Remotely Monitored, Mobile health-supported High Intensity Interval Training after COVID-19 Critical Illness (REMM HIIT-Covid19)

COVID-19 危重疾病后远程监控、移动健康支持的高强度间歇训练 (REMM HIIT-Covid19)

• 批准号: 10688052
• 负责人: Amy M Pastva
• 金额: $ 78.97万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-17 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10688052
• 关键词: Accelerometer; Address; Adherence; Adipose tissue; Adult; Aging; American; Apple watch; Area; Award; Balance training; Biological Markers; Bone Marrow Transplantation; COVID-19; COVID-19 pandemic; COVID-19 survivors; Cancer Patient; Cardiopulmonary; Caring; Cellular Phone; Clinic; Clinical Research; Clinical Trials; Clinical Trials Design; Cognition; Cognitive deficits; Computer software; Critical Care; Critical Illness; Data; Development; Devices; Disease; Dose; Education; Elderly; Equilibrium; Exercise; Exercise Test; Funding; Future; Glycogen; Goals; Heart Rate; Home; Home environment; Hospitalization; Hospitals; Impairment; Individual; Inflammation; Intensive Care; Intensive Care Units; Interdisciplinary Study; Interval training; Intervention; Intramuscular; Kentucky; Knowledge; Leukocytes; Literature; Malignant Neoplasms; Measures; Medical center; Medicine; Mental Health; Mitochondria; Monitor; Multicenter Studies; Multicenter Trials; Muscle; Muscle function; Muscular Atrophy; Near-Infrared Spectroscopy; Ohio; Operative Surgical Procedures; Outcome; Outcomes Research; Oxygen Consumption; Patient Self-Report; Patients; Performance; Persons; Phase; Physical Exercise; Physical Function; Physical Performance; Physical Rehabilitation; Physiological; Pilot Projects; Population; Public Health; Quality of life; Randomized; Recommendation; Recovery; Rehabilitation therapy; Reporting; Research; Research Institute; Resistance; Societies; Structure; Survivors; Syndrome; Testing; United States National Institutes of Health; Universities; Videoconferencing; Walking; brain dysfunction; cardiorespiratory fitness; chemotherapy; comparison control; digital; disability; exercise capacity; exercise intervention; exercise prescription; exercise training; experience; fitness; functional outcomes; improved; innovation; mHealth; mitochondrial metabolism; muscle form; muscle strength; novel; novel strategies; older patient; pandemic disease; patient safety; physically handicapped; primary endpoint; programs; rehabilitation research; rehabilitation strategy; remote monitoring; safety and feasibility; severe COVID-19; strength training; survivorship; ultrasound

Severe disease from COVID-19 requires hospitalization in 20% of adults, with a third of those patients requiring intensive care unit (ICU) treatment. While a growing number of patients are surviving COVID-19 critical illness, like other ICU survivors, the majority will experience significant post-hospital disabilities in physical function and exercise capacity, new-onset disability, muscle wasting/weakness, and new cognitive deficits. These difficulties, which can persist for months to years post-ICU, are collectively known as post-intensive care syndrome (PICS) and may be more severe in COVID-19 survivors. Despite literature demonstrating the benefit of physical rehabilitation in COVID-19 and other ICU survivors, there are limited available options and data to support an optimal post-hospital physical rehabilitation strategy. Combined with the difficulties of delivering rehabilitation in- person after hospitalization during a pandemic, addressing this “rehabilitation pandemic” from COVID-19 represents an enormous public health challenge. Previous studies of home-based physical rehabilitation in ICU survivors have utilized unsupervised exercise training without a personalized exercise prescription, and none have done so while actively monitoring and targeting exercise via physiologic data such as heart rate or included strength and balance training. In debilitated older patients, high intensity interval training (HIIT) is safe and associated with significant improvements (in as little as two weeks) in cardiorespiratory fitness (CRF) that also correlates with self-reported physical function and disability. We have evaluated this approach in a successful NIH-funded phase 1 pilot study demonstrating safety and feasibility of HIIT in debilitated older adults with cancer. Adherence to exercise was 117% (meaning patients exercised more than recommended 3 sessions/week), compliance with heart rate goals was 98% (meaning patients were actually doing HIIT vs. less-intensive exercise), and on average patients improved CRF, as measured by VO2peak on cardiopulmonary exercise testing by 25%. The key to our approach is our mHealth platform, in which patients are given Apple Watches and iPhones preloaded with our software allowing us to remotely download data after each exercise session to provide personalized up-coaching via videoconferencing in home setting. As critical illness survivors, including COVID-19 ICU survivors, have impaired CRF (similar to patients in pilot study) and other manifestations of PICS, a similar monitored, personalized, structured, and progressive multi-domain physical rehabilitation intervention has significant potential for improving recovery, but has not yet been studied in COVID-19 survivors. To address this gap in knowledge, we will randomize 140 COVID-19 ICU survivors being discharged home to our REmotely Monitored, Mobile health-supported High Intensity Interval Training after COVID-19 Critical Illness (REMM-HIIT-Covid- 19) study to test the hypothesis that the REMM-HIIT exercise intervention, in contrast to exercise education alone, will improve CRF and muscle strength/mass (Aim 1); improve physical function and quality of life (Aim 2); and improve markers of mitochondrial function and inflammation (Aim 3) measured at 3-months after discharge.

20% 的成年人因 COVID-19 患严重疾病需要住院治疗，其中三分之一的患者需要住院治疗 虽然越来越多的患者在重症监护病房 (ICU) 中幸存下来，但仍处于危重状态。 与其他 ICU 幸存者一样，大多数人出院后会出现严重的身体功能障碍和 运动能力、新发残疾、肌肉萎缩/无力和新的认知缺陷。 这种症状在 ICU 后可能持续数月至数年，统称为重症监护后综合症 (PICS) 尽管文献证明了身体锻炼的好处，但对于 COVID-19 幸存者来说，情况可能更为严重。 对于 COVID-19 和其他 ICU 幸存者来说，支持康复的可用选项和数据有限 结合院内康复的困难，制定最佳的出院后身体康复策略。 大流行病期间住院后的人，应对 COVID-19 带来的“康复大流行病” 此前对 ICU 家庭物理康复的研究是一项巨大的公共卫生挑战。 幸存者在没有个性化运动处方的情况下进行了无人监督的运动训练，并且没有 这样做的同时，通过心率等生理数据积极监测和确定锻炼目标 对于虚弱的老年患者，高强度间歇训练 (HIIT) 是安全且有效的。 与心肺健康 (CRF) 的显着改善（短短两周内）相关 我们已经成功地评估了这种方法。 美国国立卫生研究院 (NIH) 资助的第一阶段试点研究证明了 HIIT 对患有癌症的衰弱老年人的安全性和可行性。 运动坚持率为 117%（意味着患者每周运动次数超过建议的 3 次）， 心率目标的遵守率为 98%（这意味着患者实际上正在进行 HIIT 训练，而不是强度较低的训练） 运动），并且根据心肺运动的 VO2peak 测量，患者平均 CRF 有所改善 我们的方法的关键是我们的 mHealth 平台，在该平台中，患者会获得 Apple Watch。 iPhone 预装了我们的软件，使我们能够在每次锻炼后远程下载数据 通过视频会议在家庭环境中提供个性化的指导，包括作为危重疾病幸存者。 COVID-19 ICU 幸存者，CRF 受损（与试点研究中的患者相似）和 PICS 的其他表现， 类似的监测、个性化、结构化和渐进式多领域物理康复干预 具有改善康复的巨大潜力，但尚未在 COVID-19 幸存者中进行研究。 由于知识上的差距，我们将随机抽取 140 名出院回家的 COVID-19 ICU 幸存者到我们的远程中心 COVID-19 危重疾病后受监控、移动健康支持的高强度间歇训练 (REMM-HIIT-Covid- 19) 研究检验以下假设：与单独的运动教育相比，REMM-HIIT 运动干预将 提高 CRF 和肌肉力量/质量（目标 1）；改善身体机能和生活质量（目标 2）； 出院后 3 个月测量线粒体功能和炎症标志物（目标 3）。

项目成果

Automated versus manual analysis of body composition measures on computed tomography in patients with bladder cancer.

• DOI: 10.1016/j.ejrad.2022.110413
• 发表时间: 2022-09
• 期刊: EUROPEAN JOURNAL OF RADIOLOGY
• 影响因子: 3.3
• 作者: Rigiroli, Francesca;Zhang, Dylan;Molinger, Jeroen;Wang, Yingqi;Chang, Andrew;Wischmeyer, Paul E.;Inman, Brant A.;Gupta, Rajan T.
• 通讯作者: Gupta, Rajan T.

Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient.

• DOI: 10.1002/jpen.2420
• 发表时间: 2023-02
• 期刊: JOURNAL OF PARENTERAL AND ENTERAL NUTRITION
• 影响因子: 3.4
• 作者: Prado, Carla M.;Ford, Katherine L.;Gonzalez, M. Cristina;Murnane, Lisa C.;Gillis, Chelsia;Wischmeyer, Paul E.;Morrison, Chet A.;Lobo, Dileep N.
• 通讯作者: Lobo, Dileep N.