Locomotor adaptation training to prevent mobility disability

 描述（由申请人提供）：保持移动的能力是生活质量的一个基本因素，对老年人保持独立性至关重要。目前，数百万美国人报告了与移动有关的障碍，随着人口老龄化，这些数字将显著上升。自我选择的步行速度与生活质量、功能能力、平衡能力高度相关，并可预测未来健康状况、功能能力下降、住院和死亡率。因此，针对行动不便的老年人的治疗性运动干预措施侧重于改善步行，作为减少或延迟身体残疾的一种手段，但成效有限。在这里，我们建议探索物理康复技术的创新进展，双带跑步机，这是能够施加独特的推进和稳定性的要求，在步行过程中独立的每一条腿的功效。使用双带跑步机的重复运动扰动迫使中枢神经系统使用前部介导的运动和认知资源来解决/适应（运动适应）挑战。基于我们实验室令人兴奋的初步数据，我们假设，一种可以挑战安全，有效步态所需的运动过程的干预措施，同时提供有氧刺激，将在有行动能力障碍风险的老年人中产生步态表现和功能能力的有利变化。为了研究双带训练对有运动障碍风险的患者步态和功能能力的影响，提出了一项为期两年的单中心、评分者盲法探索性研究。对于这项初步可行性研究，我们将入组48名有残疾风险的久坐老年人（通常步态速度= 1.0 m/s，短期体能成套测验（SPPB）的总评分为7 - 10），并将其随机分配至传统跑步机运动组（N = 16）或具有匹配心血管强度的双带跑步机运动组（N = 16）或对照组（N=16）。目标1将测试与传统跑步机干预双重相比的假设 如步行速度和步态可变性的改善所反映的，带式跑步机训练将导致步态表现的更大改善。目标2是一个探索性目标，将检验以下假设：与传统跑步机干预相比，双带跑步机干预将导致功能能力的更大改善（即，移动性残疾， 平衡功能、功能表现、步行效率和有氧能力）。到目前为止，还没有实验研究在对照试验中评估这些主张。因此，从拟议的试点研究的结果有可能是高度创新和临床意义 同时为更大规模的随机临床试验提供初步数据。

 DESCRIPTION (provided by applicant): The ability to remain mobile is a fundamental contributor to quality of life and is essential for the preservation of independence in old age. Millions of Americans currently report mobility related impairments and these numbers will rise significantly with the aging of our populace. Self-selected walking speed highly correlates with quality of life, functional ability, balance capabilities and is predictive of future health status decline in functional capacity, hospitalization and mortality. As such, therapeutic exercise interventions for older adults with mobility limitations have focused on improving walking as a means to reduce or delay physical disability but with limited success. Herein we propose to explore the efficacy of an innovative advance in physical rehabilitation technology, dual belt treadmill, which is capable of imposing unique propulsive and stability demands independently on each leg during walking. Repetitive locomotor perturbations using the dual belt treadmill forces the central nervous system to solve/adapt (locomotor adaptation) to the challenge using both frontally-mediated locomotor and cognitive resources. Based on exciting preliminary data from our labs, we hypothesize that an intervention that can challenge the locomotor processes required for safe, efficient gait while concurrently providing an aerobic stimulus will produce favorable changes in both gait performance and functional capacity in older adults at risk for mobility disability. To investigate the effects of dual belt training on gait and functional capaciy in those at risk for mobility disability, a two year, single-center, rater-blind exploratory study s proposed. For this pilot feasibility study we will enroll 48 sedentary older adults at risk for disability (usual gait speed = 1.0 m/s and a summary score on the Short Physical Performance Battery (SPPB) 7 - 10) will be randomly assigned to either traditional treadmill exercise (N=16) or dual belt treadmill exercise (N=16) with matched cardiovascular intensities or a control group (N=16). Aim 1 will test the hypothesis that compared with a traditional treadmill intervention dual belt treadmill training will result in greater improvements in gait performance, as reflected by improvements in walking speed and gait variability. Aim 2, an exploratory aim, will test the hypothesis that compared with a traditional treadmill intervention a dual belt treadmill intervention will results in greater improvements in functional capacity (i.e. mobility disability, balance function, functional performance, walking efficiency, and aerobic capacity). To date, no experimental study has evaluated these propositions in a controlled trial. Therefore, results from the proposed pilot study have the potential to be both highly innovative and clinically significant while providing preliminary data for a larger randomized clinical trial.