Understanding the Barriers to Physical Activity in Pediatric Pulmonary Hypertension in Order to Design Effective Home-based Exercise Programs

了解小儿肺动脉高压患者体力活动的障碍，以便设计有效的家庭锻炼计划

• 批准号: 10661484
• 负责人: Catherine M. Avitabile
• 金额: $ 16.35万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10661484
• 关键词: Accelerometer; Activities of Daily Living; Adherence; Adopted; Adult; Adverse event; Aerobic; Age; Behavioral; Body Composition; Cardiac; Cardiopulmonary; Caring; Cessation of life; Child; Childhood; Clinical; Code; Data; Densitometry; Development Plans; Dual-Energy X-Ray Absorptiometry; Endothelium; Exercise; Exercise Physiology; Family; Fostering; Foundations; Fright; Future; Genetic Transcription; Goals; Health; Health Technology; Heart Diseases; Heart Rate; Home; Internet; Intervention; Interview; Leg; Life; Light; Literature; Lower Extremity; Lung diseases; Measures; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Modeling; Moderate Exercise; Monitor; Muscle; Nonpharmacologic Therapy; Outcome; Participant; Pathway interactions; Patient Recruitments; Patients; Performance; Peripheral; Personal Satisfaction; Physical activity; Physicians; Population; Provider; Psychosocial Factor; Pulmonary Hypertension; Pump; Qualitative Methods; Quality of life; Questionnaires; Reporting; Research; Resistance; Resources; Secure; Self Efficacy; Single ventricle congenital heart disease; Skeletal Muscle; Specialist; Specific qualifier value; Strategic Planning; Strenuous Exercise; Stroke Volume; Structure; Survivors; Symptoms; Testing; Therapeutic exercise; Thinness; Training; Training Programs; United States National Institutes of Health; Ventricular; Walking; behavioral construct; career; career development; clinical effect; dashboard; design; exercise intervention; exercise intolerance; exercise program; exercise training; feasibility testing; functional status; improved; interest; mHealth; mobile application; muscle strength; novel; novel therapeutic intervention; pediatric cardiologist; peer; pharmacologic; physical inactivity; preference; primary outcome; programs; recruit; research study; response; right ventricular failure; secondary outcome; sensor; sex; skills; smart watch; social cognitive theory; theories; therapy design

PROJECT SUMMARY/ABSTRACT This K23 Mentored Patient-Oriented Research Career Development Award will prepare Dr. Catherine Avitabile, a pediatric cardiologist and pulmonary hypertension specialist, for an independent research career focused on exercise interventions to improve lean mass, functional capacity, and quality of life in children with pulmonary hypertension and other heart diseases. Dr. Avitabile’s application is strengthened by her clinical expertise and her prior research demonstrating lean mass (skeletal muscle) deficits in association with worse exercise performance in cardiac patients. Under the mentorship of Drs. Babette Zemel and Stephen Paridon, Dr. Avitabile will pursue a comprehensive career development plan with training in exercise physiology and interventions, body composition assessment, wearable activity monitoring, and qualitative methods. The growing population of pulmonary hypertension survivors report low quality of life and exercise intolerance. Children with pulmonary hypertension engage in less physical activity compared to peers, which is a concern since adult data support exercise as a non-pharmacologic therapy. Exercise training safely improves exercise performance and quality of life in adults with pulmonary hypertension and in one small pediatric study, but therapeutic exercise has not been widely adopted in pediatric pulmonary hypertension. While cardiopulmonary status may limit exercise participation, other barriers to participation have not been explored. It is also unclear how exercise interventions have a clinical effect as they may have multiple targets. Skeletal muscle abnormalities are associated with worse exercise performance in adults with pulmonary hypertension and could be modifiable through exercise interventions. Dr. Avitabile has identified skeletal muscle abnormalities in children with pulmonary hypertension, and these are the focus of her research interests. Exercise interventions that slow symptom progression would improve wellbeing for pediatric pulmonary hypertension survivors and their families. Dr. Avitabile’s proposed research will increase understanding of the health consequences of physical inactivity and identify barriers to exercise in pediatric pulmonary hypertension patients in order to design effective exercise interventions. Aim 1 explores the association between physical inactivity and muscle deficits. Aim 2 employs qualitative interviews to identify barriers to physical activity in order to strengthen intervention design. Aim 3 tests the feasibility and preliminary estimates of efficacy of a home exercise intervention to increase physical activity and improve functional status. The intervention is enriched by data from wearable activity monitors, closely aligned with the priorities of the 2016-2020 NIH-Wide Strategic Plan. This K23 award will support Dr. Avitabile’s pathway to independence as a pediatric cardiologist/pulmonary hypertension expert skilled in exercise physiology and interventions, body composition assessment, and mobile health technologies. These skills will support her future R01 proposals that will use exercise to improve survivor wellbeing and will provide a model for exercise interventions in other cardiac patient groups.

项目摘要/摘要 这个K23指导的以患者为导向的研究职业发展奖将为凯瑟琳博士做好准备 儿科心脏病专家和肺动脉高压专家Avitabile，是独立研究职业 专注于运动干预措施，以改善患有儿童的瘦质量，功能能力和生活质量 肺动脉高压和其他心脏病。 Avitabile博士的临床应用程序得到了加强 专业知识和她先前的研究表明瘦质量（骨骼肌）定义了与更差的相关 心脏病患者运动表现。在博士的心态下。 Babette Zemel和Stephen Paridon， Avitabile博士将通过运动生理学培训和 干预措施，身体组成评估，可穿戴活动监测和定性方法。 肺动脉高压冲浪者的人口不断增长，报告的生活质量和运动较低 intlerance。与同龄人相比 由于成人数据支持练习是一种非药物疗法，这是一个关注。锻炼训练可以安全改进 患有肺动脉高压的成年人的运动表现和生活质量，在一项小儿研究中， 但是，在小儿肺动脉高压中尚未广泛采用热运动。尽管 心肺状态可能会限制运动的参与，其他参与障碍尚未探讨。它 还不清楚运动干预措施如何具有临床效果，因为它们可能具有多个目标。骨骼 肌肉异常与肺动脉高压的成年人的运动表现较差有关 并且可以通过运动干预进行修改。 Avitabile博士确定了骨骼肌异常 在患有肺动脉高压的儿童中，这是她研究兴趣的重点。 运动干预措施缓慢症状进展将改善小儿肺的健康状况 高血压幸存者及其家人。 Avitabile博士提议的研究将增加对 身体不活跃的健康后果并确定小儿肺动脉高压运动的障碍 为了设计有效的运动干预措施。 AIM 1探索物理之间的关联 不活动和肌肉定义。目标2员工定性访谈以确定身体活动的障碍 加强干预设计。 AIM 3测试房屋效率的可行性和初步估计 运动干预以增加体育锻炼并改善功能状态。干预措施丰富了 可穿戴活动监视器的数据与2016 - 2020年NIH范围战略的优先级紧密相符 计划。该K23奖将支持Avitabile博士作为儿科心脏病专家/肺部独立的途径 高血压专家熟练于运动生理和干预措施，身体成分评估以及移动 健康技术。这些技能将支持她未来的R01建议，这些建议将使用锻炼来提高生存 福祉，将为其他心脏病患者群体提供运动干预措施的模型。

项目成果

Measurement of Physical Activity by Actigraphy in Infants and Young Children with Pulmonary Arterial Hypertension.

通过体动记录仪测量患有肺动脉高压的婴儿和幼儿的体力活动。

• DOI: 10.1016/j.jpeds.2023.113639
• 发表时间: 2023
• 期刊: The Journal of pediatrics
• 作者: Avitabile,CatherineM;Yung,Delphine;Handler,Stephanie;Hopper,RachelK;Fineman,Jeff;Freire,Grace;Varghese,Nidhy;Mullen,MaryP;Krishnan,UshaS;Austin,Eric;Silveira,Lori;Ivy,DDunbar
• 通讯作者: Ivy,DDunbar

Quantitative Measures of Right Ventricular Size and Function by Echocardiogram Correlate with Cardiac Catheterization Hemodynamics in Congenital Diaphragmatic Hernia.

超声心动图对右心室大小和功能的定量测量与先天性膈疝的心导管插入血流动力学相关。

• DOI: 10.1016/j.jpeds.2023.113564
• 发表时间: 2023
• 期刊: The Journal of pediatrics
• 作者: Avitabile,CatherineM;Flohr,Sabrina;Mathew,Leny;Wang,Yan;Ash,Devon;Frank,DavidB;Tingo,JenniferE;Rintoul,NatalieE;Hedrick,HollyL
• 通讯作者: Hedrick,HollyL

Congenital Diaphragmatic Hernia Patients with Left Heart Hypoplasia and Left Ventricular Dysfunction Have Highest Odds of Mortality.

患有左心发育不全和左心室功能障碍的先天性膈疝患者死亡率最高。

• DOI: 10.1016/j.jpeds.2024.114061
• 发表时间: 2024
• 期刊: The Journal of pediatrics
• 作者: Fraga,MaríaV;Hedrick,HollyL;Rintoul,NatalieE;Wang,Yan;Ash,Devon;Flohr,SabrinaJ;Mathew,Leny;Reynolds,Tom;Engelman,JennyL;Avitabile,CatherineM
• 通讯作者: Avitabile,CatherineM

Treprostinil in Neonates with Congenital Diaphragmatic Hernia-Related Pulmonary Hypertension.

曲前列环素用于患有先天性膈疝相关肺动脉高压的新生儿。

• DOI: 10.1016/j.jpeds.2023.113420
• 发表时间: 2023
• 期刊: The Journal of pediatrics
• 作者: DeBie,FelixR;Avitabile,CatherineM;Flohr,Sabrina;Land,Sierra;Mathew,Leny;Wang,Yan;Ash,Devon;Rintoul,NatalieE;Hedrick,HollyL
• 通讯作者: Hedrick,HollyL