Improving Cognition Through Telehealth Aerobic Exercise and Cognitive Training After a First Schizophrenia Episode

摘要 该R01确证性疗效临床试验申请涉及远程医疗提供治疗 一种改善精神分裂症核心认知缺陷的方法，使用实验性治疗设计， NIMH提倡。我们的远程医疗干预方法结合了释放神经营养素的有氧运动 以神经可塑性为基础的认知训练，以增强认知训练对认知的影响。 远程健康认知训练和远程健康体育锻炼训练解决NIMH战略研究 制定创新干预措施的优先事项，这些干预措施可以“广泛传播”和“随时传授给 以最低的成本投入现有的劳动力。”认知训练和体育锻炼都显示出 在某种程度上改善精神分裂症的认知缺陷，我们以前的研究已经 研究表明，当它们结合在一起时， 单独治疗。在我们的初步研究中，将认知训练与联合治疗进行比较， 在没有有氧运动的情况下，我们发现了脑源性神经营养因子（BDNF）目标参与的证据， 认知的差异性改善，以及从最初的BDNF获得预测后期的认知结果。的 将通过以下方式证明拟议干预措施在学术研究项目之外的可移植性 通过视频会议进行干预。拟议的研究将纳入其他方法， 例如Fitbit腕戴式健身追踪器、基于网络的激励支持和个性化短信， 鼓励积极性和最大限度地参与锻炼的条件。我们将使用成熟的BDNF作为 我们的主要目标和认知是我们的主要成果。我们假设成熟BDNF的增加 与有规律的有氧运动相结合， 训练，以提高认知更快地比通常观察到的认知训练单独的研究。我们 假设有氧运动与认知训练相结合将产生更大的认知改善， 相对于没有运动的认知训练，所有干预都通过视频会议远程进行。 此外，我们假设完成的运动课程的比例更大， 更大的认知改善。这项研究还将测试是否在基线的内在动机， 随着时间的推移，内在动机的增加预测了远程健康体育锻炼的参与程度 程序.精神分裂症患者的认知缺陷是影响其日常功能的主要因素， 社会各界我们的目标是在精神分裂症首次发作后不久， 在慢性残疾之前，将认知改善推广到现实世界的功能结果， 确立了习这项远程医疗认知训练加有氧运动的临床试验有可能测试一种 假设的作用机制，并在严重的个人生活中发挥有意义的作用， 精神疾病

ABSTRACT This R01 confirmatory efficacy clinical trial application involves telehealth delivery of a treatment approach to improving core cognitive deficits in schizophrenia, using an experimental therapeutic design that NIMH has advocated. Our telehealth intervention approach combines neurotrophin-releasing aerobic exercise training with neuroplasticity-based cognitive training to enhance the impact of cognitive training on cognition. Telehealth cognitive training and telehealth physical exercise training address the NIMH strategic research priorities for creating innovative interventions that can be “disseminated broadly” and “readily taught to the existing workforce with minimal cost.” Cognitive training and physical exercise have each been shown separately to improve cognitive deficits in schizophrenia to some degree, and our previous research has shown that when combined they show promise of improving cognition and work/school functioning more than either treatment alone. In our preliminary studies, comparing the combined treatment with cognitive training without aerobic exercise, we find evidence of brain-derived neurotrophic factor (BDNF) target engagement, differential improvement in cognition, and prediction of later cognitive outcome from initial BDNF gain. The portability of the proposed intervention outside of academic research programs will be demonstrated by providing the interventions via videoconferencing. The proposed study will incorporate additional methods, such as Fitbit wrist-worn fitness trackers, web-based motivational support, and personalized text messages to encourage motivation and to maximize participation in the exercise condition. We will use Mature BDNF as our primary target and cognition as our primary outcome. We hypothesize that the increases in Mature BDNF associated with regular aerobic exercise provide a platform which allows neuroplasticity-based cognitive training to enhance cognition more quickly than is typically observed in studies of cognitive training alone. We hypothesize that combining aerobic exercise with cognitive training will produce larger cognitive improvements, relative to cognitive training without exercise, with all interventions conducted remotely via videoconferencing. Further, we hypothesize that a greater proportion of exercise sessions completed will be associated with greater cognitive improvement. The research will also test whether intrinsic motivation at baseline and increases in intrinsic motivation over time predict the extent of participation in the telehealth physical exercise program. Cognitive deficits in persons with schizophrenia are a major influence on their everyday functioning in the community. We target the period shortly after a first episode of schizophrenia to maximize the generalization of cognitive improvement to real-world functional outcome, before chronic disability is established. This telehealth cognitive training plus aerobic exercise clinical trial has the potential to test a hypothesized mechanism of action and to make a meaningful difference in the lives of individuals with severe mental illness.