泛传播”和“易于教授”的创新干预措施 以最低的成本拥有现有的劳动力。认知训练和体育锻炼都已展示出来。 分别在一定程度上改善精神分裂症的认知缺陷，我们之前的研究已经 结果表明，当他们结合在一起时，他们表现出的改善认知和工作/学校功能的前景比 要么单独治疗。在我们的初步研究中，将综合治疗与认知训练进行比较 在没有有氧运动的情况下，我们发现了脑源性神经营养因子(BDNF)靶标参与的证据， 认知方面的差异改善，并根据最初的脑源性神经营养因子的增加预测后来的认知结果。这个 建议的干预措施在学术研究项目之外的可移植性将通过以下方式进行证明 通过视频会议提供干预。拟议的研究将纳入其他方法， 例如Fitbit手腕佩戴健身跟踪器、基于Web的激励支持和个性化文本消息，以 鼓励动力，在锻炼条件下最大限度地参与。我们将使用成熟的BDNF作为 我们的主要目标和认知是我们的主要结果。我们假设成熟BDNF的增加 与定期有氧运动相关的提供了一个平台，允许基于神经可塑性的认知 训练以更快的速度提高认知能力，而不是仅仅在认知训练的研究中观察到。我们 假设有氧运动和认知训练相结合将产生更大的认知改善， 相对于没有运动的认知训练，所有干预都通过视频会议远程进行。 此外，我们假设，完成的锻炼课程的更大比例将与 认知能力得到了更大的改善。这项研究还将测试基准和基准的内在动机 随着时间的推移，内在动机的增加可以预测参与远程健康体育锻炼的程度 程序。精神分裂症患者的认知缺陷是影响其日常功能的主要因素 社区。我们的目标是精神分裂症第一次发作后不久的时期，以最大限度地 认知改善对现实世界功能结果的概括，在慢性残疾发生之前 已经成立了。这项远程健康认知训练加有氧运动的临床试验有可能测试 假想的行动机制，并在严重疾病患者的生活中产生有意义的改变 精神疾病。