Enhanced Home-Based Exercise Therapy for Peripheral Arterial Disease through Mobile Health and Remote Monitoring

通过移动健康和远程监控增强外周动脉疾病的家庭运动疗法

• 批准号: 10508514
• 负责人: Arash Harzand
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-10-01 至 2026-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10508514
• 关键词: Accelerometer; Activities of Daily Living; Adherence; Adult; Affect; American; Amputation; Behavioral; Body Weight decreased; COVID-19 pandemic; Cardiac rehabilitation; Cellular Phone; Clinical; Complex; Coronary Arteriosclerosis; Data; Devices; Diabetes Mellitus; Elements; Enhancement Technology; Enrollment; Exercise; Exercise Therapy; Face; Goals; Gold; Guidelines; Health; Health Technology; Home; Hospitals; Hypertension; Impairment; Income; Indirect Calorimetry; Intervention; Interview; Leadership; Leg; Life Style; Life Style Modification; Light; Measurement; Monitor; Myocardial Infarction; Oxygen Consumption; Pain in lower limb; Patient Education; Patients; Peripheral arterial disease; Physical activity; Physicians; Population; Provider; Quality of Care; Quality of life; Rehabilitation Centers; Rehabilitation therapy; Reproducibility; Resolution; Risk; Risk Factors; Safety; Scientist; Smoking; Stroke; Structure; Supervision; Symptoms; Technology; Testing; Time; Training; Travel; Treatment outcome; Vertebral column; Veterans; Walking; aged; base; behavior change; claudication; cost; design; evidence base; exercise prescription; exercise program; exercise regimen; exercise rehabilitation; experience; functional independence; functional loss; functional outcomes; high risk; improved; improved mobility; informant; innovation; mHealth; mortality risk; multi-component intervention; novel; patient oriented; primary outcome; programs; randomized trial; remote monitoring; rural area; satisfaction; success; symptomatic improvement; tool

An estimated 8.5 million Americans (or 7% of US adults) and nearly 10% of veterans are estimated to have peripheral arterial disease (PAD). Significantly debilitating and negatively impacting quality of life, the primary symptom of PAD is claudication (reproducible leg pain with ambulation) that leads to impaired mobility, loss of functional independence, and a heightened risk for amputation. Veterans are at an increased risk of developing symptomatic PAD due to their disproportionately high rates of PAD risk factors such as diabetes, smoking, and hypertension, the most prominent PAD risk factors. Supervised exercise therapy is proven to decrease claudication and enhance mobility in PAD; however, fewer than 25% of eligible patients enroll. Participation in this facility-based program requires travel to a rehabilitation center 3 times per week for 12-weeks, which can be burdensome and costly for Veterans, many of whom live in rural areas and on fixed incomes. There is, therefore, a need to develop a convenient and effective alternative exercise rehabilitation program for Veterans with PAD, particularly in light of safety considerations now associated with this population’s travel to group facilities in the current COVID pandemic. A promising approach to increase access to exercise rehabilitation for PAD is remote, home-based exercise therapy (HBET). Our group has successfully delivered a smartphone-enabled HBET program to Veterans with coronary artery disease with a 3-fold increase in participation and high satisfaction (80%). To this end, we are committed to utilizing technology innovations to implement HBET for Veterans with PAD successfully. HBET programs combine self-led walking exercises with health coaching and exercise tracking with a wearable activity monitor. Adapting HBET to PAD is difficult, however, due to the added complexity of an exercise prescription that requires the patient to walk until they experience near-maximal leg pain. Even with active coaching, successfully implementing HBET for PAD with long-term adherence has been difficult in the past. Our goal, therefore, is to leverage newer mobile health (mHealth) tools to adapt HBET for PAD. We propose to test our technology-enhanced approach for HBET by partnering with a successful VA lifestyle program, MOVE!, which has demonstrated success in achieving sustained weight loss and reduced diabetes onset through lifestyle modification. As increased physical activity is a core element of MOVE!, participation may help increase adherence with HBET for PAD. Our newly proposed program, Smart MOVE!, will be a multi-component program featuring a tailored version of MOVE! and a novel mHealth device called the LifeQ to improve convenience, access, and adherence to HBET for PAD. Aim 1 (Years 1-2): Identify barriers and facilitators to MOVE! participation among Veterans with PAD. Aim 2 (Years 1-2): Evaluate the feasibility of the LifeQ device to monitor exercise during HBET Aim 3 (Years 2-5): Determine the feasibility of proceeding with Smart MOVE! through a pilot randomized trial. As a VA physician actively treating Veterans with PAD, I have seen first-hand the challenges they face in accessing guideline-directed treatments such as supervised exercise. This study will lay the groundwork and provide evidence to proceed with Smart MOVE!, a much-needed patient-centered exercise rehabilitation program for PAD. Additionally, the proposed training plan will support my progress towards becoming an independent VA rehabilitation clinician-scientist focused on improving care quality and treatment outcomes for Veterans with PAD.

估计有850万美国人（或美国成年人的7％）和近10％的退伍军人估计为 有周围替代疾病（PAD）。 PAD的主要症状是lautaintrication（可重复的腿部疼痛，带有行走），这会导致活动能力受损， 功能独立性的丧失和截肢风险增加。 由于其糖尿病等帕德危险因素的高度高率，开发有症状的垫子， 吸烟和高血压是最突出的垫危险因素。 被监督的运动疗法被证明可以降低laudaintaination并提高PAD的流动性） 不到25％的符合条件的患者参加了这一基于设施的项目。 12周的康复中心每周3次，这对于退伍军人来说可能是繁重和昂贵的 因此，他们居住在农村地区和固定收入。 有效的有垫退伍军人的替代运动康复计划，尤其是鉴于安全性 现在，考虑到该人口前往货币大流行的集体设施的旅行。 一种有前途的方法来增加垫子的锻炼康复，这是遥远的，基于家庭的 运动疗法（HBET）。 患有冠状动脉疾病的退伍军人参与和高高的饱和度增加了3倍（80％）。 这一目的，我们致力于利用技术创新为退伍军人实施HBET 成功。 但是，使用可穿戴的监视器。 锻炼处方患者走路，直到他们经历近乎最大的腿部疼痛。 积极的指导，成功地实施长期依从性的HBET在The中很难 因此，我们的目标是利用新的移动健康（MHealth）工具来适应HBET。 我们建议通过与成功的VA合作测试HBET技术增强的方法 生活方式计划，Move！ 随着体育活动的增加，糖尿病是通过生活方式进行的。 参与可能有助于提高HBET的粘附力，以实现我们的新计划，Smart Move！ 将是一个多组件程序，具有量身定制的Move！ LifeQ可以提高方便，访问和遵守HBET的垫子。 目标1（1-2年）：确定障碍物和促进者在退伍军人中的参与。 目标2（1-2年）：评估LIFEQ设备在HBET期间监视锻炼的可行性 目标3（2-5年）：通过飞行员确定智能移动的可行性 随机试验。 就像VA医师积极用垫子珍惜退伍军人一样，我亲眼目睹了他们面临的挑战 在访问指导治疗时，例如监督运动。 提供证据以继续进行明智之举！ PAD计划。此外，支撑培训计划将支持我 独立的VA康复临床医生 - 科学家，旨在改善护理质量和信任结果 带有垫子的退伍军人。