Examining the effects of live telehealth exercise training on cardiometabolic outcomes in wheelchair users

项目摘要/摘要 对于550多万美国人来说，轮椅是他们主要的步行方式， 关于通过有组织的运动降低心脏代谢风险的研究普遍缺乏。 验证性分析显示，轮椅使用者主要生活在久坐不动的生活方式中 与普通人群相比，心脏代谢危险因素显著更高。虽然很少锻炼 培训研究已经调查了某些残疾亚组的心脏代谢风险，样本较小 规模和同质群体限制了这一知识转化为临床实践风险的可能性 轮椅使用者的策略。为了解决这些问题，我们建议使用强大的远程培训系统 内置视频会议和实时监测生命体征数据 (例如，心率、呼吸频率)。 这个程序将使我们能够检查基于证据的音乐运动(M2M)计划的有效性 适用于远程保健交付和心脏重点(M2M-C)。我们提出了一种双臂随机试验 包括132名心脏代谢状况不佳(如甘油三酯升高)的轮椅使用者的对照试验 通过我们已建立的服务于这一人群的诊所网络招募。这项提议的长期目标是 为轮椅使用者开发一种有效和愉快的方式来推广有益健康的运动 通过确认这一代表性不足群体的运动剂量需求。主要目标将审查 24周M2M-C方案对≥轮椅使用者CMH核心指标的平均治疗效果 2心脏代谢危险因素。CMH结果将通过血液测试(即高敏感性C反应)进行测量 蛋白质、血红蛋白、空腹胰岛素、甘油三酯和胆固醇)和DEXA扫描(即身体成分) 基线和12周和24周的同步M2M-C训练后。次要目标将探索 M2M-C对心血管容量、体力活动和生活质量的有益影响。心血管病 容量将通过最大耗氧量来衡量。体力活动和生活质量将被测量 通过自我报告工具对这一人群进行验证。第三个目标1是评估持续效果 M2M-C(24至36周)的体力活动。在M2M参与者完成为期24周的计划后，他们 将被指示使用指导的M2M在线视频进行异步运动训练 12周。第三个目标2是检查治疗效果的异质性，其目的是 了解谁的干预最有效。

Project Summary/Abstract For the more than 5.5 million people in the U.S. who use wheelchairs as their primary mode of ambulation, there is a pervasive lack of research on reducing cardiometabolic risk through structured exercise. Confirmatory analyses have revealed that wheelchair users live predominantly sedentary lifestyles and have substantially higher cardiometabolic risk factors compared to the general population. Although few exercise training studies have investigated cardiometabolic risk in certain subgroups with a disability, small sample sizes and homogeneous groups limit the translatability of this knowledge into clinical practice risk reduction strategies for wheelchair users. To address these issues, we propose to use a robust remote training system with built-in videoconferencing and real-time monitoring of vital sign data (e.g., heart rate, respiratory rate). This procedure will allow us to examine the efficacy of an evidence-based Movement-to-Music (M2M) program adapted for telehealth delivery and cardio emphasis (M2M-C). We are proposing a two-arm randomized controlled trial including 132 wheelchair users with a poor cardiometabolic profile (e.g., elevated triglycerides) recruited through our established network of clinics serving this population. The long-term goal of this proposal is to develop an effective and enjoyable modality for promoting health-enhancing exercise for wheelchair users by confirming exercise dose requirements for this underrepresented group. The primary aim will examine the average treatment effects of a 24-week M2M-C program on core indicators of CMH in wheelchair users with ≥ 2 cardiometabolic risk factors. CMH outcomes will be measured via blood tests (i.e., high sensitivity C-reactive protein, hemoglobin, fasting insulin, triglycerides, and cholesterol) and DEXA scan (i.e., body composition) at baseline and after 12 and 24 weeks of synchronous M2M-C training. The secondary aim will explore the beneficial effects of M2M-C on cardiovascular capacity, physical activity, and quality of life. Cardiovascular capacity will be measured via peak oxygen consumption. Physical activity and quality of life will be measured by self-report instruments validated for this population. The tertiary aim 1 is to evaluate the sustained effects of M2M-C (24 to 36 weeks) on physical activity. After M2M participants complete the 24-week program, they will be instructed to perform asynchronous exercise training using guided M2M online videos for an additional 12 weeks. The tertiary aim 2 is to examine the heterogeneity of treatment effect (HTE), which aims to understand whom the intervention is most effective.