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

修改后的项目摘要/摘要部分 摘要 三十多岁的儿童癌症幸存者有运动不耐受，这反映了老年人的价值观 一般人口中的成年人。幸存者中的运动不耐受大大增加了他们早期患病的风险 死亡率、认知功能降低、生活质量差、情绪困扰和次优参与 社会角色。幸运的是，运动不耐受是可以改变的，即使在心脏受损的人中也是如此， 肺脏和神经肌肉健康。尽管如此，幸存者平均而言并不参加锻炼。我们的 假设有规律的锻炼对儿童癌症幸存者来说可能是困难的和/或不舒服的，因为 潜在的器官系统损害(符合条件的特定损害患病率为15.5%-37.7% 人口)。这项提议的前提是，由一个 需要具有适当专业知识的专业人员来帮助有严重损伤的幸存者 通过锻炼和体力活动来获得舒适和自信。这些干预措施需要在 一种既包括这些幸存者所需的初步监督和建议，同时尽量减少 扰乱了他们的日常生活。这项建议测试了个人处方运动干预的有效性。 关于运动耐量，在一次临床就诊时提供初步指导，随后进行监督和 远程提供运动进度。这项研究使用了一个经验丰富的多学科团队(练习 生理学、心理学、心脏病学、内科、肿瘤学、生存学、执行学专家)， 如果有效，将把运动不耐受的护理标准(鼓励体力活动)从目前的 从对许多幸存者无效的国家，到临床上可操作的、实用的、可持续的、相对较低的 成本和可推广的干预措施。

Modified Project Summary/Abstract Section 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.