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

间歇运动对患有慢性阻塞性肺病和阻塞性睡眠呼吸暂停的退伍军人功能结果的影响

• 批准号: 10597107
• 负责人: Madalina Macrea
• 金额: --
• 依托单位: SALEM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10597107
• 关键词: Accelerometer; Address; Behavioral; C-reactive protein; Chronic Obstructive Pulmonary Disease; Chronic lung disease; Classification; Complex; Continuous Positive Airway Pressure; Data; Disease; Drowsiness; Dyspnea; Economic Burden; Educational Intervention; Endothelium; Excessive Daytime Sleepiness; Exercise; Exhibits; Experimental Designs; Feedback; Future; General Population; Glucose; Goals; Health; Health Benefit; Home; Individual; International; Interval training; Knowledge; Life; Life Style; Lipids; Literature; Lung diseases; Measures; Mediating; Morbidity - disease rate; Obstructive Sleep Apnea; Outcome; Patients; Phenotype; Physical activity; Pilot Projects; Premature aging syndrome; Psyche structure; Quality of life; Reporting; Risk; SF-36; Scientist; Self Efficacy; Serum; Surveys; Syndrome; Techniques; Testing; Training; Translations; Veterans; behavioral study; cardiorespiratory fitness; cardiovascular health; career; clinical phenotype; common symptom; design; disability; exercise intervention; exercise rehabilitation; exercise training; functional decline; functional outcomes; functional status; healthy lifestyle; high risk; implementation barriers; improved; mortality; novel; optimal treatments; patient population; preference; randomized trial; rehabilitation research; response; standard of care; translational barrier; treatment as usual; validation studies

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.

术语“重叠综合征”（OS）用于描述两种慢性阻塞性肺的存在 一名患者的疾病（COPD）和阻塞性睡眠呼吸暂停（OSA）。由于过早衰老，患有OS的患者 比普通人群早于20年的功能下降容易发展。国际 功能，残疾和健康（ICF）的分类评估慢性肺部疾病的功能状态 全球在5个域中。我们建议在其中3个领域中研究经过验证的结果：1）参与生活 情况，通过36项简短表格调查（SF-36）衡量； 2）体育锻炼（PA），通过每日步骤测量 计数； 3）心血管健康，通过心肺适应性（CRF）测量，流动介导的内皮 扩张（FMD）和血清HS-CRP，脂质和葡萄糖。我们的长期目标是制定锻炼策略 针对具有OS的退伍军人量身定制，这将通过增加PA来降低其功能下降的风险。 白天过度嗜睡（EDS）是OSA的常见症状，三分之一的患者持续存在 尽管有连续的正气道压力（CPAP）最佳处理。 EDS与减少有关 生活质量和日常活动以及CVD的风险增加，进一步的运动可以改善。了解 在运动干预的背景下，ED与这些功能状态的这些领域的关系 为这个复杂的患者人群量身定制运动策略的机会。我们建议调查退伍军人 使用EDS-OS，因为它们具有功能下降的最高风险，但具有最大的运动障碍。 在患有COPD或OSA患者的患者进行的运动试验表明中等强度连续训练 （MICT）减少EDS并增加了SF-36，PA，CRF和HS-CRP。尽管米特仍然没有得到充分利用 公认的好处。因此，我们建议测试中等强度间隔训练（MIIT），这是一种新颖的5分钟 基于间隔的运动干预措施可以满足OS的个人需求和能力。在 此外，我们还将研究使用锻炼自我效能感（请参阅）规模的行为障碍 脑写作Premortem是一种有效的利益相关者反馈技术，旨在促进未来家庭的设计 基于MIIT的干预及其成功地转化为Daily PA的回合（未来值得应用）。 我们提出了MIIT的随机试验（每周30％的50％vo2peak的间隔为5分钟，持续12周） 在具有OS与护理标准控制的退伍军人中。 Epworth嗜睡量表（ESS）将在 基线。 EDS-OS表型（ESS> 10）的退伍军人将进入MIIT试验。具体目的是： 1）与通常的护理控制相比，要确定MIIT对生活情况的影响 假设1：MIIT改善：A）SF-36身体和心理评分； b）Epworth嗜睡量表。 假设2。EDS-OS表型将与较差的SF-36分数有关，并将表现出改善 通过改善Epworth嗜睡量表介导的MIIT。 2）确定MIIT对体育活动的影响与通常的护理控制 假设3：MIIT增加每日步数，如加速度测定法测量。 假设4。EDS-OS表型将与基线步数中更大的限制有关，并且将 通过改善Epworth嗜睡量表介导的MIIT的改善。 3）与通常的护理控制相比，要确定MIIT对心血管健康的影响 假设5：MIIT a）增加CRF（VO2PEAK）和FMD； b）减少血清HS-CRP，脂质和葡萄糖 假设6：EDS-OS表型将与基线心血管的更大限制有关 健康并将通过MIIT表现出改善，这是由Epworth嗜睡量表提高的。 4）探索将MIIT转化为可持续健康生活方式改变的行为障碍 假设7：运动的自我效能低与对MIIT的依从性不佳有关。 假设8：Braintring Premortem将确定未来家庭MIIT的实现障碍。