The Effect of Interval Exercise on Functional Outcomes in Veterans with COPD and OSA

重叠综合征(OS)一词用于描述慢性阻塞性肺疾病的存在 一名患者患有慢性阻塞性肺疾病(COPD)和阻塞性睡眠呼吸暂停(OSA)。由于过早衰老，OS患者 容易发生机能衰退的时间比一般人群早20岁。《国际邮报》 功能、残疾与健康分类(ICF)评估慢性肺病患者的功能状态 全球范围内的5个领域。我们建议研究以下三个领域的有效结果：1)参与生活 情况，由36个项目的简表调查(SF-36)衡量；2)体力活动(PA)，按每日步数衡量 计数；3)心血管健康，通过心肺适合度(CRF)、血流介导的内皮细胞来衡量 舒张期(FMD)及血清hs-CRP、血脂、血糖。我们的长期目标是制定一套锻炼策略 专为患有OS的退伍军人量身定做，通过增加PA来降低他们功能衰退的风险。 日间过度嗜睡(EDS)是阻塞性睡眠呼吸暂停综合征(OSA)的常见症状，三分之一的患者持续存在 尽管采用持续气道正压(CPAP)进行最佳治疗。EDS与减少有关 生活质量和日常活动的质量和心血管疾病风险的增加，并进一步通过锻炼而改善。了解 在运动干预的背景下，EDS与这些领域的功能状态的关系提供了 为这一复杂的患者群体量身定做锻炼策略的机会。我们建议调查退伍军人 对于EDS-OS，因为他们功能衰退的风险最高，但锻炼的障碍也最大。 对COPD或OSA患者进行的运动试验表明，中等强度的持续训练 (MICT)降低EDS，升高SF-36、PA、CRF和hs-CRP。MICT仍然没有得到充分利用，尽管 既定的福利。因此，我们建议测试中等强度间歇训练(MIIT)，一种新的5分钟 基于间隔的运动干预，满足患有OS的退伍军人的个人需求和能力。在……里面 此外，我们将使用锻炼自我效能感量表(参见)来研究锻炼的行为障碍 头脑写作Premortem，一种有效的利益相关者反馈技术，以促进未来住宅的设计- 基于工信部的干预，并成功地转化为每日PA(未来功绩申请)。 我们提出了一项MIIT的随机试验(间隔5分钟，50%VO2峰值，每周3次，共12周) 在操作系统与标准护理控制的退伍军人中。爱普沃斯嗜睡量表(ESS)将在 基线。具有EDS-OS表型(ESS&GT；10)的退伍军人将参加工信部的试验。具体目标是： 1)确定与常规护理对照相比，工信部对参与生活情境的影响 假设1：工信部改善了：a)SF-36身体和精神评分；b)Epworth嗜睡量表。 假设2：EDS-OS表型与较差的SF-36分数相关，并将表现出改善 在工信部，这是通过改进的爱普沃斯嗜睡量表进行调节的。 2)确定工信部与常规护理对照对体力活动的影响 假设3：工信部增加了通过加速度计测量的每日步数。 假设4.EDS-OS表型将与基线步数的更大限制相关，并将 通过改进的爱普沃斯嗜睡量表，工信部的表现有所改善。 3)确定与常规护理对照相比，工信部对心血管健康的影响 假设5：工信部a)增加CRF(VO2峰值)和FMD；b)降低血清hs-CRP、血脂和血糖 假设6：EDS-OS表型与基线心血管疾病的更大局限性相关 健康状况，并将在工信部改善爱普沃斯嗜睡量表的中介下表现出改善。 4)探索将工信部转化为可持续健康生活方式的行为障碍 假设7：运动自我效能感低与工信部依从性差有关。 假设8：头脑写作前兆将识别未来以家庭为基础的MIIT的实施前障碍。

The term "Overlap Syndrome" (OS) is used to describe the presence of both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) in a single patient. Due to premature aging, patients with OS are prone to developing functional decline up to 20 years earlier than the general population. The International Classification of Functioning, Disability and Health (ICF) evaluates functional status in chronic pulmonary disease globally in 5 domains. We propose to study validated outcomes in 3 of these domains: 1) participation in life situations, measured by the 36-item Short Form Survey (SF-36); 2) physical activity (PA), measured by daily step counts; and 3) cardiovascular health, measured by cardiorespiratory fitness (CRF), flow-mediated endothelial dilation (FMD) and serum hs-CRP, lipids and glucose. Our long-term goal is to develop an exercise strategy tailored to Veterans with OS which will reduce their risk of functional decline through increased PA. Excessive daytime sleepiness (EDS) is a common symptom of OSA that persists in a third of patients despite optimal treatment with continuous positive airway pressure (CPAP). EDS is associated with decreased quality of life and daily activity and increased risk of CVD and further, improves with exercise. Understanding the relationship of EDS with these domains of functional status within the context of an exercise intervention provides an opportunity to tailor exercise strategies to this complex patient population. We propose to investigate Veterans with EDS-OS because they are at highest risk for functional decline yet have the greatest barriers to exercise. Exercise trials performed in patients with COPD or OSA show that moderate intensity continuous training (MICT) decreased EDS and increased SF-36, PA, CRF and hs-CRP. MICT remains underutilized despite its well-established benefits. Thus, we propose to test moderate intensity interval training (MIIT), a novel 5-minute interval-based exercise intervention that meets the individual needs and capacities of Veterans with OS. In addition, we will study behavioral barriers to exercise using the self-efficacy for exercise (SEE) Scale and Brainwriting Premortem, an efficient stakeholder feedback technique, to facilitate the design of a future home- based MIIT intervention and its successful translation into bouts of daily PA (future Merit Application). We propose a randomized trial of MIIT (5-minute intervals at 50% VO2peak 3 times weekly for 12 weeks) in Veterans with OS vs. standard of care controls. The Epworth Sleepiness Scale (ESS) will be assessed at baseline. Veterans with the EDS-OS phenotype (ESS >10) will enter the MIIT trial. The specific aims are: 1) To determine the effect of MIIT on participation in life situations compared to usual care control Hypothesis 1: MIIT improves: a) SF-36 physical and mental scores; and b) Epworth Sleepiness Scale. Hypothesis 2. The EDS-OS phenotype will be associated with poor SF-36 scores and will exhibit improvement with MIIT that is mediated by improved Epworth Sleepiness Scale. 2) To determine the effect of MIIT on physical activity compared to usual care control Hypothesis 3: MIIT increases daily step count as measured by accelerometry. Hypothesis 4. The EDS-OS phenotype will be associated with greater limitations in baseline step count and will exhibit improvement with MIIT that is mediated by improved Epworth Sleepiness Scale. 3) To determine the effect of MIIT on cardiovascular health compared to usual care control Hypothesis 5: MIIT a) increases CRF (VO2peak) and FMD; and b) decreases serum hs-CRP, lipids and glucose Hypothesis 6: The EDS-OS phenotype will be associated with greater limitations in baseline cardiovascular health and will exhibit improvement with MIIT that is mediated by improved Epworth Sleepiness Scale. 4) To explore behavioral barriers to translation of MIIT into sustainable healthy lifestyle change Hypothesis 7: Low self-efficacy for exercise is associated with poor compliance to MIIT. Hypothesis 8: Brainwriting Premortem will identify pre-implementation barriers to a future home-based MIIT.