Telehealth based exercise intervention to improve functional capacity in survivors of childhood cancer with significantly limited exercise tolerance

摘要 30多岁的儿童癌症幸存者有运动不耐受，反映了老年人的价值观。 一般人群中的成年人。幸存者的运动不耐受大大增加了他们早期患病的风险。 死亡率、认知功能下降、生活质量差、情绪困扰和次优参与 社会角色。幸运的是，运动不耐症是可以改变的，即使是在心脏受损的人中， 肺和神经肌肉健康。然而，幸存者一般不参加锻炼。我们 有一种假设认为，对于儿童癌症幸存者来说，定期锻炼可能是困难的和/或不舒服的， 潜在的器官系统损伤（特定的损伤患病率范围为15.5-37.7%， 人口）。这一建议的前提是，由一个人设计和监督的有针对性的干预措施， 需要具有适当专业知识的专业人员来帮助有重大损伤的幸存者感到 通过锻炼和体育活动获得舒适和信心。这些干预措施需要在 一种既包含这些幸存者所需的初步监督和建议， 扰乱他们的日常生活。这项建议测试了个别规定的运动干预的有效性 运动耐量，在一次临床访视时提供初步指导，随后进行监督， 远程提供锻炼进度。这项研究，使用经验丰富的多学科团队（练习 生理学、心理学、心脏病学、内科学、肿瘤学、生存学、实施科学专家）， 如果有效话，将使运动不耐受的护理标准（鼓励身体活动）从其目前的 国家，其中是无效的许多幸存者，以临床上可行的，实际的，可持续的，相对较低的 成本和可推广的干预措施。

Abstract Survivors of childhood cancer in their thirties have exercise intolerance that mirrors values found among older adults in the general population. Exercise intolerance among survivors substantially increases their risk for early mortality, reduced cognitive function, poor quality of life, emotional distress, and sub-optimal participation in social roles. Fortunately, exercise intolerance is modifiable, even among individuals with impaired cardiac, pulmonary, and neuromuscular health. Nevertheless, survivors do not, on average, engage in exercise. Our hypothesis is that regular exercise may be difficult and/or uncomfortable for childhood cancer survivors because of underlying organ system impairments (specific impairment prevalence ranges from 15.5-37.7% in our eligible population). The premise of this proposal is that tailored interventions, designed, and supervised by a professional with appropriate expertise are necessary to help survivors with significant impairment feel comfortable and gain confidence with exercise and physical activity. These interventions need to be delivered in a way that both incorporates the initial supervision and advice that these survivors need, while minimizing disruption in their daily lives. This proposal tests the efficacy of an individually prescribed exercise intervention on exercise tolerance, with initial instruction provided at one clinical visit, and subsequent supervision and exercise progression provided remotely. This study, using an experienced multidisciplinary team (exercise physiology, psychology, cardiology, internal medicine, oncology, survivorship, implementation science experts), if effective, will move standard of care (encouraging physical activity) for exercise intolerance from its’ current state, where it is ineffective for many survivors, to a clinically actionable, practical, sustainable, relatively low cost, and generalizable intervention.