Home-Based Exercise Tele-Rehabilitation in High-Risk Veterans: Impact of COVID-19 Exposure and Socioeconomic Factors

高风险退伍军人的家庭远程运动康复：COVID-19 暴露和社会经济因素的影响

• 批准号: 10538686
• 负责人: KRISANN K OURSLER
• 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: 2022-10-01 至 2026-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10538686
• 关键词: 2019-nCoV; Address; Adherence; Admission activity; Adult; Affect; Ambulatory Care Facilities; Area; Award; Baltimore; Black race; COVID-19; COVID-19 impact; COVID-19 mortality; COVID-19 pandemic; COVID-19 patient; COVID-19 survivors; Cardiopulmonary; Cardiovascular Diseases; Cessation of life; Chronic; Chronic Kidney Failure; Chronic Obstructive Pulmonary Disease; Chronic lung disease; Classification; Clinical Research; Collaborations; Communicable Diseases; Communities; Coronavirus; Databases; Development; Diabetes Mellitus; Dyspnea; Epidemic; Ethnic Origin; Exercise; Exercise Physiology; Exercise Test; Fatigue; Future; Geographic Locations; Group Homes; Guidelines; HIV Infections; Hand Strength; Health; Healthcare; Healthcare Systems; High Prevalence; Hispanic; Home; Hospitalization; Hypertension; Impairment; Individual; Infection; Inflammatory; Inflammatory Response; Intervention; Knowledge; Long COVID; Lung; Maryland; Muscle Weakness; Not Hispanic or Latino; Organ; Outcome; Patients; Physical Function; Physical Performance; Physical activity; Physiological; Post-Acute Sequelae of SARS-CoV-2 Infection; Procedures; Pulmonary function tests; Questionnaires; Race; Recovery; Rehabilitation therapy; Research; Research Design; Research Priority; Risk; Risk Factors; Rural Community; SARS-CoV-2 exposure; SARS-CoV-2 negative; SARS-CoV-2 positive; Seasons; Self Efficacy; Social Distance; Socioeconomic Factors; Socioeconomic Status; Source; Step Tests; Support Groups; Symptoms; Syndrome; Testing; United States; Urban Community; Vaccines; Variant; Veterans; Veterans Health Administration; Viral; World Health Organization; cardiometabolism; cardiorespiratory fitness; clinical practice; comorbidity; coronavirus disease; disability; disability risk; ethnic disparity; exercise intensity; exercise intervention; exercise program; exercise rehabilitation; exercise training; fitness; functional decline; functional improvement; health care disparity; heart disease risk; high risk; hospitalization rates; human old age (65+); improved; international health organization; long term consequences of COVID-19; long-term sequelae; member; multiple chronic conditions; novel; pandemic disease; post-COVID-19; programs; pulmonary function; racial disparity; rehabilitation research; rehabilitation strategy; rehabilitative care; rurality; systemic inflammatory response; telerehabilitation; transmission process; ventilation; virtual group

The Coronavirus Disease 2019 (COVID-19) pandemic is widespread throughout the world despite multiple strategic efforts and precautions to impede its transmission. Comorbid conditions, especially hypertension, diabetes and chronic lung and cardiac disease are risk factors for hospitalization and death. Veterans have a high prevalence of these conditions and are at increased risk for complications and poor recovery. The development and successful implementation of rehabilitative strategies for Veterans during and post COVID-19 should be a high clinical research priority. The long-term impact of COVID-19 on cardiopulmonary and physical function is uncertain; and further, rehabilitation strategies to target impairments must be feasible within constraints of social distancing. Pertinent knowledge gaps regarding the post-recovery physiologic trajectory in patients with pulmonary and cardiometabolic conditions also need to be addressed to tailor effective exercise rehabilitation strategies. The objective of this exercise trial is to investigate the effect of a home-based exercise tele-rehabilitation on these outcomes and to evaluate five individual World Health Organization’s International Classification of Functioning, Disability and Health (ICF) components identified for research in COVID-19 survivors. Our central hypothesis is that home-based exercise with a group component (COVID Tele-EX) improves cardiopulmonary and physical function in Veterans post COVID-19. The study design includes an investigative team who have a track record of VA rehabilitation collaboration and will allow the exploration of healthcare disparities related to COVID-19, which are associated with functional decline and may affect sustainability of exercise rehabilitation strategies deployed under social distancing restrictions. Veterans from the Baltimore VAMC and surrounding Community Based Outpatient Clinics (CBOCs) will participate from home in the 12-week exercise intervention which will consist of virtual group exercise classes in VA Video Connect (VVC). Procedures before and after the intervention will include cardiopulmonary exercise test, pulmonary function test, physical function, and questionnaires targeted at exercise self-efficacy. Our study of cardiopulmonary and physical function in Veterans recovered from COVID-19 will provide critical and novel information on “Long COVID” or Post-Acute Sequelae of SARS-Co-V-2 infection. Findings from this trial will provide evidence to implement this tele-home group exercise program across VA centers that can extend beyond the COVID-19 pandemic and has vital implications for improving and creating a new standard of rehabilitative care for Veterans.

2019年冠状病毒病（COVID-19）大流行在全球目的地广泛存在 多种战略努力和预防措施阻碍了其传播。尤其是合并条件 高血压，糖尿病和慢性肺和心脏病是住院和死亡的危险因素。 退伍军人的患病率很高，并且发生并发症的风险增加 恢复。在和 Covid-19应该是高临床研究的优先事项。 COVID-19对 心肺和身体功能尚不确定；此外，针对损害的康复策略 在社会疏远的限制内必须是可行的。有关恢复后的相关知识差距 肺和心脏代谢疾病患者的生理轨迹也需要解决 量身定制有效的运动康复策略。 这项运动试验的目的是调查基于家庭的练习远程审查的效果 关于这些结果，并评估五个个人世界卫生组织的国际分类 在COVID-19生存中确定的功能，残疾和健康（ICF）组件。我们的中心 假设是基于组件的家庭练习（Covid Tele-ex）可改善心肺 与退伍军人的身体机能在Covid-19。研究设计包括一个调查团队 VA康复合作的记录记录，并将允许探索与 COVID-19，与功能下降有关，可能会影响运动康复的可持续性 在社会距离限制下部署的策略。巴尔的摩VAMC及周围的退伍军人 基于社区的门诊诊所（CBOC）将在家中参加为期12周的运动干预 其中将包括VA视频连接（VVC）中的虚拟小组练习课。程序前后 干预将包括心肺运动测试，肺功能测试，身体功能和 针对运动自我效能的问卷。我们对退伍军人的心肺和身体机能的研究 从COVID-19恢复将提供有关“长卷”或急性后遗症的关键和新颖信息 SARS-CO-V-2感染。 该试验的发现将提供证据，以实施此远程居家小组锻炼计划 VA中心可以超越199大流行，并对改善和创造具有至关重要的意义 退伍军人的新康复护理标准。