Promoting Recovery Optimization with WALKing Exercise after Stroke (PROWALKS)

通过中风后步行运动 (PROWALKS) 促进恢复优化

• 批准号: 9334270
• 负责人: DARCY S. REISMAN
• 金额: $ 84.48万
• 依托单位: UNIVERSITY OF DELAWARE
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9334270
• 关键词: Accelerometer; Adult; American; Arteries; Attention; Biomechanics; Blinded; Blood Pressure; Blood Vessels; Cardiovascular system; Cessation of life; Characteristics; Chronic; Clinic; Data; Development; Devices; Disease; Elderly; Event; Exercise; Experimental Designs; Feedback; Glucose; Goals; Health; Hospitalization; Individual; Intervention; Intervention Studies; Measures; Meta-Analysis; Monitor; Myocardial Infarction; Outcome; Oxygen Consumption; Participant; Patients; Peripheral; Persons; Physical activity; Prevention Guidelines; Quality of life; Randomized; Recovery; Recurrence; Rehabilitation therapy; Research; Risk; Risk Factors; Secondary Prevention; Speed; Step training; Stimulus; Stroke; Testing; Time; Training; Translations; Treatment Efficacy; Unstable angina; Walking; blood lipid; cardiorespiratory fitness; cerebrovascular; chronic stroke; comparative efficacy; cost; design; disability; effective intervention; follow-up; improved; intervention effect; intervention program; mortality; novel; physical inactivity; post intervention; post stroke; programs; sedentary; stroke survivor; therapy design; treadmill training; walking intervention; walking speed

Project Summary/Abstract The overarching goal of this research is to develop interventions that improve the overall health and quality of life of individuals post-stroke. As a group, stroke survivors are more physically inactive than even the most sedentary older adults. Lack of physical activity has serious consequences in persons with stroke, including an increased risk of recurrent stroke, developing other diseases and mortality. Current rehabilitation interventions do little to improve real-world walking activity after stroke, suggesting that simply improving walking capacity is not sufficient for improving daily physical activity after stroke. Rather, we hypothesize that the combination of a fast walking intervention that improves walking capacity, with a step activity monitoring program that facilitates translation of gains from the clinic to the “real-world”, would generate greater improvements in real world walking activity than with either intervention alone. Data from our lab provides support for this hypothesis; however, it suggests that the greater efficacy of combining the 2 interventions depends on a participant's initial walking activity. Thus, we do not expect that one intervention will be superior to the others for all participants, but rather that the combined intervention will be superior for those with low levels of baseline walking activity, speed and endurance. The specific objective of this proposal is to test whether and for whom combining fast walking training with a step activity monitoring program (FAST+SAM) is superior in improving real-world walking activity compared to fast walking training alone (FAST) or a step activity monitoring and feedback program alone (SAM) in those with chronic stroke. Using a randomized controlled experimental design, 225 chronic (> 6 months) stroke survivors, will complete 12 weeks of fast walking training (FAST), a step activity monitoring program (SAM) or a fast walking training + step activity monitoring program (FAST+SAM).The primary (steps per day), secondary (self-selected and fastest walking speed, walking endurance, oxygen consumption) and exploratory (vascular events, blood lipids, glucose, blood pressure) outcomes will be assessed by blinded evaluators prior to initiating treatment, after the last treatment and at a 6 and 12 month follow-up. Moderation of specific intervention outcomes by baseline characteristics will be evaluated to determine for whom the interventions are effective. Following completion of this study, we will not only understand the efficacy of the interventions and the individuals for which they are effective, we will have the necessary information to design a study investigating the secondary prevention benefits of improved physical activity post-stroke. This study is, therefore, an important step in the development of secondary prevention guidelines for persons with stroke.

项目概要/摘要 这项研究的总体目标是开发改善整体健康和质量的干预措施 中风后个体的生活 作为一个群体，中风幸存者的身体活动量甚至比大多数人还要少。 久坐的老年人缺乏体力活动会对中风患者造成严重后果，包括中风。 复发性中风、发展其他疾病和死亡的风险增加。 对改善中风后现实世界的步行活动几乎没有什么作用，这表明仅仅提高步行能力是 不足以改善中风后的日常身体活动，相反，我们追求的是两者的结合。 快速步行干预可提高步行能力，并通过步数活动监测程序促进 将临床成果转化为“现实世界”，将为现实世界带来更大的改善 我们实验室的数据支持了这一假设； 然而，它表明结合两种干预措施的更大功效取决于参与者的初始 因此，我们并不期望对于所有参与者来说，一种干预措施会优于其他干预措施， 而是对于那些基线步行活动水平较低的人来说，联合干预会更有效， 该提案的具体目标是测试速度和耐力是否适合谁。 带有步数活动监测程序 (FAST+SAM) 的步行训练在改善现实世界方面效果更佳 步行活动与单独快速步行训练 (FAST) 或步数活动监测和反馈的比较 单独治疗慢性中风患者的方案 (SAM) 使用随机对照实验设计，225 慢性（> 6 个月）中风幸存者，将完成 12 周的快走训练 (FAST)，这是一项踏步活动 监测计划（SAM）或快走训练+步伐活动监测计划（FAST+SAM）。 主要（每日步数）、次要（自选最快步行速度、步行耐力、氧气 消耗）和探索性（血管事件、血脂、血糖、血压）结果将 由盲法评估员在开始治疗前、最后一次治疗后以及第 6 个月和第 12 个月时进行评估 将评估基线特征对具体干预结果的调节。 完成这项研究后，我们不仅会确定干预措施对谁有效。 了解干预措施的有效性以及干预措施对哪些人有效，我们将有 设计一项研究，调查改善身体状况的二级预防益处所需的信息 因此，这项研究是二级预防发展的重要一步。 中风患者指南。