Passive leg movement: A tool to assess vascular health and guide rehabilitation

目前美国退伍军人的人口统计数据显示，老龄化人口患有严重的心血管功能障碍。 这最终表现为活动受限、不活动，以及随后的心血管恶化 通常导致死亡的疾病(CVD)。然而，尽管发生了这种明显的负面循环，但没有 单一的临床接受的，因此经常使用的血管健康评估方法。作为一氧化氮 (NO)是抗动脉粥样硬化和心脏保护的，确定了体内生物测试的NO生物利用度 在这个竞技场上有重要的价值。在此续签申请之前，主要由退伍军人事务部荣誉奖提供支持， 单次被动腿部运动(SPLM)和随后的血流量增加，无创测量 超声多普勒在股总动脉，作为一种方法，通过它来检测血管内皮细胞 功能，因此无法确定生物利用度。然而，尽管这项工作已经产生了初步的 SPLM的特征，并建立了该方法是一种新的、有效的和临床相关的方法 确定血管健康，进一步了解随年龄增长的SPLM反应，并最终了解其 康复和临床领域的实施和评估仍然是必要的。随着不断增长的 对个性化医疗的兴趣，开发工具，如SPLM，允许个性化 指导医生、病人和康复团队的评估是必不可少的。因此，两个 提出了具体的目标，以解决SPLM范式提供 血管内皮细胞功能的临床有意义评估。首先，心脏康复将通过SPLM进行评估 ，并结合对年轻人的研究，将阐明导致 血管内皮细胞功能随衰老和康复的变化。第二，SPLM对心血管疾病的诊断价值 内皮功能的评估将相对于亚临床的经典测量和标记物进行评估 疾病，以加速将内皮功能障碍纳入心血管疾病的危险因素。建议进行的研究 目的促进SPLM血管内皮功能评价从研究向临床的转变 练习一下。

Current U.S. Veteran demographics reveal an aging population with significant cardiovascular dysfunction. This ultimately manifests as mobility limitation, inactivity, and a subsequent worsening of cardiovascular disease (CVD) that often leads to death. However, despite this clear negative cycle of events, there is not a single clinically accepted, and therefore routinely utilized, method of assessing vascular health. As nitric oxide (NO) is anti-atherogenic and cardioprotective, identifying an in vivo bioassay of NO bioavailability has significant worth in this arena. Fueled predominantly by the VA Merit Award prior to this renewal application, single passive leg movement (sPLM) and the subsequent blood flow increase, measured non-invasively by ultrasound Doppler in the common femoral artery, is emerging as a method by which vascular endothelial function and therefore NO bioavailability can be determined. However, although this work has yielded an initial characterization of sPLM and established this method to be a novel, valid, and a clinically relevant approach to determine vascular health, further understanding of the sPLM response with advancing age and, ultimately, its implementation and assessment in both rehabilitation and clinical arenas is still necessary. With the growing interest in personalized medicine, the development of tools, such as sPLM, that allow individualized assessments to guide the physician, the patient, and the rehabilitative team, are essential. Therefore, two specific aims are proposed that will address the Central Hypothesis that the sPLM paradigm provides a clinically meaningful assessment of endothelial function. First, cardiac rehabilitation will be assessed by sPLM in the elderly, and, coupled with studies in the young, will elucidate the predominant pathways responsible for the change in endothelial function with aging and rehabilitation. Second, the CVD diagnostic value of the sPLM assessment of endothelial function will be evaluated relative to classic measures and markers of subclinical disease in order accelerate the inclusion of endothelial dysfunction as a CVD risk factor. The proposed studies aim to catalyze the transition of the assessment of endothelial function by sPLM from research to clinical practice.