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

项目概要/摘要 对于美国超过550万使用轮椅作为主要代步方式的人来说， 目前普遍缺乏通过有组织的锻炼来降低心脏代谢风险的研究。 实证分析显示，轮椅使用者主要生活在久坐的生活方式中， 与一般人群相比，心脏代谢风险因素显著更高。虽然很少锻炼 训练研究调查了某些残疾亚组的心脏代谢风险，小样本 规模和同质组限制了将这一知识转化为临床实践风险降低的可能性 轮椅使用者的策略。为了解决这些问题，我们建议使用一个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 (e.g.,心率、呼吸率）。 这一程序将使我们能够检查基于证据的运动到音乐（M2M）计划的有效性 适用于远程医疗服务和心脏重点（M2M-C）。我们提出了一个双臂随机 对照试验包括132名心脏代谢不良的轮椅使用者（例如，甘油三酯升高） 通过我们为这一人群服务的诊所网络招募。这项提案的长期目标是 是为轮椅使用者发展一套有效及愉快的运动模式，以推广促进健康的运动 通过确认这个代表性不足的群体的运动剂量要求。主要目的是检查 24周M2M-C计划对≥ 10岁的轮椅使用者CMH核心指标的平均治疗效果 2心脏代谢危险因素。CMH结局将通过血液检查（即，高敏c反应 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，身体组成）. 基线和12周和24周的同步M2M-C训练后。第二个目标将探索 M2M-C对心血管功能、体力活动和生活质量的有益影响。心血管 将通过峰值耗氧量来测量容量。将测量身体活动和生活质量 通过自我报告工具验证该人群。第三个目标1是评估持续效果 M2M-C（24至36周）的身体活动。在M2M参与者完成24周的计划后，他们 将被指示使用引导的M2M在线视频进行异步运动训练， 12周第三个目的2是检查治疗效果的异质性（HTE），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.