Task Specific Exercise for the Clinically Disabled

说明(申请人提供)：临床前残疾是残疾过程中的一个早期预警系统，其特点是选择较少地执行日常任务，并对仍在执行的任务进行补偿。这一阶段是预防战略的理想目标，因为可以为濒临残疾的个人设计治疗方案，从而阻止彻底残疾的发生。其中一种优化适应到现实情况的策略是任务特定锻炼(TSE)。这种类型的干预有望确定临床前残疾的老年人可能如何中断残疾过程，转而开始使能过程，从而引导我们进行更好的干预，以治疗和预防残疾的发生。然而，由于残疾过程的复杂性，客观地确定代表任务(SOC领域)选择、优化和补偿的变化的结果一直是极具挑战性的。本研究的目的是首先采用单盲随机对照设计，探讨TSE在60岁以上老年失能患者中的短期和长期疗效。其次，我们寻求通过使用智能能源支出和活动设备(IDEEA)对SOC领域进行非侵入性监控来改进和验证我们的结果。第三，我们将为TSE是否改变神经机械和心理因素提供令人兴奋的新线索。我们想从机械学的角度了解这一点，以便深入了解TSE改善残疾结果的过程。此外，这将有助于我们更好地了解如何加强TSE干预，以治疗临床前残疾患者。因此，我们提出了两个假设：假设1：TSE增加了对日常任务的选择和优化，同时减少了薪酬以实现任务绩效。假设2：TSE通过神经机械(减少运动的可变性和增加肌肉做功能力)和心理(增强执行任务的信心和增强执行功能)属性来调节SOC领域的变化。这些数据有望指导我们设计一项随机对照试验，以测试临床前残疾患者的TSE是否可以降低未来完全残疾的发生率。与公共健康相关：拟议的项目将制定一个研究轨迹，以确定个人的身体残疾版本，并通过专门为改善日常任务表现而设计的练习进行干预。这项研究与公共卫生高度相关，因为它将为扩大独立生活能力提供证据。

DESCRIPTION (provided by applicant): Pre-clinical disability is an early warning system in the disablement process as it is characterized by selecting to perform everyday tasks less often and compensating for those tasks still being performed. This phase serves as an ideal target for preventative strategies because treatments can be designed for individuals on the verge of disability thus interrupting the occurrence of outright disability. One such strategy that optimizes the transfer of adaptations to real-life situations is task-specific exercise (TSE). This type of intervention holds promise to determine how pre-clinically disabled older adults might interrupt the disablement process and instead begin an enablement process and thus lead us to better interventions to treat and prevent disability from occurring. However, because of the complexity of the disablement process, it has been extremely challenging to objectively identify outcomes that represent changes in selection, optimization, and compensation of tasks (the SOC domains). The objective of the current application is first, to ask what are the short and long-term responses of TSE in the pre-clinically disabled older adults (aged 60+ years) using a single-masked randomized controlled design. Second we seek to refine and validate our outcomes using non-invasive monitoring of SOC domains with the Intelligent Device for Energy Expenditure and Activity (IDEEA). Thirdly, we will shed exciting new light on whether TSE alters neuromechanical and psychological factors. We want to know this, in part, from a mechanistic perspective to gain insight into the processes by which TSE improves disablement outcomes. Also, this will help us to better understand how to enhance the TSE intervention to treat pre-clinically disabled patients. Thus, we offer two hypotheses: Hypothesis #1: TSE increases selection and optimization of everyday tasks, while reducing compensation to achieve task performance. Hypothesis #2: TSE mediates changes in SOC domains through both neuromechanical (decrease variability of movement and increase muscle work capacity) and psychological (increased confidence to perform tasks and increased executive function) properties. These data are expected to guide us in designing a randomized controlled trial that will test whether TSE in the pre-clinically disabled can reduce future incidence of outright disability. PUBLIC HEALTH RELEVANCE: The proposed project will develop a trajectory of research that will identify individuals on the version of physical disability and intervene with exercises specifically designed to improve everyday task performance. This research is highly relevant to the public health as it will build evidence for extending the capacity to live independently.