Effects of Obesity in the Aged

肥胖对老年人的影响

基本信息

批准号：
10468906
负责人：
TONY G BABB
金额：
$ 50.45万
依托单位：
UT SOUTHWESTERN MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-15 至 2025-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10468906
关键词：
Abdomen Activities of Daily Living Adult Affective Aging Body Weight decreased Breathing Cardiopulmonary Caring Chest Chest wall structure Clinical Coupled Diagnosis Dimensions Dyspnea Elderly Ergometry Exercise Exercise Tolerance Exertion Fatty acid glycerol esters Functional Residual Capacity Laboratories Lead Lung Mechanics Medical Research Council Dyspnea Scale Metabolic Non obese Obesity Overweight Perception Physical Fitness Prevention Pulmonary Heart Disease Respiration Respiratory Mechanics Respiratory Signs and Symptoms Respiratory physiology Rest Risk Sensory Shortness of Breath Supination Testing Time Woman Work Work of Breathing adult obesity age related aged base cost deconditioning exercise intolerance experience improved lung volume mechanical load men novel obesity treatment overweight adults preservation pressure pulmonary function research clinical testing respiratory rib bone structure treatment strategy unnecessary treatment ventilation

项目摘要

PROJECT SUMMARY/ABSTRACT Seventy% of older adults (60+ yr) are overweight or obese and many are unable or unwilling to exercise due to exercise intolerance and/or dyspnea on exertion (DOE). We have identified numerous obesity- related effects that could influence exercise tolerance and DOE in obese adults. We have also identified many age-related ventilatory constraints in nonobese older adults. However, it is unclear whether obesity- related and aging-related effects combine to reduce exercise tolerance, provoke DOE, or contribute to respiratory symptoms in older obese adults. We propose that many of the obesity-related effects in older obese adults are the result of low lung volume breathing, i.e., a reduction in functional residual capacity (FRC) at rest and end-expiratory lung volume (EELV) during exercise. Increased fat on the chest wall produces low FRC and EELV levels, where breathing limitations like expiratory flow limitation (EFL) and enhanced perception of dyspnea are more likely to occur due to the age-related decline in maximal expiratory flow at low lung volumes. Our overall hypothesis is that respiratory limitations, exercise intolerance, DOE, and respiratory symptoms in older obese adults are due to mechanical loading of the thorax and low lung volume breathing. We propose to test this hypothesis with the use an external cuirass (i.e., a plastic shell over the thorax) to mechanically unload the chest wall. This will decrease the load on the thorax thereby increasing FRC at rest and EELV during exercise, and potentially decrease the work of breathing during exercise. The overall objective of this application is to investigate the effects of obesity on lung function, exercise tolerance, and DOE in older obese adults as compared with older adults without obesity, using a novel probe for mechanically unloading the thorax at rest and during exercise. We will use 1) continuous negative cuirass pressure, and 2) assisted biphasic cuirass ventilation to decrease obesity-related effects in older obese adults. Our approach will be to examine respiratory function, exercise tolerance, and DOE with and without mechanical unloading in older obese men and women (65-75 yr), including those with respiratory symptoms, as compared with older adults without obesity. Specific Aims: We will test the following hypotheses: Aim 1) Obesity will decrease respiratory function but to a greater extent in older obese adults with respiratory symptoms; Aim 2) Obesity will decrease exercise tolerance but not cardiorespiratory fitness, except in older obese adults with respiratory symptoms where both may be reduced; Aim 3) Obesity will increase DOE but to a greater extent in older obese adults with respiratory symptoms; and Aim 4) Mechanical unloading of the thorax will improve respiratory function, exercise tolerance, and DOE in older obese adults, but to a greater extent in older obese adults with respiratory symptoms. These results will have broad and immediate clinical impact on the care of older obese adults with DOE.

项目概要/摘要 70% 的老年人（60 岁以上）超重或肥胖，许多人无法或不愿意锻炼由于运动不耐受和/或运动时呼吸困难 (DOE)。我们已经发现许多肥胖者—— 可能影响肥胖成人运动耐量和 DOE 的相关影响。我们还确定了非肥胖老年人存在许多与年龄相关的通气受限。然而，尚不清楚肥胖是否会导致相关和与衰老相关的影响结合起来会降低运动耐量、引发 DOE 或导致老年肥胖者的呼吸道症状。我们认为，许多与肥胖相关的影响对老年人来说肥胖成年人是肺容量呼吸低的结果，即功能残气量减少休息时的 (FRC) 和运动时的呼气末肺容量 (EELV)。胸壁脂肪增加产生较低的 FRC 和 EELV 水平，其中呼吸限制如呼气流量限制 (EFL) 和由于年龄相关的最大呼吸困难的下降，更有可能出现呼吸困难的感觉增强低肺容量时的呼气流量。我们的总体假设是呼吸受限、运动老年肥胖者的不耐受、DOE 和呼吸道症状是由于机械负荷造成的胸腔和低肺容量呼吸。我们建议使用外部胸甲来测试这个假设（即胸部上方的塑料壳）以机械方式卸载胸壁。这将减少负载胸腔从而增加静息时的 FRC 和运动时的 EELV，并可能减少运动时的呼吸。该应用程序的总体目标是研究以下因素的影响：与老年人相比，肥胖对老年肥胖者的肺功能、运动耐量和 DOE 的影响没有肥胖的成年人，使用一种新型探针在休息和运动期间机械地减轻胸部负荷锻炼。我们将使用 1) 连续负胸甲压力，以及 2) 辅助双相胸甲通气以减少老年肥胖者与肥胖相关的影响。我们的方法是检查老年肥胖者的呼吸功能、运动耐量和有或没有机械减负的 DOE 与老年人相比，男性和女性（65-75 岁），包括有呼吸道症状的人没有肥胖。具体目标：我们将测试以下假设：目标 1) 肥胖率将会减少呼吸功能，但在有呼吸道症状的老年肥胖人群中影响更大；目标2) 肥胖会降低运动耐量，但不会降低心肺健康，老年肥胖者除外患有呼吸道症状的成年人，两者都可能减轻；目标 3) 肥胖会增加 DOE，但在患有呼吸道症状的老年肥胖人群中影响更大；和目标 4) 机械胸部卸载将改善老年人的呼吸功能、运动耐量和 DOE 肥胖成年人，但更大程度是有呼吸道症状的老年肥胖成年人。这些结果将对患有 DOE 的老年肥胖患者的护理产生广泛而直接的临床影响。