Improving Cognition Through Telehealth Aerobic Exercise and Cognitive Training After a First Schizophrenia Episode

在首次精神分裂症发作后通过远程医疗有氧运动和认知训练提高认知能力

• 批准号: 10647268
• 负责人: KEITH H NUECHTERLEIN
• 金额: $ 125.44万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-01 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10647268
• 关键词: Address; Advocate; Aerobic Exercise; Applications Grants; Brain-Derived Neurotrophic Factor; Chronic; Clinic; Clinical Trials; Cognition; Cognitive; Cognitive deficits; Combined Modality Therapy; Communities; Data; Disease; Educational Intervention; Educational process of instructing; Exercise; Future; Individual; Intervention; Investigational Therapies; Measures; Methods; Motivation; National Institute of Mental Health; Neuronal Plasticity; Online Systems; Outcome; Outpatients; Persons; Physical Exercise; Public Health; Research; Research Priority; Schizophrenia; Schools; Signal Transduction; Synaptic plasticity; Testing; Text Messaging; Time; Training; Training Programs; Treatment Efficacy; United States National Institutes of Health; Videoconferencing; Work; Wrist; cognitive function; cognitive training; computerized; confirmatory clinical trial; cost; design; disability; efficacy validation; exercise program; exercise training; first episode schizophrenia; fitbit; fitness; functional outcomes; improved; innovation; intrinsic motivation; neurotrophic factor; novel; portability; primary outcome; programs; psychotic; severe mental illness; telehealth; videoconference

ABSTRACT This R01 confirmatory efficacy clinical trial application involves telehealth delivery of a treatment approach to improving core cognitive deficits in schizophrenia, using an experimental therapeutic design that NIMH has advocated. Our telehealth intervention approach combines neurotrophin-releasing aerobic exercise training with neuroplasticity-based cognitive training to enhance the impact of cognitive training on cognition. Telehealth cognitive training and telehealth physical exercise training address the NIMH strategic research priorities for creating innovative interventions that can be “disseminated broadly” and “readily taught to the existing workforce with minimal cost.” Cognitive training and physical exercise have each been shown separately to improve cognitive deficits in schizophrenia to some degree, and our previous research has shown that when combined they show promise of improving cognition and work/school functioning more than either treatment alone. In our preliminary studies, comparing the combined treatment with cognitive training without aerobic exercise, we find evidence of brain-derived neurotrophic factor (BDNF) target engagement, differential improvement in cognition, and prediction of later cognitive outcome from initial BDNF gain. The portability of the proposed intervention outside of academic research programs will be demonstrated by providing the interventions via videoconferencing. The proposed study will incorporate additional methods, such as Fitbit wrist-worn fitness trackers, web-based motivational support, and personalized text messages to encourage motivation and to maximize participation in the exercise condition. We will use Mature BDNF as our primary target and cognition as our primary outcome. We hypothesize that the increases in Mature BDNF associated with regular aerobic exercise provide a platform which allows neuroplasticity-based cognitive training to enhance cognition more quickly than is typically observed in studies of cognitive training alone. We hypothesize that combining aerobic exercise with cognitive training will produce larger cognitive improvements, relative to cognitive training without exercise, with all interventions conducted remotely via videoconferencing. Further, we hypothesize that a greater proportion of exercise sessions completed will be associated with greater cognitive improvement. The research will also test whether intrinsic motivation at baseline and increases in intrinsic motivation over time predict the extent of participation in the telehealth physical exercise program. Cognitive deficits in persons with schizophrenia are a major influence on their everyday functioning in the community. We target the period shortly after a first episode of schizophrenia to maximize the generalization of cognitive improvement to real-world functional outcome, before chronic disability is established. This telehealth cognitive training plus aerobic exercise clinical trial has the potential to test a hypothesized mechanism of action and to make a meaningful difference in the lives of individuals with severe mental illness.

抽象的 R01确认性疗效临床远程医疗提供治疗 改善核心认知缺陷的方法 NIMH提倡我们的远程医疗干预措施 基于神经塑料的认知训练对认知训练对认知的影响。 远程医疗培训和远程医疗体育锻炼培训介绍了NIMH战略研究 创建创新干预措施的优先事项，这些干预措施可以“广泛传播”和“很容易教授” 现有的劳动力以最低的成本显示。 分别以在某种程度上分别改善精神分裂症的认知缺陷，我们以前的研究已经 表明他们的总和表现出了提高认知和工作/学校功能的希望大于 任何一种治疗 没有有氧运动，我们发现脑衍生的神经营养因子（BDNF）靶标参与的证据， 认知的差异改善，以及对初始BDNF增益的后来认知结果的预测。 在学术研究计划之外的支撑干预措施的可移植性将由 通过视频会议提供干预措施。 例如，Fitbit Worn Wornness Trackers，基于Web的动机支持以及个性化短信 鼓励动机并最大程度地参与运动条件。 我们的主要目标和认知作为我们的主要结果。 与常规有氧运动相关的提供一个平台，该平台允许基于神经塑料的认知 训练比单独的认知研究中通常观察到的训练更快 假设将有氧运动与认知训练与认知训练相结合会产生更大的认知改善， 相对于锻炼的认知训练，所有干预措施均与远程cipdeoccontrenccing结合。 此外，我们假设Sessiss完成的练习将与 认知的改进也将测试基线的内在动机 随着时间的推移，内在动机的增加预测了参与远程医疗体育锻炼的程度 计划的认知缺陷。 社区。 在慢性残疾之前，认知改善对现实世界功能结果的概括是 建立。 假设的行动机制，并在严重的人的生活中具有意义 精神疾病。