Examining the effects of live telehealth exercise training on cardiometabolic outcomes in wheelchair users

检查实时远程健康运动训练对轮椅使用者心脏代谢结果的影响

• 批准号: 10598883
• 负责人: Jereme Wilroy
• 金额: $ 66.12万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-20 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10598883
• 关键词: 2 arm randomized control trial; Address; Adult; African American; Age; Asian; Blood Tests; Body Composition; C-reactive protein; Cardiovascular system; Caucasians; Cholesterol; Clinic; Communities; Data; Dose; Dual-Energy X-Ray Absorptiometry; Effect Modifiers (Epidemiology); Elements; Equipment; Ethnic Origin; Exclusion; Exercise; Fasting; Foundations; Future; General Population; Geography; Goals; Health; Health Promotion; Heart Rate; Hemoglobin; Heterogeneity; Home; Hypertriglyceridemia; Imagery; Insulin; Intervention; Knowledge; Maintenance; Measures; Meta-Analysis; Modality; Movement; Music; Non obese; Obesity; Outcome; Oxygen Consumption; Participant; Patient Self-Report; Pattern; Persons; Phase; Physical activity; Population; Procedures; Quality of life; Research; Risk Factors; Risk Reduction; Sample Size; Scanning; Site; Specific qualifier value; Statistical Models; Structure; Subgroup; System; Testing; Training; Triglycerides; Underrepresented Populations; Videoconferencing; Wheelchairs; Woman; cardiometabolic risk; cardiometabolism; clinical practice; clinical training; disability; effectiveness evaluation; efficacy evaluation; efficacy testing; evidence base; exercise intensity; exercise intervention; exercise program; exercise training; fitness; implementation evaluation; improved; instrument; men; mode of exercise; post intervention; programs; real time monitoring; recruit; respiratory; response; sedentary lifestyle; sex; synchronous delivery; telehealth; treatment effect; virtual

Project Summary/Abstract For the more than 5.5 million people in the U.S. who use wheelchairs as their primary mode of ambulation, there is a pervasive lack of research on reducing cardiometabolic risk through structured exercise. Confirmatory analyses have revealed that wheelchair users live predominantly sedentary lifestyles and have substantially higher cardiometabolic risk factors compared to the general population. Although few exercise training studies have investigated cardiometabolic risk in certain subgroups with a disability, small sample sizes and homogeneous groups limit the translatability of this knowledge into clinical practice risk reduction strategies for wheelchair users. To address these issues, we propose to use a robust remote training system with built-in videoconferencing and real-time monitoring of vital sign data (e.g., heart rate, respiratory rate). This procedure will allow us to examine the efficacy of an evidence-based Movement-to-Music (M2M) program adapted for telehealth delivery and cardio emphasis (M2M-C). We are proposing a two-arm randomized controlled trial including 132 wheelchair users with a poor cardiometabolic profile (e.g., elevated triglycerides) recruited through our established network of clinics serving this population. The long-term goal of this proposal is to develop an effective and enjoyable modality for promoting health-enhancing exercise for wheelchair users by confirming exercise dose requirements for this underrepresented group. The primary aim will examine the average treatment effects of a 24-week M2M-C program on core indicators of CMH in wheelchair users with ≥ 2 cardiometabolic risk factors. CMH outcomes will be measured via blood tests (i.e., high sensitivity C-reactive protein, hemoglobin, fasting insulin, triglycerides, and cholesterol) and DEXA scan (i.e., body composition) at baseline and after 12 and 24 weeks of synchronous M2M-C training. The secondary aim will explore the beneficial effects of M2M-C on cardiovascular capacity, physical activity, and quality of life. Cardiovascular capacity will be measured via peak oxygen consumption. Physical activity and quality of life will be measured by self-report instruments validated for this population. The tertiary aim 1 is to evaluate the sustained effects of M2M-C (24 to 36 weeks) on physical activity. After M2M participants complete the 24-week program, they will be instructed to perform asynchronous exercise training using guided M2M online videos for an additional 12 weeks. The tertiary aim 2 is to examine the heterogeneity of treatment effect (HTE), which aims to understand whom the intervention is most effective.

项目摘要/摘要 对于美国有550万人使用轮椅作为主要行动方式的人来说， 对于通过结构化锻炼来降低心脏代谢风险的研究普遍缺乏研究。 确认性分析表明，轮椅使用者主要是久坐的生活方式，并且 与普通人群相比，心脏代谢风险因素要高得多。虽然很少运动 培训研究研究了某些残疾的某些亚组中的心脏代谢风险，样本很小 大小和同质群体限制了这种知识的转换性为临床实践降低风险 轮椅使用者的策略。为了解决这些问题，我们建议使用强大的远程培训系统 内置视频会议和生命体征数据的实时监控 （例如，心率，呼吸率）。 该程序将使我们能够检查基于证据的运动（M2M）计划的效率 适用于远程医疗交付和有氧运动（M2M-C）。我们正在提议随机的两臂 对照试验，包括132个轮椅使用者，心脏代谢轮廓差（例如，甘油三酸酯升高） 通过我们已建立的诊所网络招募，为该人群提供服务。该提议的长期目标 是为了促进轮椅使用者促进健康增强运动的有效和愉快的方式 通过确认该代表性不足的组的运动剂量要求。主要目的将检查 24周M2M-C计划对轮椅使用者中CMH的核心指标的平均治疗效果≥ 2个心脏代谢风险因素。 CMH结果将通过血液测试（即高灵敏度C反应性）测量 在 基线以及同步M2M-C训练12和24周后。次要目标将探索 M2M-C对心血管容量，体育锻炼和生活质量的有益影响。心血管 容量将通过峰值消耗量来衡量。体育锻炼和生活质量将衡量 通过为该人群验证的自我报告工具。三级目标1是评估持续效应 M2M-C（24至36周）的体育锻炼。在M2M参与者完成24周计划之后，他们 将指示使用指导的M2M在线视频进行异步运动培训 12周。第三级目标2是检查治疗效应的异质性（HTE），旨在 了解干预最有效的人。