Enhanced Home-Based Exercise Therapy for Peripheral Arterial Disease through Mobile Health and Remote Monitoring

通过移动健康和远程监控增强外周动脉疾病的家庭运动疗法

• 批准号: 10686930
• 负责人: Arash Harzand
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-10-01 至 2026-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10686930
• 关键词: Accelerometer; Activities of Daily Living; Adherence; Adult; Affect; American; Amputation; Behavioral; Body Weight decreased; COVID-19 pandemic; Cardiac rehabilitation; Cellular Phone; Clinical; Combined Modality Therapy; Complex; Coronary Arteriosclerosis; Creativeness; Data; Devices; Diabetes Mellitus; Education; Elements; Eligibility Determination; Enhancement Technology; Enrollment; Exercise; Exercise Therapy; Face; Goals; Guidelines; Health; Health Technology; Home; Hospitals; Hypertension; Impairment; Income; Indirect Calorimetry; Intervention; Interview; Leadership; Leg; Life Style; Life Style Modification; Light; Measurement; Monitor; Myocardial Infarction; Oxygen Consumption; Pain in lower limb; Patient Education; Patients; Peripheral arterial disease; Physical activity; Physicians; Population; Provider; Quality of Care; Quality of life; Recommendation; Rehabilitation Centers; Rehabilitation therapy; Reproducibility; Resolution; Risk; Risk Factors; Safety; Scientist; Smoking; Stroke; Structure; Symptoms; Testing; Training; Travel; Treatment outcome; Vertebral column; Veterans; Walking; aged; behavior change; claudication; cost; design; evidence base; exercise prescription; exercise program; exercise regimen; exercise rehabilitation; experience; functional independence; functional loss; functional outcomes; high risk; improved; improved mobility; informant; innovation; mHealth; mortality risk; multi-component intervention; novel; participant enrollment; patient oriented; primary outcome; programs; randomized trial; remote monitoring; rural area; satisfaction; success; symptomatic improvement; technological innovation; tool; trial enrollment; wearable monitor

An estimated 8.5 million Americans (or 7% of US adults) and nearly 10% of veterans are estimated to have peripheral arterial disease (PAD). Significantly debilitating and negatively impacting quality of life, the primary symptom of PAD is claudication (reproducible leg pain with ambulation) that leads to impaired mobility, loss of functional independence, and a heightened risk for amputation. Veterans are at an increased risk of developing symptomatic PAD due to their disproportionately high rates of PAD risk factors such as diabetes, smoking, and hypertension, the most prominent PAD risk factors. Supervised exercise therapy is proven to decrease claudication and enhance mobility in PAD; however, fewer than 25% of eligible patients enroll. Participation in this facility-based program requires travel to a rehabilitation center 3 times per week for 12-weeks, which can be burdensome and costly for Veterans, many of whom live in rural areas and on fixed incomes. There is, therefore, a need to develop a convenient and effective alternative exercise rehabilitation program for Veterans with PAD, particularly in light of safety considerations now associated with this population’s travel to group facilities in the current COVID pandemic. A promising approach to increase access to exercise rehabilitation for PAD is remote, home-based exercise therapy (HBET). Our group has successfully delivered a smartphone-enabled HBET program to Veterans with coronary artery disease with a 3-fold increase in participation and high satisfaction (80%). To this end, we are committed to utilizing technology innovations to implement HBET for Veterans with PAD successfully. HBET programs combine self-led walking exercises with health coaching and exercise tracking with a wearable activity monitor. Adapting HBET to PAD is difficult, however, due to the added complexity of an exercise prescription that requires the patient to walk until they experience near-maximal leg pain. Even with active coaching, successfully implementing HBET for PAD with long-term adherence has been difficult in the past. Our goal, therefore, is to leverage newer mobile health (mHealth) tools to adapt HBET for PAD. We propose to test our technology-enhanced approach for HBET by partnering with a successful VA lifestyle program, MOVE!, which has demonstrated success in achieving sustained weight loss and reduced diabetes onset through lifestyle modification. As increased physical activity is a core element of MOVE!, participation may help increase adherence with HBET for PAD. Our newly proposed program, Smart MOVE!, will be a multi-component program featuring a tailored version of MOVE! and a novel mHealth device called the LifeQ to improve convenience, access, and adherence to HBET for PAD. Aim 1 (Years 1-2): Identify barriers and facilitators to MOVE! participation among Veterans with PAD. Aim 2 (Years 1-2): Evaluate the feasibility of the LifeQ device to monitor exercise during HBET Aim 3 (Years 2-5): Determine the feasibility of proceeding with Smart MOVE! through a pilot randomized trial. As a VA physician actively treating Veterans with PAD, I have seen first-hand the challenges they face in accessing guideline-directed treatments such as supervised exercise. This study will lay the groundwork and provide evidence to proceed with Smart MOVE!, a much-needed patient-centered exercise rehabilitation program for PAD. Additionally, the proposed training plan will support my progress towards becoming an independent VA rehabilitation clinician-scientist focused on improving care quality and treatment outcomes for Veterans with PAD.

据估计，有850万美国人(占美国成年人的7%)和近10%的退伍军人 有外周动脉疾病(PAD)。严重削弱和负面影响生活质量， PAD的主要症状是跛行(可重复的腿部疼痛和行走)，导致行动不便， 丧失功能独立性，截肢的风险增加。退伍军人患癌症的风险增加 由于糖尿病等PAD危险因素的比例过高而导致出现症状性PAD， 吸烟和高血压是PAD最突出的危险因素。 有监督的运动疗法被证明可以减少PAD的跛行和提高活动能力；然而， 只有不到25%的符合条件的患者登记参加。参加这一以设施为基础的计划需要前往 康复中心每周3次，为期12周，这对退伍军人来说可能是负担沉重和昂贵的，许多人 其中一部分人生活在农村地区，靠固定收入生活。因此，有必要制定一种方便和 为患有PAD的退伍军人提供有效的替代运动康复计划，特别是在安全性方面 在当前的新冠肺炎大流行中，目前与该人群前往团体设施的旅行有关的考虑因素。 一种有希望增加PAD运动康复机会的方法是远程的、基于家庭的 运动疗法(HBET)。我们的团队已经成功地将支持智能手机的HBET计划交付给 冠心病退伍军人的参与度增加了3倍，满意度很高(80%)。至 为此，我们致力于利用技术创新为具有PAD的退伍军人实施HBET 成功了。HBET项目将自主步行练习与健康指导和运动跟踪相结合 配有可穿戴式活动监控器。然而，使HBET适应PAD是困难的，因为增加了 运动处方，要求患者步行，直到他们经历几乎最大的腿部疼痛。即使是在 积极的指导，成功地为PAD实施HBET并长期坚持一直是困难的 过去时。因此，我们的目标是利用较新的移动健康(MHealth)工具使HBET适应PAD。 我们建议通过与成功的退伍军人管理局合作来测试我们针对HBET的技术增强型方法 生活方式计划，Move！，已经证明成功地实现了持续的减肥和减少 糖尿病是通过改变生活方式发病的。因为增加体力活动是运动的核心要素！ 参与可能有助于增加对HBET用于PAD的依从性。我们新提出的计划，聪明的举动！ 将是一个多组件程序，具有量身定做的版本的Move！和一种名为mHealth的新型设备 LifeQ，以提高PAD的便利性、访问和对HBET的遵从性。 目标1(1-2岁)：确定要移动的障碍和促进者！患有PAD的退伍军人的参与。 目标2(1-2岁)：评估LifeQ设备在HBET期间监测运动的可行性 目标3(第2-5年)：确定继续实施Smart Move的可行性！通过飞行员 随机试验。 作为一名积极治疗退伍军人PAD的退伍军人内科医生，我亲眼目睹了他们面临的挑战 在获得指导方针的治疗方面，如监督锻炼。这项研究将奠定基础和 为继续实施Smart Move！提供证据，这是一种亟需的以患者为中心的运动康复 PAD程序。此外，拟议的培训计划将支持我成为一名 独立的退伍军人康复临床医生-科学家，专注于提高护理质量和治疗结果 有PAD的退伍军人。