Enhanced Home-Based Exercise Therapy for Peripheral Arterial Disease through Mobile Health and Remote Monitoring

通过移动健康和远程监控增强外周动脉疾病的家庭运动疗法

• 批准号: 10686930
• 负责人: Arash Harzand
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-10-01 至 2026-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10686930
• 关键词: Accelerometer; Activities of Daily Living; Adherence; Adult; Affect; American; Amputation; Behavioral; Body Weight decreased; COVID-19 pandemic; Cardiac rehabilitation; Cellular Phone; Clinical; Combined Modality Therapy; Complex; Coronary Arteriosclerosis; Creativeness; Data; Devices; Diabetes Mellitus; Education; Elements; Eligibility Determination; Enhancement Technology; Enrollment; Exercise; Exercise Therapy; Face; Goals; Guidelines; Health; Health Technology; Home; Hospitals; Hypertension; Impairment; Income; Indirect Calorimetry; Intervention; Interview; Leadership; Leg; Life Style; Life Style Modification; Light; Measurement; Monitor; Myocardial Infarction; Oxygen Consumption; Pain in lower limb; Patient Education; Patients; Peripheral arterial disease; Physical activity; Physicians; Population; Provider; Quality of Care; Quality of life; Recommendation; Rehabilitation Centers; Rehabilitation therapy; Reproducibility; Resolution; Risk; Risk Factors; Safety; Scientist; Smoking; Stroke; Structure; Symptoms; Testing; Training; Travel; Treatment outcome; Vertebral column; Veterans; Walking; aged; behavior change; claudication; cost; design; evidence base; exercise prescription; exercise program; exercise regimen; exercise rehabilitation; experience; functional independence; functional loss; functional outcomes; high risk; improved; improved mobility; informant; innovation; mHealth; mortality risk; multi-component intervention; novel; participant enrollment; patient oriented; primary outcome; programs; randomized trial; remote monitoring; rural area; satisfaction; success; symptomatic improvement; technological innovation; tool; trial enrollment; wearable monitor

An estimated 8.5 million Americans (or 7% of US adults) and nearly 10% of veterans are estimated to have peripheral arterial disease (PAD). Significantly debilitating and negatively impacting quality of life, the primary symptom of PAD is claudication (reproducible leg pain with ambulation) that leads to impaired mobility, loss of functional independence, and a heightened risk for amputation. Veterans are at an increased risk of developing symptomatic PAD due to their disproportionately high rates of PAD risk factors such as diabetes, smoking, and hypertension, the most prominent PAD risk factors. Supervised exercise therapy is proven to decrease claudication and enhance mobility in PAD; however, fewer than 25% of eligible patients enroll. Participation in this facility-based program requires travel to a rehabilitation center 3 times per week for 12-weeks, which can be burdensome and costly for Veterans, many of whom live in rural areas and on fixed incomes. There is, therefore, a need to develop a convenient and effective alternative exercise rehabilitation program for Veterans with PAD, particularly in light of safety considerations now associated with this population’s travel to group facilities in the current COVID pandemic. A promising approach to increase access to exercise rehabilitation for PAD is remote, home-based exercise therapy (HBET). Our group has successfully delivered a smartphone-enabled HBET program to Veterans with coronary artery disease with a 3-fold increase in participation and high satisfaction (80%). To this end, we are committed to utilizing technology innovations to implement HBET for Veterans with PAD successfully. HBET programs combine self-led walking exercises with health coaching and exercise tracking with a wearable activity monitor. Adapting HBET to PAD is difficult, however, due to the added complexity of an exercise prescription that requires the patient to walk until they experience near-maximal leg pain. Even with active coaching, successfully implementing HBET for PAD with long-term adherence has been difficult in the past. Our goal, therefore, is to leverage newer mobile health (mHealth) tools to adapt HBET for PAD. We propose to test our technology-enhanced approach for HBET by partnering with a successful VA lifestyle program, MOVE!, which has demonstrated success in achieving sustained weight loss and reduced diabetes onset through lifestyle modification. As increased physical activity is a core element of MOVE!, participation may help increase adherence with HBET for PAD. Our newly proposed program, Smart MOVE!, will be a multi-component program featuring a tailored version of MOVE! and a novel mHealth device called the LifeQ to improve convenience, access, and adherence to HBET for PAD. Aim 1 (Years 1-2): Identify barriers and facilitators to MOVE! participation among Veterans with PAD. Aim 2 (Years 1-2): Evaluate the feasibility of the LifeQ device to monitor exercise during HBET Aim 3 (Years 2-5): Determine the feasibility of proceeding with Smart MOVE! through a pilot randomized trial. As a VA physician actively treating Veterans with PAD, I have seen first-hand the challenges they face in accessing guideline-directed treatments such as supervised exercise. This study will lay the groundwork and provide evidence to proceed with Smart MOVE!, a much-needed patient-centered exercise rehabilitation program for PAD. Additionally, the proposed training plan will support my progress towards becoming an independent VA rehabilitation clinician-scientist focused on improving care quality and treatment outcomes for Veterans with PAD.

据估计，有 850 万美国人（即美国成年人的 7%）和近 10% 的退伍军人 患有外周动脉疾病（PAD），会严重削弱生活质量并对其产生负面影响。 PAD 的主要症状是跛行（行走时可重复出现腿部疼痛），导致活动能力受损， 丧失功能独立性以及截肢的巨大风险 退伍军人的风险增加。 由于糖尿病等 PAD 危险因素的发生率极高，因此出现有症状的 PAD 吸烟和高血压是最重要的 PAD 危险因素。 然而，监督运动疗法已被证明可以减少跛行并增强 PAD 的活动能力； 只有不到 25% 的符合资格的患者需要前往医疗机构参加该计划。 每周 3 次去康复中心，持续 12 周，这对于退伍军人来说可能是负担和昂贵的，许多人 其中一些人生活在农村地区，靠固定收入生活，因此，有必要开发一种方便、可靠的服务。 为患有 PAD 的退伍军人提供有效的替代运动康复计划，特别是考虑到安全性 在当前新冠疫情大流行期间，目前需要考虑与该人群前往团体设施相关的考虑因素。 增加 PAD 运动康复机会的一种有前景的方法是远程、家庭式 我们的团队已成功向患者提供了支持智能手机的 HBET 计划。 患有冠状动脉疾病的退伍军人的参与度增加了 3 倍，满意度很高 (80%)。 为此，我们致力于利用技术创新为带有 PAD 的退伍军人实施 HBET HBET 项目成功地将自我主导的步行锻炼与健康指导和锻炼跟踪结合起来。 然而，由于增加了可穿戴活动监测器的复杂性，因此将 HBET 适配到 PAD 上很困难。 运动处方要求患者步行直至出现接近最大的腿部疼痛。 积极辅导，长期坚持成功实施 HBET 治疗 PAD 一直是困难的 因此，我们的目标是利用更新的移动健康 (mHealth) 工具来使 HBET 适应 PAD。 我们建议通过与成功的 VA 合作来测试我们的 HBET 技术增强方法 生活方式计划 MOVE!，该计划在实现持续减肥和减少体重方面取得了成功 通过改变生活方式来预防糖尿病。由于增加体力活动是 MOVE! 的核心要素， 参与可能有助于提高 HBET for PAD 的依从性。我们新提出的计划 Smart MOVE!， 将是一个多组件计划，其中包括定制版本的 MOVE！ LifeQ 旨在提高 PAD 的 HBET 便利性、可及性和依从性。 目标 1（1-2 年）：找出 PAD 退伍军人参与 MOVE! 的障碍和促进因素。 目标 2（第 1-2 年）：评估 LifeQ 设备在 HBET 期间监测运动的可行性 目标 3（2-5 年）：通过试点确定继续实施 Smart MOVE 的可行性！ 随机试验。 作为一名积极治疗患有 PAD 的退伍军人的退伍军人管理局医生，我亲眼目睹了他们面临的挑战 这项研究将为获得指导性治疗（例如监督锻炼）奠定基础。 提供证据以继续进行 Smart MOVE!，这是一项急需的以患者为中心的运动康复项目 此外，拟议的培训计划将支持我成为一名专业人士。 独立的 VA 康复临床医生兼科学家致力于提高护理质量和治疗结果 患有 P.A.D. 的退伍军人