RR&D Research Career Scientist Award Application

迈尔斯博士的研究计划的首要目标是应用运动疗法和生活方式 帮助慢性病退伍军人恢复功能、减少残疾和降低医疗费用的干预措施 疾病。这些领域包括心肺运动试验的诊断和预后应用， 以及多学科康复计划对慢性心力衰竭患者的生理影响， 冠状动脉疾病，腹主动脉瘤疾病，脊髓损伤，轻度认知障碍， 和慢性肾功能衰竭。他目前是两个退伍军人管理局研发项目的PI，其中一个项目的标题是 持续运动(暂停)“和另一个标题为”运动以防止肌肉肿块和功能性 老年透析患者的失落(完美)。暂停项目扩展了他在临床上的工作 康复在心血管疾病患者中的应用。心血管疾病仍然是 退伍军人死亡的主要原因，除了评估运动和 生活方式干预作为冠状动脉疾病侵入性治疗的替代方案，该研究提出 无创(生活方式干预)与有创(冠状动脉支架植入)策略的成本效益。这个 Perfect Trial专注于运动疗法对慢性肾脏患者肌肉质量和功能的影响 失败了。肾功能衰竭是退伍军人管理局的一种重要情况，因为它的成本(估计是第二位 退伍军人事务部最昂贵的疾病)，其流行率(估计比一般人口高34%)， 以及它对身体功能和残疾的破坏性影响。迈尔斯博士目前的工作还包括三个 资助的项目涉及运动疗法对轻度认知障碍患者的影响。这些 研究旨在评估运动增强策略和认知策略的有效性 训练干预以改善患有轻度认知障碍的老年退伍军人的认知表现。 迈尔斯博士发起并管理了一个包含临床、血管造影和运动试验反应的关系型数据库 可追溯到1987年。这个数据库一直是回答许多流行病学问题的资源 影响退伍军人(称为退伍军人运动测试研究，或兽医)。兽医研究正在进行中， 对因临床原因转介进行运动测试的退伍军人受试者进行前瞻性评估，旨在 阐述运动试验、临床和生活方式因素及其与健康结果的关系。研究来自 兽医队列已经解决了与以下疾病相关的流行率、时间趋势和医疗成本 他汀类药物的使用、肥胖、慢性心力衰竭、心律失常和其他慢性疾病，以及如何 这些情况受健康状况和体力活动模式的影响。来自兽医队列的分析 影响了主要卫生组织的运动测试指南。他协调了另外两个人 国家数据库，一个由7个中心组成的心力衰竭心肺运动试验联盟，以及AHA/CDC- 赞助健身登记和锻炼的重要性：国家数据库(FRIEND)。《朋友》 该计划旨在建立全民健身登记表，以便更好地向临床医生和公众提供信息 关于体育活动和健身的重要性以及它们在预防慢性病方面的作用。AS 最近，他完成了由美国国立卫生研究院资助的为期6年的临床导向研究专业中心 (SCCOR)题为“腹主动脉瘤病的运动疗法”的项目。SCCOR计划 是由国家心肺血液研究所发起的，旨在促进临床上的多学科研究 促进基础科学成果更快地应用于临床问题的相关主题，以及 强调对特定疾病的预防、诊断和治疗。这个项目有特别的 与退伍军人的相关性，因为已经表明腹主动脉瘤疾病在 退伍军人60岁是14.3%，如果这种疾病得不到治疗，可能会产生致命的后果。

The overarching goals of Dr. Myers' research program are to apply exercise therapy and lifestyle intervention to help restore function, reduce disability, and reduce health care costs in Veterans with chronic disease. These areas include diagnostic and prognostic applications of cardiopulmonary exercise testing, and the physiologic effects of multidisciplinary rehabilitation programs in patients with chronic heart failure, coronary artery disease, abdominal aortic aneurysm disease, spinal cord injury, mild cognitive impairment, and chronic renal failure. He is currently PI on two VA RR&D projects, one entitled, “PCI Alternative using Sustained Exercise (PAUSE),” and the other entitled, “Exercise to Prevent Muscle Mass and Functional Loss in Elderly Dialysis Patients (PERFECT).” The PAUSE project extends his work on the clinical applications of rehabilitation in patients with cardiovascular disease. Cardiovascular disease remains the leading cause of mortality in Veterans, and in addition to assessing the physiologic effects of exercise and lifestyle intervention as an alternative to invasive treatment of coronary artery disease, the study addresses the cost effectiveness of non-invasive (lifestyle intervention) vs. invasive (coronary stenting) strategies. The PERFECT trial focuses on the effects of exercise therapy on muscle mass and function in chronic renal failure. Renal failure is an important condition in the VA because of its cost (estimated to be the second most costly condition in the VA), its prevalence (estimated to be 34% higher than the general population), and its devastating effects on physical function and disability. Dr. Myers current work also includes three funded projects involving the effects of exercise therapy in patients with mild cognitive impairment. These studies are designed to evaluate the effectiveness of exercise augmentation strategies along with cognitive training interventions to improve cognitive performance in older Veterans with mild cognitive impairment. Dr. Myers initiated and manages a relational database of clinical, angiographic, and exercise test responses dating back to 1987. This database has been a resource for answering many epidemiologic questions affecting Veterans (termed the Veterans Exercise Testing Study, or VETS). The VETS study is an ongoing, prospective evaluation of Veteran subjects referred for exercise testing for clinical reasons, designed to address exercise test, clinical, and lifestyle factors and their association with health outcomes. Studies from the VETS cohort have addressed the prevalence, temporal trends, and health care costs associated with statin use, obesity, chronic heart failure, cardiac rhythm abnormalities and other chronic conditions, and how these conditions are influenced by fitness and physical activity patterns. Analyses from the VETS cohort have influenced guidelines on exercise testing from major health organizations. He coordinates two other national data bases, a 7-center heart failure cardiopulmonary exercise test consortium, and the AHA/CDC- sponsored Fitness Registry and the Importance of Exercise: A National Data Base (FRIEND). The FRIEND initiative is designed to develop a national fitness registry in order to better inform clinicians and the public about the importance of physical activity and fitness and their role in the prevention of chronic disease. As Co-PI, he recently completed a 6-year NIH-funded Specialized Center of Clinically-Oriented Research (SCCOR) project entitled, “Exercise Therapy in Abdominal Aortic Aneurysm Disease.” The SCCOR program was initiated by the National Heart, Lung, and Blood Institute to foster multidisciplinary research on clinically relevant topics facilitating basic science findings to be more rapidly applied to clinical problems, with an emphasis on prevention, diagnosis, and treatment of a particular disease. This project has particular relevance to Veterans, since it has been shown that the prevalence of abdominal aortic aneurism disease in Veterans >60 years is 14.3%, with potentially lethal consequences if the disease is not treated.