Impact of aerobic exercise on aging brain in TBI

有氧运动对 TBI 中大脑老化的影响

• 批准号: 10002115
• 负责人: KATHLEEN R BELL
• 金额: $ 29.07万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10002115
• 关键词: Acceleration; Address; Aerobic Exercise; Age; Age-associated memory impairment; Animals; Apple; Attenuated; Biological Models; Brain; Cellular Phone; Cerebrum; Chronic; Clinical Trials; Clinical trial protocol document; Cognitive; Control Groups; Data; Databases; Dementia; Deterioration; Ecosystem; Elderly; Executive Dysfunction; Exercise; Feedback; Focus Groups; Goals; Health; Impaired cognition; Individual; Infrastructure; Injury; Intervention; Intervention Studies; Knowledge; Link; Manuals; Measurable; Measurement; Memory; Memory impairment; Neurocognitive; Neurocognitive Deficit; Neurodegenerative Disorders; Outcome; Parkinsonian Disorders; Participant; Patient Self-Report; Pattern; Performance; Perfusion; Persons; Pharmacology; Phase; Physical Fitness; Pilot Projects; Population; Prevention; Procedures; Protocols documentation; Randomized; Randomized Clinical Trials; Sample Size; Solid; Stretching; Structure; Surveys; Survivors; System; Telephone Interviews; Texas; Training Programs; Transportation; Traumatic Brain Injury; United States; active control; aged; aging brain; base; brain health; brain tissue; cardiorespiratory fitness; clinical care; clinical decision-making; cloud based; cognitive function; dementia risk; disability; evidence base; exercise program; exercise training; experience; high risk; improved; middle age; mild traumatic brain injury; patient-level barriers; peer; physically handicapped; premature; preservation; prevent; primary outcome; prospective; recruit; trend; usability; white matter

PROJECT SUMMARY/ABSTRACT Each year in the United States, at least 2.8 million people sustain a traumatic brain injury (TBI) and 1.1% of the US population has lifelong disabilities as a consequence of TBI. Sustaining a moderate to severe TBI in middle age is associated with the acceleration of brain aging and increased risk of dementia. However, to date, there are no effective pharmacological agents for prevention or treatment of post-TBI cognitive deterioration. Conversely, mounting evidence suggests that aerobic exercise attenuates age-related cognitive decline linked to the preservation of brain tissue volume, white structural integrity, and cerebral perfusion. Our pilot study along with a few other small studies suggests that TBI persons may also benefit from aerobic exercise to improve cognitive function. Thus, a randomized controlled exercise clinical trial (RCT) is needed to provide evidence-based clinical decision-making regarding whether aerobic exercise training prevents or slows accelerated brain aging and cognitive decline after TBI. Therefore, the overarching goal of this proposal is to develop a study protocol to conduct a national multicenter exercise RCT assessing the efficacy of aerobic exercise training to improve cognitive function in mid-aged and older adults with moderate to severe TBI within the TBI model system (TBIMS) network (Primary outcome). We will address the following aims: Aim 1a: Identify potential barriers to exercise for middle-aged and older adults with moderate to severe TBI 1 year post-injury. We will conduct focus group and develop a survey to assess global neurocognitive function, and identify exercise barriers, as well as patterns of smartphone use among persons with moderate to severe TBI. Aim 1b: Develop a Personal Mobile Trainer ecosystem (PMT) to improve exercise compliance and reduce study burden. Using the Apple ResearchKit and CareKit, we will develop a cloud-based application – “PMT” to build in an individualized exercise-training protocol, collect exercise data, send reminders and video feedback, and conduct survey to improve the usability of PMT in persons with TBI. Aim 1c: Refine our individualized aerobic exercise- training program for persons with TBI in the North Texas TBIMS. We will: 1) tailor our exercise protocol to meet the individual needs of persons with TBI; 2) refine PMT based on participant’s feedback on the usability of the system. Aim 2: Establish the infrastructure to conduct a multicenter exercise RCT within the TBIMS. We will develop a RCT protocol, manual of operating procedures (MOP), establish the investigative team and define collaborative arrangements. This project will establish a solid infrastructure to conduct a phase II exercise RCT to promote regular aerobic exercise for improving brain health among middle aged and older adults with moderate to severe TBI.

项目总结/摘要 在美国，每年至少有280万人遭受创伤性脑损伤（TBI）， 美国人口由于TBI而终身残疾。持续中度至重度TBI， 中年与大脑老化加速和痴呆症风险增加有关。但要 迄今为止，还没有有效的药物用于预防或治疗TBI后认知功能障碍。 恶化相反，越来越多的证据表明，有氧运动减弱了与年龄有关的 与脑组织体积、白色结构完整性和大脑功能保护相关的认知能力下降 灌注。我们的试点研究沿着和其他一些小型研究表明，TBI患者也可能受益 从有氧运动到改善认知功能。因此，一项随机对照运动临床试验 (RCT)需要提供基于证据的临床决策， 训练可以预防或减缓脑外伤后大脑加速老化和认知能力下降。因此 本提案的首要目标是制定一项研究方案，以进行全国多中心的演习 评估有氧运动训练改善中老年认知功能的疗效的RCT TBI模型系统（TBIMS）网络中的中度至重度TBI成人（主要结局）。我们 将针对以下目标：目标1a：确定中年人运动的潜在障碍， 老年人中度至重度TBI损伤后1年。我们将进行焦点小组讨论， 调查评估整体神经认知功能，并确定运动障碍，以及模式， 中度至重度TBI患者的智能手机使用情况。目标1b：开发个人移动的 教练生态系统（PMT），以提高运动依从性和减少学习负担。使用Apple ResearchKit和CareKit，我们将开发一个基于云的应用程序-“PMT”，以建立个性化的 运动训练协议，收集运动数据，发送提醒和视频反馈，并进行调查， 提高PMT在TBI患者中的可用性。目标1c：完善我们的个性化有氧运动- 北德克萨斯州TBIMS TBI患者的培训计划。我们将：1）调整我们的锻炼方案 满足TBI患者的个人需求; 2）根据参与者对 系统的可用性。目标2：建立开展多中心运动RCT的基础设施 在TBIMS中。我们将制定RCT方案、操作程序手册（MOP）， 调查小组和确定合作安排。该项目将建立一个坚实的基础设施， 进行第二阶段运动随机试验，推广规律有氧运动，以改善 中度至重度TBI的中年和老年人。