Field-Based Assessment of Energy Expenditure in Spinal Cord Injury

描述(由申请人提供)： 在过去的几年里，使用基于加速度计的监测器来测量体力活动(PA)的情况有了很大的增加。这些设备通常佩戴在身体上，具有内部时钟和大容量的存储容量，因此非常适合作为一种非侵入性的客观方法，跟踪几天到几周的身体活动模式。通常，通过使用单线性回归方程将加速度计数据转换为能量消耗(EE)估计值。然而，这种方程式是专门为捕捉流动人口的下肢运动而开发的，因此不适用于依赖上肢活动的轮椅使用者。我们最近评估了三种现成的基于加速度计的监测器在评估45名患有脊髓损伤(SCI)的全职手动轮椅使用者的EE方面的作用。结果显示，每个设备的输出与轮椅相关活动(如轮椅推进和手臂测功)的间接量热法之间存在很大差异。在以前工作的基础上，这项建议解决了对PA评估工具的需求，该工具适用于跟踪患有脊髓损伤和疾病(SCI/D)的退伍军人中自由生活的PA和EE，特别是那些使用手动轮椅作为主要活动手段的退伍军人。在这个拟议的项目中，我们将联合两个退伍军人中心(即宾夕法尼亚州匹兹堡的轮椅和相关康复工程卓越中心和纽约布朗克斯的SCI医疗后果中心)，为患有SCI/D的退伍军人开发一个生态有效的EE预测模型，并广泛评估其在自然条件下的表现。这项研究的具体目的是：1)基于基于加速计的活动监测器，使用从久坐行为到剧烈运动的各种活动(n=84)，开发基于机器学习的预测模型；在半自然和自然条件下(n=24)，评估新的EE预测模型在具有SCI/D的MWU的单独样本中的准确性和精确度；以及(3)在自然条件下(n=16)，评估新的EE预测模型在具有SCI/D的MWU的长期有效性。我们期待这项建议将产生一个准确和精确的评估工具，用于估计患有SCI/D的退伍军人的自由生活EE和在轻度、中度和剧烈PA中花费的时间。患有SCI/D的退伍军人可以使用该工具定期和准确地自我监控他们的日常PA和EE，以增加他们的自我意识--这是健康决策和长期生活方式改变的先决条件。研究人员和临床医生可以使用该工具客观和准确地评估PA干预措施，并确定适当的体重控制干预措施。建议的工具可以帮助患有脊髓损伤/D的退伍军人和非退伍军人在PA、能量平衡和更健康的生活方式方面做出更好的个人和临床决策。

DESCRIPTION (provided by applicant): The use of accelerometer-based monitors for the measurement of physical activity (PA) has increased substantially over the last several years. These devices are typically worn on the body and have internal clocks and large memory capacities making them well suited as a non- invasive objective method of tracking physical activity patterns for days to weeks. Typically, accelerometer data are converted to estimates of energy expenditure (EE) by using single linear regression equations. However, such equations are exclusively developed to capture the lower extremity movements of ambulatory populations and thus are not applicable to wheelchair users who rely on their upper extremities for mobility. We recently evaluated three off-the-shelf accelerometer-based monitors in estimating EE among 45 full-time manual wheelchair users with spinal cord injury (SCI). The results revealed large discrepancies between each device output and indirect calorimetry for wheelchair related activities such as wheelchair propulsion and arm ergometry. Building upon this previous work, this proposal addresses the need for a PA assessment tool suitable for tracking free-living PA and EE among veterans with spinal cord injury & disorders (SCI/D), especially those who use manual wheelchairs as their primary means of mobility. We will team up two VA centers in this proposed project (i.e., the Center of Excellence on Wheelchairs and Associated Rehabilitation Engineering in Pittsburgh, PA and the Center for Medical Consequences of SCI in Bronx, NY) to develop an ecologically valid EE prediction model for veterans with SCI/D and evaluate its performance extensively under naturalistic conditions. The specific aims of the study are to: 1) to develop machine-learning based prediction models of EE in MWUs with SCI/D based on accelerometer-based activity monitors using a variety of activities that will range from sedentary behaviors to vigorous PAs (n=84); 2) to evaluate the accuracy and precision of the new EE prediction model in a separate sample of MWUs with SCI/D under semi-naturalistic and naturalistic conditions (n=24); and 3) to evaluate the long-term validity of the new EE prediction model in a separate sample of MWUs with SCI/D under naturalistic conditions (n=16). We expect this proposal will result in an accurate and precise assessment tool for estimating free-living EE and time spent in light, moderate, and vigorous PA in veterans with SCI/D. Veterans with SCI/D could use the tool to regularly and accurately self-monitor their everyday PA and EE to increase their self-awareness - a prerequisite for healthy decision making and long-term lifestyle change. Researchers and clinicians could use the tool to objectively and accurately assess PA interventions and determine appropriate interventions for weight management. The proposed tool could facilitate better personal and clinical decisions on PA, energy balance, and healthier lifestyle for both veteran and non-veteran populations with SCI/D.