Remotely Monitored, Mobile health-supported High Intensity Interval Training after COVID-19 Critical Illness (REMM HIIT-Covid19)

COVID-19 危重疾病后远程监控、移动健康支持的高强度间歇训练 (REMM HIIT-Covid19)

• 批准号: 10688052
• 负责人: Amy M Pastva
• 金额: $ 78.97万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-17 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10688052
• 关键词: Accelerometer; Address; Adherence; Adipose tissue; Adult; Aging; American; Apple watch; Area; Award; Balance training; Biological Markers; Bone Marrow Transplantation; COVID-19; COVID-19 pandemic; COVID-19 survivors; Cancer Patient; Cardiopulmonary; Caring; Cellular Phone; Clinic; Clinical Research; Clinical Trials; Clinical Trials Design; Cognition; Cognitive deficits; Computer software; Critical Care; Critical Illness; Data; Development; Devices; Disease; Dose; Education; Elderly; Equilibrium; Exercise; Exercise Test; Funding; Future; Glycogen; Goals; Heart Rate; Home; Home environment; Hospitalization; Hospitals; Impairment; Individual; Inflammation; Intensive Care; Intensive Care Units; Interdisciplinary Study; Interval training; Intervention; Intramuscular; Kentucky; Knowledge; Leukocytes; Literature; Malignant Neoplasms; Measures; Medical center; Medicine; Mental Health; Mitochondria; Monitor; Multicenter Studies; Multicenter Trials; Muscle; Muscle function; Muscular Atrophy; Near-Infrared Spectroscopy; Ohio; Operative Surgical Procedures; Outcome; Outcomes Research; Oxygen Consumption; Patient Self-Report; Patients; Performance; Persons; Phase; Physical Exercise; Physical Function; Physical Performance; Physical Rehabilitation; Physiological; Pilot Projects; Population; Public Health; Quality of life; Randomized; Recommendation; Recovery; Rehabilitation therapy; Reporting; Research; Research Institute; Resistance; Societies; Structure; Survivors; Syndrome; Testing; United States National Institutes of Health; Universities; Videoconferencing; Walking; brain dysfunction; cardiorespiratory fitness; chemotherapy; comparison control; digital; disability; exercise capacity; exercise intervention; exercise prescription; exercise training; experience; fitness; functional outcomes; improved; innovation; mHealth; mitochondrial metabolism; muscle form; muscle strength; novel; novel strategies; older patient; pandemic disease; patient safety; physically handicapped; primary endpoint; programs; rehabilitation research; rehabilitation strategy; remote monitoring; safety and feasibility; severe COVID-19; strength training; survivorship; ultrasound

Severe disease from COVID-19 requires hospitalization in 20% of adults, with a third of those patients requiring intensive care unit (ICU) treatment. While a growing number of patients are surviving COVID-19 critical illness, like other ICU survivors, the majority will experience significant post-hospital disabilities in physical function and exercise capacity, new-onset disability, muscle wasting/weakness, and new cognitive deficits. These difficulties, which can persist for months to years post-ICU, are collectively known as post-intensive care syndrome (PICS) and may be more severe in COVID-19 survivors. Despite literature demonstrating the benefit of physical rehabilitation in COVID-19 and other ICU survivors, there are limited available options and data to support an optimal post-hospital physical rehabilitation strategy. Combined with the difficulties of delivering rehabilitation in- person after hospitalization during a pandemic, addressing this “rehabilitation pandemic” from COVID-19 represents an enormous public health challenge. Previous studies of home-based physical rehabilitation in ICU survivors have utilized unsupervised exercise training without a personalized exercise prescription, and none have done so while actively monitoring and targeting exercise via physiologic data such as heart rate or included strength and balance training. In debilitated older patients, high intensity interval training (HIIT) is safe and associated with significant improvements (in as little as two weeks) in cardiorespiratory fitness (CRF) that also correlates with self-reported physical function and disability. We have evaluated this approach in a successful NIH-funded phase 1 pilot study demonstrating safety and feasibility of HIIT in debilitated older adults with cancer. Adherence to exercise was 117% (meaning patients exercised more than recommended 3 sessions/week), compliance with heart rate goals was 98% (meaning patients were actually doing HIIT vs. less-intensive exercise), and on average patients improved CRF, as measured by VO2peak on cardiopulmonary exercise testing by 25%. The key to our approach is our mHealth platform, in which patients are given Apple Watches and iPhones preloaded with our software allowing us to remotely download data after each exercise session to provide personalized up-coaching via videoconferencing in home setting. As critical illness survivors, including COVID-19 ICU survivors, have impaired CRF (similar to patients in pilot study) and other manifestations of PICS, a similar monitored, personalized, structured, and progressive multi-domain physical rehabilitation intervention has significant potential for improving recovery, but has not yet been studied in COVID-19 survivors. To address this gap in knowledge, we will randomize 140 COVID-19 ICU survivors being discharged home to our REmotely Monitored, Mobile health-supported High Intensity Interval Training after COVID-19 Critical Illness (REMM-HIIT-Covid- 19) study to test the hypothesis that the REMM-HIIT exercise intervention, in contrast to exercise education alone, will improve CRF and muscle strength/mass (Aim 1); improve physical function and quality of life (Aim 2); and improve markers of mitochondrial function and inflammation (Aim 3) measured at 3-months after discharge.

在20%的成年人中，来自新冠肺炎的严重疾病需要住院治疗，其中三分之一的患者需要 重症监护病房(ICU)治疗。虽然越来越多的患者在新冠肺炎危重疾病中幸存下来， 像其他ICU幸存者一样，大多数人将在医院后经历严重的身体功能残疾和 运动能力、新发残疾、肌肉萎缩/虚弱，以及新的认知缺陷。这些困难， 可在ICU后持续数月至数年的疾病统称为重症监护后综合征(PICS) 而新冠肺炎幸存者的情况可能更为严重。尽管有文献证明了身体锻炼的好处 在新冠肺炎和其他重症监护病房的幸存者中，可用于支持康复的选择和数据有限 最佳的院后体能康复策略。再加上提供康复服务的困难- 大流行期间住院治疗后的人，从新冠肺炎应对这场“康复大流行” 这是一个巨大的公共卫生挑战。ICU居家物理康复的研究现状 幸存者在没有个性化运动处方的情况下使用了无人监督的运动训练，而且没有 这样做的同时，通过心率或包括的生理数据主动监控和确定运动目标 力量和平衡训练。对于虚弱的老年患者，高强度间歇训练(HIIT)是安全和 与心肺适能(CRF)显著改善(短短两周内)相关，也 与自我报告的身体功能和残疾相关。我们已经对这种方法进行了成功的评估 由美国国立卫生研究院资助的第一阶段试点研究证明了HIIT在患有癌症的虚弱老年人中的安全性和可行性。 坚持锻炼的比例为117%(这意味着患者每周锻炼超过3次)， 对心率目标的遵从率为98%(这意味着患者实际上正在进行HIIT，而不是低强度的 运动)，根据心肺运动VO2峰值测量，患者平均改善CRF 测试增加了25%。我们方法的关键是我们的mHealth平台，在这个平台上，患者可以得到Apple Watch IPhone预装了我们的软件，允许我们在每次锻炼后远程下载数据 在家中通过视频会议提供个性化的向上指导。作为危重疾病幸存者，包括 新冠肺炎重症监护病房的幸存者，有CRF受损(类似于试点研究中的患者)和其他PICS表现， 类似的监控、个性化、结构化和渐进式多领域物理康复干预 具有显著改善康复的潜力，但尚未在新冠肺炎幸存者中进行研究。致信地址 在这种知识的缺口下，我们将随机将140名新冠肺炎重症监护室幸存者远程送到我们的家中 新冠肺炎危重疾病后的高强度间歇训练(REMM-HIIT-Covid-) 19)对REMM-HIIT运动干预与单独的运动教育相反的假设进行检验的研究 改善慢性肾功能衰竭和肌肉力量/质量(目标1)；改善身体功能和生活质量(目标2)； 出院后3个月测定线粒体功能和炎症标志物(AIM 3)。

项目成果

Automated versus manual analysis of body composition measures on computed tomography in patients with bladder cancer.

• DOI: 10.1016/j.ejrad.2022.110413
• 发表时间: 2022-09
• 期刊: EUROPEAN JOURNAL OF RADIOLOGY
• 影响因子: 3.3
• 作者: Rigiroli, Francesca;Zhang, Dylan;Molinger, Jeroen;Wang, Yingqi;Chang, Andrew;Wischmeyer, Paul E.;Inman, Brant A.;Gupta, Rajan T.
• 通讯作者: Gupta, Rajan T.

Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient.

• DOI: 10.1002/jpen.2420
• 发表时间: 2023-02
• 期刊: JOURNAL OF PARENTERAL AND ENTERAL NUTRITION
• 影响因子: 3.4
• 作者: Prado, Carla M.;Ford, Katherine L.;Gonzalez, M. Cristina;Murnane, Lisa C.;Gillis, Chelsia;Wischmeyer, Paul E.;Morrison, Chet A.;Lobo, Dileep N.
• 通讯作者: Lobo, Dileep N.