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

目前美国退伍军人人口统计数据显示，人口老龄化，心血管功能障碍严重。 这最终表现为活动受限、不活动和随后的心血管疾病恶化。 心血管疾病（CVD），往往导致死亡。然而，尽管出现了这种明显的负面循环， 单一临床上接受的，因此常规使用的，评估血管健康的方法。如一氧化氮 (NO)具有抗动脉粥样硬化和心脏保护作用，确定NO生物利用度的体内生物测定法， 在这个竞技场中有着重要的价值在此更新申请之前，主要由VA优异奖推动， 单次被动腿部运动（sPLM）和随后的血流量增加，通过无创测量 超声多普勒在股总动脉，正在成为一种方法，血管内皮 因此可以确定NO的生物利用度。然而，尽管这项工作取得了初步成果， sPLM的表征，并建立了这种方法是一种新的，有效的和临床相关的方法， 确定血管健康，进一步了解sPLM随年龄增长的反应，最终， 在康复和临床领域中的实施和评估仍然是必要的。与不断增长的 对个性化医疗的兴趣，工具的开发，如sPLM，允许个性化 指导医生、患者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，将解决中心假设，即sPLM范式提供了一个 具有临床意义的内皮功能评估。首先，将通过sPLM评估心脏康复 在老年人中，再加上年轻人的研究，将阐明主要的途径， 内皮功能随衰老和康复的变化。第二，sPLM的CVD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价。 疾病，以加速纳入内皮功能障碍作为CVD的危险因素。拟议的研究 旨在促进通过sPLM评估内皮功能从研究到临床的过渡 实践

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.