Neurobiological and Psychological Benefits of Exercise in Fibromyalgia and PTSD

运动对纤维肌痛和创伤后应激障碍 (PTSD) 的神经生物学和心理益处

• 批准号: 10091304
• 负责人: Erica Rose Checko
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-01-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10091304
• 关键词: Acute; Allopregnanolone; American; Anhedonia; Anti-Inflammatory Agents; Biological Markers; Boston; Cardiology; Cardiopulmonary; Chronic; Clinical Research; Cognitive; Conflict (Psychology); Data; Development; Disease; Educational Intervention; Exercise; Exercise Test; Exposure to; Fibromyalgia; Fostering; Functional disorder; Funding; Generations; Grant; Guidelines; Health; Health Benefit; Health behavior change; Healthcare Systems; Heart Rate; Home environment; Hormones; Hydrocortisone; IL8 gene; Immune; Individual; Inflammation; Inflammatory; Injury; Interleukin-6; Intervention; Maintenance; Mental Depression; Mental Health; Modification; Monitor; Motivation; Neurobiology; Neurohormones; Neuromodulator; Pain; Pain Threshold; Participant; Patients; Physiological; Population; Post-Traumatic Stress Disorders; Pregnanolone; Problem Solving; Process; Protocols documentation; Publishing; Research Design; Rewards; Running; Self Efficacy; Severities; Stress; Substance P; Supervision; Symptoms; System; Telephone; Testing; Training; Training Programs; Translational Research; Treatment Protocols; United States National Institutes of Health; Up-Regulation; Veterans; Walking; Woman; Work; actigraphy; base; behavior change; chronic musculoskeletal pain; chronic pain; chronic painful condition; clinically significant; college; comorbidity; cytokine; depressive symptoms; design; disability; exercise adherence; exercise intervention; exercise physiologist; exercise prescription; exercise program; exercise regimen; exercise training; experience; fibromyalgia pain; fibromyalgia patients; follow-up; health care service utilization; improved; innovation; intrinsic motivation; neurobiological mechanism; neuropeptide Y; neurosteroids; pain reduction; pain sensitivity; physical conditioning; prevent; psychologic; psychological trauma; recruit; response; trauma exposure

This study will compare the effects of a 12-week progressive exercise training program on 1) Fibromyalgia (FM) pain and PTSD symptoms, 2) pain threshold and tolerance, and 3) relevant biomarkers and neuromodulators including: a) anti-stress, anti-nociceptive, immune modulating factors such as neuropeptide Y (NPY) and GABAergic neuroactive steroids such as allopregnanolone and pregnanolone (together termed ALLO) b) factors that upregulate the expression of NPY and the GABAergic neuroactive steroids, and otherwise modulate inflammation, such as cortisol, c) excitatory factors such as substance P that directly promote pain transduction and d) pro-inflammatory cytokines such as IL-6 and IL-8 that not only increase pain and inflammation, but also contribute to psychological dysfunction (e.g. anhedonia and depression) via impact on the CNS reward system. This study will focus on Veterans with FM/PTSD. The study design includes a baseline, acute, cardiopulmonary exercise assessment (CPX) that will inform the exercise prescription for a 12- week “progressive exercise” training program, comprised of three 30-45 minute exercise sessions per week (walking or running, depending on the ability/capacity of the participant). Exercise sessions will be initially supervised by an exercise physiologist in the Clinical Studies Unit (CSU) at the VA Boston Healthcare System and then each participant will transition into the home. Weekly telephone calls by the PI will provide additional motivational support and problem solving. Implementation of the prescribed exercise regimen will also be supported by the use of heart rate and actigraph monitors programmed for the participant to achieve their prescribed heart rate range (HRR). Finally, an “endpoint” CPX assessment will occur at week 13 to track changes in psychological and neurobiological factors and to delineate their impact on pain and PTSD symptoms. Both CPX, maximum load, exercise tests will be performed in accordance with guidelines published by the American College of Cardiology. Among Veterans with FM/PTSD, changes in the biomarkers assessed after acute, CPX exercise testing will be associated with improvements in pain and PTSD symptoms. Once identified, such biomarkers could be augmented by modification of the exercise regimen to help enhance the anti-stress hormone levels for the FM/PTSD population and experience clinically significant reductions in their symptoms. To obtain sufficient power, 36 participants (18/year) will be recruited. Data from this pilot work will be used to demonstrate feasibility and inform the further development of individually prescribed exercise regimens and a motivationally based exercise behavior change intervention aimed at reducing chronic musculoskeletal pain, including FM, and PTSD symptoms in Veterans. In the short-term, this SPiRE proposal will allow the PI to develop a more effective, motivationally based, exercise behavior change protocol that fosters long-term exercise adherence in patients with FM/PTSD. In the long-term, this intervention will be used as an adjunct to cognitive interventions for these disorders to be further developed and studied via a larger VA, NIH, or DOD-funded grant for which the PI will apply year 2 of the current SPiRE proposal.

这项研究将比较一个为期12周的渐进式训练计划对1）纤维肌痛的影响 （FM）疼痛和PTSD症状，2）疼痛阈值和耐受性，以及3）相关生物标志物和 神经调节剂包括：a）抗应激，抗伤害感受，免疫调节因子，例如神经肽 Y（NPY）和GABA能神经活性类固醇，例如Allopregnanolone和untixtolone（一起称为 allo）b）上调NPY和GABA能神经活性类固醇和的因素 否则调节注射，例如皮质醇，c）兴奋性因素，例如直接的物质P 促进疼痛转移和d）促炎性细胞因子，例如IL-6和IL-8，不仅会增加疼痛 和炎症，但也会导致心理功能障碍（例如Anhedonia和抑郁症） 在CNS奖励系统上。这项研究将集中于具有FM/PTSD的退伍军人。研究设计包括 基线，急性，心肺运动评估（CPX），将为锻炼处方提供12-- 周的“渐进式锻炼”培训计划，每周完成3个30-45分钟的练习课程 （步行或跑步，具体取决于参与者的能力/能力）。运动最初将是 由VA波士顿医疗保健系统的临床研究部门（CSU）中的运动生理学家监督 然后每个参与都将过渡到房屋。 PI每周电话将提供额外的电话 动机支持和解决问题。规定的运动方案的实施也将是 通过编程为参与的心率和动作法监视的使用，以实现他们的支持 处方心率范围（HRR）。最后，将在第13周进行“终点” CPX评估以跟踪 心理和神经生物学因素的变化，并描述其对疼痛和PTSD的影响 症状。 CPX，最大负载，运动测试都将根据指南进行 由美国心脏病学院出版。在具有FM/PTSD的退伍军人中，生物标志物的变化 急性后评估，CPX运动测试将与疼痛和PTSD症状的改善有关。 一旦确定，可以通过修改运动方案来增强这种生物标志物以帮助增强 FM/PTSD人口的抗压力马龙水平，并在临床上显着降低 他们的症状。为了获得足够的权力，将招募36名参与者（18/年）。该飞行员的数据 工作将用于证明可行性，并告知单独规定的进一步发展 运动方案和基于动力的运动行为改变干预措施，旨在减少慢性 退伍军人中的肌肉骨骼疼痛，包括FM和PTSD症状。在短期内，这个尖顶提案 PI将允许PI开发更有效，基于动力的，锻炼行为改变协议， FM/PTSD患者的长期运动依从性。从长远来看，将使用此干预措施 作为认知干预措施的辅助，这些疾病要进一步发展，并通过较大的VA进行研究， NIH或DOD资助的赠款，PI将为当前尖峰提案的第二年应用。