Asymptomatic Carotid Stenosis and Mobility Function with Exercise Intervention (ACCOF-Ex)

无症状颈动脉狭窄和活动功能与运动干预 (ACCOF-Ex)

• 批准号: 10539774
• 负责人: Sarasijhaa K. Desikan
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-11-01 至 2027-10-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10539774
• 关键词: Address; Adverse event; Aerobic; Aerobic Exercise; Affect; Aging; Award; Balance training; Blood Vessels; Caliber; Carotid Arteries; Carotid Stenosis; Cerebrovascular Circulation; Cerebrum; Cessation of life; Clinical; Clinical Management; Clinical Trials Design; Collateral Circulation; Computer Models; Data; Development; Disease; Drops; Education; Elderly; Equilibrium; Evaluation; Exercise; Fall prevention; Functional disorder; Gait; Goals; Impairment; Individual; Intervention; Lead; Leadership; Learning; Literature; Magnetic Resonance Imaging; Measures; Mentorship; Modality; Operative Surgical Procedures; Outcome; Outcome Measure; Patients; Perfusion; Physical Function; Play; Quality of life; Randomized; Randomized Clinical Trials; Reporting; Research Personnel; Risk; Risk Factors; Role; Scientist; Statistical Data Interpretation; Stenosis; Stroke; Stroke prevention; Supervision; Surgeon; System; Telephone; Testing; Time; Training; Translating; United States; Veterans; Veterans Health Administration; base; cardiovascular risk factor; career; cerebral hypoperfusion; cerebrovascular imaging; clinical translation; cost; disability; equilibration disorder; exercise intervention; exercise program; experience; fall injury; fall risk; falls; functional independence; functional near infrared spectroscopy; improved; modifiable risk; motor learning; multimodality; novel; novel imaging technique; patient population; patient subsets; preservation; prevent; primary outcome; prospective; secondary outcome; skills; standard of care; stroke outcome; stroke risk; targeted treatment; treatment strategy; vascular risk factor

Asymptomatic carotid artery stenosis (ACAS) affects ~10% of older adults. The clinical outcome of stroke has been studied extensively. Recent literature, including our preliminary data, demonstrates that moderate (50- 69%) and severe (≥70%) ACAS are also associated with falls and balance and mobility dysfunction. The primary hypothesized factor underlying these deficits is cerebral hypoperfusion. In patients with severe ACAS, carotid revascularization has been shown to improve perfusion, as well as balance and mobility dysfunction. Patients with moderate stenosis, who form a much larger proportion of ACAS patients, do not qualify for surgery. With 830,000 Veterans estimated to have moderate ACAS, developing targeted treatment strategies to improve bal- ance and mobility function is critical to prevent disability and preserve functional independence. Targeted aerobic and balance exercises increase cerebral perfusion and improve balance and mobility func- tion in older adults without carotid stenosis. Based on these findings, we hypothesize that an aerobic and chal- lenging balance (AeroBal) exercise intervention will improve balance and mobility function in Veterans with mod- erate ACAS while enhancing cerebral perfusion. For this CDA-2, I propose a randomized study to evaluate the effects of a 12-week supervised AeroBal exercise program on balance and mobility function in patients with moderate ACAS versus standard-of-care controls. Towards this goal, I propose the following Aims: Aim 1. Determine the effect of a 12-week supervised AeroBal exercise program on balance and mobility function in Veterans with moderate ACAS. Hypothesis: Supervised AeroBal exercises plus standard-of-care will lead to greater improvement in balance and mobility (primary outcome: Mini Balance Evaluation Systems Test [Mini BESTest]) compared to standard-of-care vascular risk-factor reduction alone in patients with moderate ACAS. Secondary outcome measures will include rate of prospective falls and measures of physical function. Aim 2. Determine the effect of a 12-week supervised AeroBal exercise program on cerebral perfusion in the presence of moderate ACAS. Hypothesis: Supervised AeroBal exercises plus standard-of-care will lead to greater improvement in cerebral perfusion (primary measure: perfusion-weighted magnetic resonance imaging and secondary measure: transcranial Doppler) compared to standard-of-care vascular risk-factor reduction alone in patients with moderate carotid stenosis. We will also explore functional near-infrared spectroscopy as a novel measure of perfusion that is ideal for clinical translation as it assesses perfusion during mobility tasks. An exploratory analysis will examine the relationship between changes in balance and mobility function and changes in cerebral perfusion. Hypothesis: Exercise-induced changes in balance and mobility function will be related to changes in cerebral perfusion independent of changes in known vascular risk factors. The identification of exercise as an intervention to improve cerebral perfusion and balance and mobility func- tion in patients with moderate ACAS could lead to significant changes in the clinical management, functional independence, and quality of life of this patient population who are not candidates for surgery. My long-term goal is to become an independent VA investigator in targeted interventions to preserve and improve functional inde- pendence in ACAS patients. More specifically, I aim to elucidate the role that cerebral perfusion plays in the development of balance and mobility dysfunction in this VA patient subset. Thus, by being a VA surgeon-scien- tist, I aim to improve the clinical outcomes of not only my patients, but the broader vascular patient population via exercise interventions. With the proposed VA CDA-2 award, I will be able to acquire additional education and mentorship in balance and mobility function assessments, exercise intervention, clinical trial design and statistical analysis, advanced cerebrovascular imaging, and leadership and management of a study team. The skills and experience derived from this opportunity will prepare me for a career as an independent investigator within the VA RR&D.

无症状颈动脉狭窄 (ACAS) 影响约 10% 的老年人 中风的临床结果。 主要研究了最近的文献，包括我们的初步数据，表明中等（50- 69%）和严重（≥70%）ACAS 也与跌倒、平衡和活动功能障碍有关。 在患有严重 ACAS、颈动脉的患者中，这些缺陷的潜在因素是脑灌注不足。 血运重建已被证明可以改善灌注以及患者的平衡和活动功能障碍。 中度狭窄的患者在 ACAS 患者中所占比例要大得多，不符合手术资格。 830,000 名退伍军人估计患有中度 ACAS，正在制定有针对性的治疗策略以改善平衡 运动和活动功能对于预防残疾和保持功能独立性至关重要。 有针对性的有氧运动和平衡运动可增加脑灌注并改善平衡和活动功能 基于这些发现，我们发现有氧运动和无颈动脉狭窄的老年人。 延长平衡 (AeroBal) 运动干预将改善退伍军人的平衡和活动功能 对于这个 CDA-2，我提出了一项随机研究来评估 ACAS。 为期 12 周监督的 AeroBal 锻炼计划对患有以下疾病的患者的平衡和活动功能的影响 适度的 ACAS 与标准护理控制相比，为了实现这一目标，我提出以下目标： 目标 1. 确定为期 12 周的监督 AeroBal 锻炼计划对平衡和活动能力的影响 中度 ACAS 的退伍军人的功能假设：监督 AeroBal 练习加上标准护理。 将导致平衡性和活动性的更大改善（主要成果：迷你平衡评估系统 测试[Mini BESTest]）与仅降低中度患者血管危险因素的标准护理进行比较 ACAS 次要结果指标包括预期跌倒率和身体功能指标。 目标 2. 确定 12 周监督 AeroBal 运动计划对脑灌注的影响 中等 ACAS 的存在 假设：监督 AeroBal 练习加上标准护理将导致 脑灌注的更大改善（主要措施：灌注加权磁共振成像 和次要措施：经颅多普勒）与单独降低血管危险因素的标准护理相比 我们还将探索功能性近红外光谱作为一种新方法。 灌注测量是临床转化的理想选择，因为它可以评估移动任务期间的灌注。 探索性分析将检查平衡和活动功能变化之间的关系 假设：运动引起的平衡和活动功能的变化。 与脑灌注变化相关，独立于已知血管危险因素的变化。 运动作为改善脑灌注、平衡和活动功能的干预措施的确定 中度 ACAS 患者的治疗可能会导致临床管理、功能和功能方面的重大变化。 我的长期目标是提高不适合手术的患者群体的独立性和生活质量。 是成为一名独立的 VA 调查员，进行有针对性的干预措施，以保持和改善功能独立性 更具体地说，我的目的是阐明脑灌注在 ACAS 患者中所起的作用。 因此，作为一名 VA 外科医生，该患者亚群会出现平衡和活动功能障碍。 因此，我的目标不仅是改善我的患者的临床结果，而且还改善更广泛的血管患者群体的临床结果 通过锻炼干预，我将能够获得额外的教育和机会。 平衡和活动功能评估、运动干预、临床试验设计和 统计分析、高级脑血管成像以及研究的领导和管理 从这个机会中获得的技能和经验将为我的独立职业生涯做好准备。 VA RR&D 内的调查员。