A novel mobile health exercise intervention for older patients with myeloid neoplasms

项目摘要 概述：超过60%的髓系肿瘤（MN）是在≥ 60岁的成年人中诊断出来的，高达98%的 这些患者[包括接受低甲基化剂（HMA）的患者]经历身体功能下降 和症状（如疲劳、情绪障碍），导致生活质量（QoL）差。运动可以预防 老年MN患者躯体功能下降，症状改善。老年MN患者可以 安全地锻炼，但坚持可能是一个挑战。移动的健康（mHealth）应用程序（app）可能会改善 通过增强锻炼自我效能和帮助解决锻炼障碍来坚持锻炼。炎性 调节异常[特别是肿瘤坏死因子（TNF）α和相关细胞因子]与身体 功能减退、疲劳和情绪紊乱。在本K99/R00中，我们建议开发、调整和评估 一种新的mHealth运动干预，用于预防身体功能下降，改善症状， 预防接受门诊HMA的老年MN患者生活质量恶化，并探讨 干预TNF α及相关细胞因子基因启动子甲基化及其基因和蛋白表达。 职业发展规划：洛博士是一位新兴的老年肿瘤学家，已经开始研究mHealth， 癌症控制成为一名独立的临床科学家进行mHealth行为干预 针对老年MN患者的研究，洛博士需要培训（1）开发和适应mHealth行为 老年癌症患者的干预措施，（2）获得技能，成为一个独立的研究者， 设计、实施和分析临床试验，（3）发展身体功能生物标志物方面的专业知识。洛医生的 指导团队在老年病和运动肿瘤学，行为干预研究，移动健康， 和转化科学。罗切斯特大学在老年肿瘤学和癌症控制方面是世界一流的。 研究计划：拟议的移动健康运动干预（GO-EXCAP移动的应用程序）整合了内容 使用移动的应用程序交付平台（TouchStream）的既定锻炼计划（EXCAP）。EXCAP是一个 以家庭为基础的渐进式步行和阻力锻炼计划。TouchStream移动的应用程序跟踪 运动数据、症状和运动坚持性的障碍，运动生理学家可以调整 运动处方和解决运动障碍。在K99中，我们将首先开发和适应GO-EXCAP 移动的应用程序通过获得10名接受HMA的MN患者的反馈。第二，我们将进行一次- 在25例患者中优化GO-EXCAP移动的App的1期试验。在R00中（II期随机对照 试验），我们将评估GO-EXCAP移动的应用程序与化疗教育相比的初步疗效 对照（行为安慰剂）对身体功能和患者报告的结局（疲劳、情绪和QoL）的影响， 一百个病人。我们还将探讨干预对TNF α和相关细胞因子通路的影响。 影响：结合培训和研究计划将使洛博士成为少数老年人之一， 研究移动健康干预措施的肿瘤学研究人员，并允许她过渡到独立。

PROJECT SUMMARY Overview: Over 60% of myeloid neoplasms (MN) are diagnosed in adults aged ≥60 years, and up to 98% of these patients [including those receiving hypomethylating agents (HMA)] experience physical function decline and symptoms (e.g. fatigue, mood disturbances), leading to poor quality of life (QoL). Exercise may prevent physical function decline and improve symptoms in older patients with MN. Older patients with MN can exercise safely, but adherence may be a challenge. Mobile health (mHealth) application (app) may improve adherence by enhancing exercise self-efficacy and by helping to address barriers to exercise. Inflammatory dysregulation [specifically tumor necrosis factor (TNF)α and related cytokines] is associated with physical function decline, fatigue, and mood disturbances. In this K99/R00, we propose to develop, adapt, and evaluate a novel mHealth exercise intervention for preventing physical function decline, improving symptoms, and preventing worsening QoL in older patients with MN receiving outpatient HMA, and to explore the effect of the intervention on TNFα and related cytokine gene promoter methylation and their gene and protein expression. Career Development Plan: Dr. Loh is an emerging geriatric oncologist and has begun to study mHealth and cancer control. To become an independent clinician scientist conducting mHealth behavioral intervention research for older patients with MN, Dr. Loh needs training to (1) develop and adapt mHealth behavioral interventions for older patients with cancer, (2) acquire skills to become an independent investigator who can design, conduct, and analyze clinical trials, (3) develop expertise in biomarkers of physical function. Dr. Loh's mentoring team has expertise in geriatric and exercise oncology, behavioral intervention research, mHealth, and translational science. The University of Rochester is world-class for geriatric oncology and cancer control. Research Plan: The proposed mHealth exercise intervention (GO-EXCAP Mobile App) integrates the content of an established exercise program (EXCAP) with a mobile app delivery platform (TouchStream). EXCAP is a home-based progressive walking and resistance exercise program. The TouchStream mobile app tracks exercise data, symptoms, and barriers to exercise adherence, and the exercise physiologist can adjust exercise prescriptions and address barriers to exercise. In K99, we will first develop and adapt the GO-EXCAP Mobile App by obtaining feedback from 10 patients with MN receiving HMA. Second, we will conduct a single- arm phase 1 trial to optimize the GO-EXCAP Mobile App in 25 patients. In R00 (phase 2 randomized controlled trial), we will assess the preliminary efficacy of the GO-EXCAP Mobile App versus a chemotherapy education control (behavioral placebo) on physical function and patient-reported outcomes (fatigue, mood, and QoL) in 100 patients. We will also explore the effect of the intervention on TNFα and related cytokine pathways. Impact: The combined training and research plan will position Dr. Loh to become one of the few geriatric oncology investigators studying mHealth interventions, and to allow her to transition to independence.