Exercise and Weight Loss to Improve Mobility Function in Veterans with PAD

运动和减肥可改善患有 PAD 的退伍军人的活动功能

基本信息

批准号：
10371020
负责人：
Odessa Addison
金额：
--
依托单位：
BALTIMORE VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-06-01 至 2022-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10371020
关键词：
Adult Aerobic Affect American Award Biopsy Blood Blood Circulation Blood Vessels Blood flow Body Composition Body Weight Body Weight decreased Body measure procedure Cessation of life Chronic Clinic Clinical Clinical Skills Clinical Treatment Coupled Development Diagnosis Diet Dual-Energy X-Ray Absorptiometry Elderly Exercise Exercise Tolerance Exertion Fatty acid glycerol esters Functional disorder Funding Gait Gait speed Goals Guidelines Health Health Care Costs Healthcare Home Hospitalization Hour Impairment Individual Infiltration Inflammation Inflammatory Instruction Interleukin-6 Intervention Ischemia Knowledge Learning Learning Skill Leg Lipids Literature Lower Extremity Measures Mentors Metabolic Mission Morbidity - disease rate Muscle Muscle Weakness Non obese Obesity Outcome Overweight Pain Pain in lower limb Participant Patient Self-Report Patients Perfusion Peripheral arterial disease Physical Function Physical Performance Plant Roots Population Quality of life Questionnaires Randomized Randomized Controlled Trials Recommendation Rehabilitation therapy Research Research Personnel Rest Risk Risk Factors Scientist Standardization Symptoms System TNF gene Testing Time Training Training Programs Translating Treadmill Tests Treatment Cost Ultrasonography United States National Institutes of Health Veterans Walking Weight X-Ray Computed Tomography adult obesity bench to bedside cardiometabolic risk claudication comorbidity contrast enhanced design disability disabling disease early onset exercise intervention exercise program exercise training experience frailty functional independence functional status health care service utilization improved improved mobility lifestyle intervention limb ischemia muscle form muscle strength novel obese person patient oriented performance tests premature primary outcome public health relevance recruit rehabilitative care secondary outcome skills strength training tool treatment guidelines weight loss intervention weight loss program

项目摘要

DESCRIPTION: Peripheral artery disease (PAD) affects an estimated 12 -15 million adults in the US and an estimated 20% of older Veterans. Those with PAD ambulate with slow gait and experience decreased leg strength, dysmobility, reduced quality of life, serious morbidity and often premature death. It is estimated that over 60% of individuals with PAD are overweight or obese. While PAD itself worsens mobility, obesity adds a further functional burden to older adults with PAD. Individuals diagnosed with PAD, who are also obese typically claudicate 40% more quickly than non-obese individuals and take 20% longer to recover after claudication. Studies of older obese adults without PAD have demonstrated that the combination of exercise and weight loss is more effective at improving physical function, body composition, and cardiometabolic risk factors than exercise alone. While these findings likely translate to older adults with PAD, this hypothesis has yet to be tested. This CDA-2 is designed to determine whether weight loss and exercise (WL+EX) versus exercise ( EX ) alone will 1) improve mobility function to a greater extent than exercise alone and 2) determine the mechanisms underlying changes in mobility function by measuring muscle microvascular perfusion, systemic and muscle inflammation, cardiometabolic risk, and muscle composition. We hypothesize that a combined intervention of weight loss and exercise (aerobic and resistive) will result in greater improvements in mobility function through improved muscle perfusion, reduced inflammation and reduced muscle fat infiltration than exercise alone in obese Veterans with PAD. The goals of this 5 year CDA-2 are for me to conduct a randomized controlled trial to determine the functional and underlying metabolic effects of 6 months of weight loss and exercise (WL+EX) versus exercise training alone (EX) in obese Veterans with Fontaine Stage II PAD to learn skills in the assessment of muscle perfusion, inflammation and lipid infiltration. The specific aims are: Aim 1: To compare the effects of WL+EX vs EX on mobility function in Veterans with PAD. Aim 2: To compare the effects of WL+EX vs EX on the mechanisms underlying changes in mobility function measured as muscle perfusion, inflammation and lipid infiltration. We will study 76 older (60+ years) obese Veterans with PAD. Prior to baseline testing all participants will be weight stabilized. After weight stabilization baseline testing followed by randomization will occur. Participants will undergo mobility testing (gait speed, modified physical performance test, and six minute walk distance), walking impairment questionnaires, lower extremity muscle strength testing (1RM for major lower extremity muscle groups),and measures of body composition (DXA and CT scan) and muscle perfusion (contrast enhanced ultrasonography). Muscle biopsies and blood draws will determine inflammatory levels (IL- 6 and TNF-α). All participants will participate in a gradul and progressive walking and strength training program 3x/week in our clinic and a home walking 2x/week for 6 months. Individuals randomized to the weight loss group will also attend weekly classes where they will receive instructions on how to implement a 250-350 kcal diet reduction per day. Post-testing will be done 24 hours after the last bout of exercise. We anticipate this proposal will show the importance of the addition of a weight loss program to exercise programs to improve the health and reduce disability in obese Veterans with PAD. The skills gained in this CDA-2 will greatly enhance my development into an independent investigator while the information gained from this study will allow us to make new clinical guidelines that include weight loss to improve mobility function in older Veterans with PAD. These findings may potentially result in reduced healthcare utilization, costs of treatment, and hospitalization relatd to poor circulation and mobility dysfunction in those with PAD.

描述：外周动脉疾病 (PAD) 影响着美国大约 12 -1500 万成年人，大约有 20% 的老年退伍军人患有外周动脉疾病 (PAD)，他们行走时步态缓慢，腿部力量下降、行动不便、生活质量下降、发病严重。据估计，超过 60% 的 PAD 患者超重或肥胖，而 PAD 本身会导致活动能力恶化，而肥胖则进一步增加了患有 PAD 的老年人的功能负担。患有 PAD 的肥胖者通常比非肥胖者跛行的速度快 40%，并且在跛行后恢复的时间要长 20%；对没有 PAD 的老年肥胖者的研究表明，运动和减肥相结合可以更有效地改善症状。虽然这些发现可能适用于患有 PAD 的老年人，但该 CDA-2 旨在确定减肥和锻炼是否有效。 (WL+EX) 与单独运动 (EX) 相比，1) 比单独运动更大程度地改善运动功能，2) 通过测量肌肉微血管灌注、全身和肌肉炎症、心脏代谢风险和我们综合认为，对于患有 PAD 的肥胖退伍军人来说，与单独运动相比，减肥和运动（有氧运动和阻力运动）的干预将通过改善肌肉灌注、减少炎症和减少肌肉脂肪浸润来更大程度地改善运动功能。我的这个 5 年 CDA-2 的目标是进行一项随机对照试验，以确定 6 个月的减肥和运动 (WL+EX) 与仅运动训练 (EX) 对接受 Fontaine 的肥胖退伍军人的功能和潜在代谢影响第二阶段 PAD 学习评估肌肉灌注、炎症和脂质浸润的技能具体目标是：目标 1：比较 WL+EX 与 EX 对退伍军人活动功能的影响目标 2：比较。 WL+EX 与 EX 对运动功能变化的影响（通过肌肉灌注、炎症和脂质渗透来衡量）我们将研究 76 名患有 PAD 的老年（60 岁以上）肥胖退伍军人，然后对所有参与者进行体重测量。体重稳定后，将进行基线测试，然后进行随机分组，参与者将接受流动性测试（步态速度、改良的身体表现测试和六分钟步行距离）、步行障碍问卷、下肢肌肉力量测试（主要下肢肌肉力量测试为 1RM）。四肢肌肉群）、身体成分测量（DXA 和 CT 扫描）和肌肉灌注（对比增强超声检查）将确定炎症水平（IL-6 和 TNF-α）。在我们的诊所进行每周 3 次的渐进式步行和力量训练计划，以及每周 2 次的家庭步行，为期 6 个月。每天减少 250-350 kcal 的饮食量将在最后一次运动后 24 小时进行，我们预计该提案将显示在运动计划中添加减肥计划以改善健康和减少体重的重要性。患有 PAD 的肥胖退伍军人的残疾。在 CDA-2 中获得的技能将极大地促进我成为一名独立研究者，而从这项研究中获得的信息将使我们能够制定新的临床指南，其中包括减轻体重以改善老年退伍军人的活动功能。与 P.A.D.这些发现可能会导致外周动脉疾病患者与血液循环不良和活动功能障碍相关的医疗保健利用率、治疗费用和住院费用减少。