Impact of aerobic exercise on aging brain in TBI

项目摘要/摘要 在美国，每年至少有280万人遭受创伤性脑损伤(TBI)，1.1%的人 由于脑外伤，美国人有终生残疾。持续中度至重度颅脑损伤 中年与大脑老化加速和患痴呆症的风险增加有关。然而，为了 目前，尚无有效的药物来预防或治疗脑外伤后认知功能障碍。 恶化。相反，越来越多的证据表明有氧运动可以减轻与年龄有关的疾病。 认知功能减退与脑组织体积、白色结构完整性和大脑的保存有关 灌流。我们的初步研究和其他一些小规模研究表明，脑外伤患者也可能受益。 从有氧运动到改善认知功能。因此，一项随机对照运动临床试验 (RCT)为有氧运动是否需要提供循证的临床决策 训练可防止或延缓脑损伤后加速的大脑衰老和认知能力下降。因此， 这项提议的总体目标是制定一项研究方案，以进行国家多中心演习 RCT评价有氧运动训练改善中老年人认知功能的效果 在TBI模型系统(TBIMS)网络中患有中度至重度TBI的成人(主要结果)。我们 将针对以下目标：目标1a：确定中年和 中重度创伤后1年的老年人。我们将开展焦点小组，并制定一个 调查评估全球神经认知功能，并确定运动障碍以及 中度至重度颅脑损伤患者的智能手机使用情况。目标1b：开发个人移动设备 教练生态系统(PMT)，以提高运动依从性和减轻学习负担。使用苹果 ResearchKit和CareKit，我们将开发一个基于云的应用程序-“PMT”，以构建一个个性化的 运动训练方案，收集运动数据，发送提醒和视频反馈，并进行调查 提高PMT在脑外伤患者中的可用性。目标1c：完善我们的个性化有氧运动- 为德克萨斯州北部TBIMS的创伤性脑损伤患者提供培训计划。我们将：1)调整我们的锻炼计划 以满足脑外伤患者的个人需求；2)根据参与者对 系统的可用性。目标2：建立进行多中心演习RCT的基础设施 在TBIMS内。我们将制定一项RCT协议，操作程序手册(MOP)，建立 调查小组，并确定协作安排。该项目将建立坚实的基础设施，以 进行第二阶段运动RCT，以促进有规律的有氧运动，以改善大脑健康 中度至重度脑外伤的中老年人。

PROJECT SUMMARY/ABSTRACT Each year in the United States, at least 2.8 million people sustain a traumatic brain injury (TBI) and 1.1% of the US population has lifelong disabilities as a consequence of TBI. Sustaining a moderate to severe TBI in middle age is associated with the acceleration of brain aging and increased risk of dementia. However, to date, there are no effective pharmacological agents for prevention or treatment of post-TBI cognitive deterioration. Conversely, mounting evidence suggests that aerobic exercise attenuates age-related cognitive decline linked to the preservation of brain tissue volume, white structural integrity, and cerebral perfusion. Our pilot study along with a few other small studies suggests that TBI persons may also benefit from aerobic exercise to improve cognitive function. Thus, a randomized controlled exercise clinical trial (RCT) is needed to provide evidence-based clinical decision-making regarding whether aerobic exercise training prevents or slows accelerated brain aging and cognitive decline after TBI. Therefore, the overarching goal of this proposal is to develop a study protocol to conduct a national multicenter exercise RCT assessing the efficacy of aerobic exercise training to improve cognitive function in mid-aged and older adults with moderate to severe TBI within the TBI model system (TBIMS) network (Primary outcome). We will address the following aims: Aim 1a: Identify potential barriers to exercise for middle-aged and older adults with moderate to severe TBI 1 year post-injury. We will conduct focus group and develop a survey to assess global neurocognitive function, and identify exercise barriers, as well as patterns of smartphone use among persons with moderate to severe TBI. Aim 1b: Develop a Personal Mobile Trainer ecosystem (PMT) to improve exercise compliance and reduce study burden. Using the Apple ResearchKit and CareKit, we will develop a cloud-based application – “PMT” to build in an individualized exercise-training protocol, collect exercise data, send reminders and video feedback, and conduct survey to improve the usability of PMT in persons with TBI. Aim 1c: Refine our individualized aerobic exercise- training program for persons with TBI in the North Texas TBIMS. We will: 1) tailor our exercise protocol to meet the individual needs of persons with TBI; 2) refine PMT based on participant’s feedback on the usability of the system. Aim 2: Establish the infrastructure to conduct a multicenter exercise RCT within the TBIMS. We will develop a RCT protocol, manual of operating procedures (MOP), establish the investigative team and define collaborative arrangements. This project will establish a solid infrastructure to conduct a phase II exercise RCT to promote regular aerobic exercise for improving brain health among middle aged and older adults with moderate to severe TBI.