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Principal Investigator: Jorge Antonio Antonio Gutierrez
Organization: DURHAM VA MEDICAL CENTER
Fiscal Year: 2024
Funding agency: Veterans Affairs
The present study aims to increase Veteran access to supervised exercise therapy and expand its role in
improving functional status, quality of life, and cardiovascular risk profile of Veterans with PAD. To accomplish
these goals, we will use the VA Telehealth service to deploy a remotely accessible supervised exercise training
program and evaluate whether a telehealth-based intervention can improve walking performance, quality of life,
and ultimately cardiac risk in Veterans with PAD. The impetus for the current proposal stems from the following:
1) over 50% of VA-enrolled Veterans live in rural communities; 2) Veterans with PAD are older (mean age, 70
years), further increasing their risk for functional decline; and 3) there is a significant lack of access to facility-
based supervised exercise training for Veterans with PAD.
The training goals of the present proposal are the following: 1) To obtain practical research study
management experience as primary investigator; 2) To develop skills required for scalable intervention
development and implementation; and 3) To improve stakeholder engagement skills. By completing the
following aims, the applicant will undergo invaluable training in regard to the development, implementation,
and dissemination of a newly proposed Veteran model of care for local and national adoption. The central
hypothesis of this proposed research is that a telehealth-based intervention can improve physical function,
health-related quality of life, and reduce coronary artery disease risk among Veterans with PAD. Two
prospective pilot studies will accomplish our initial steps and include the following:
Aim 1. To develop a telehealth-facilitated exercise intervention for Veterans with PAD that
serves as a Veteran centric new model of care. We will evaluate the feasibility, acceptability, and
implementation of a telehealth-facilitated supervised exercise program. Using a prospective pre-post pilot study
design, Veterans with PAD (n=54) will be enrolled in a 12-week, 3 day a week, aerobic training program in a self-
selected location. Nine exercise cohorts of 6 patients are planned. Data on participation, satisfaction, technical
errors, and adherence will be collected. Walking performance, quality of life, and PAD risk factor metrics at
baseline and completion of intervention (3 months) will also be evaluated.
Aim 2. To integrate Veteran preferences into the development of a telehealth-facilitated
supervised exercise program. We will collect and evaluate patient, provider, and stakeholder feedback with
each exercise cohort. These data will be used to actively modify the intervention to improve feasibility,
acceptability, and potential scalability for future broad based implementation.
Aim 3. To assess the long term patterns of functional impairment and quality of life among
Veterans with PAD not undergoing supervised exercise training. We will conduct a prospective
longitudinal study contemporaneous to the pilot study described above. Using a prospective cohort study design,
we will measure the natural course of overall physical performance and its impact on PAD risk factors and quality
of life of Veterans with PAD (n=100) in the absence of supervised exercise therapy. This cohort will not include
Veterans participating in Aims 1 and 2. Data on walking performance, functional status, perception of walking
ability, quality of life, PAD risk factors, and cardiovascular risk will be collected at baseline and 12 months.
The pilot data collected through this proposal will guide the development of a novel Veteran centric model
of care. Telehealth is highlighted as a research priority by the VA Office of Research and Development/Health
Services Research and Development Service to improve access to care for underserved populations.
Furthermore, this work serves as a foundation for a [subsequent Merit Award application during year 3 of the
proposal focusing on a multi-site implementation trial and outcomes assessing reach, adoption, fidelity, and
sustainability.]
Terms: <Access to Care><Adherence><Adoption><Aerobic Activity><Aerobic Exercise><Aerobic Training><Aerobic fitness><Age><Award><Cardiac><Caring><Cholesterol><Coronary Arteriosclerosis><Coronary Artery Disease><Coronary Artery Disorder><Coronary Atherosclerosis><Data><Development><Development and Research><Eligibility><Eligibility Determination><Enrollment><Event><Exercise><Exercise Therapy><Exercise based rehabilitation><Feedback><Foundations><Functional impairment><Future><Goals><Health Services><Health Services Accessibility><Health Services Evaluation><Health Services Research><High Prevalence><Home><Improve Access><Intervention><Intervention Strategies><Investigators><Ischemic Heart><Ischemic Heart Disease><Ischemic myocardium><Leg><Leg Pain><Life Style><Lifestyle><Location><Long-term prospective studies><Longterm prospective studies><Measures><Medical><Medical Care Research><Mission><Modeling><Myocardial Ischemia><Outcome Assessment><Pain><Pain in lower limb><Painful><Patients><Pattern><Perception><Peripheral arterial disease><Physical Function><Physical Performance><Physical activity><Pilot Projects><Practice Guidelines><Premature Mortality><Prospective, cohort study><Protocol Screening><Provider><QOL><Quality of life><R & D><R&D><Recommendation><Research><Research Design><Research Personnel><Research Priority><Researchers><Risk><Risk Factors><Role><Rural Community><Sedentary behavior><Sedentary life-style><Services><Site><Study Type><Supervision><Therapeutic exercise><Training><Training Programs><Travel><Underserved Population><Vascular blood supply><Veterans><Walking><Work><access to health services><access to services><access to treatment><accessibility to health services><ages><atherosclerotic coronary disease><availability of services><blood supply><cardiac disease risk><cardiac disorder risk><cardiac ischemia><cardiovascular risk><cardiovascular risk factor><care access><claudication><cohort><common symptom><coronary arterial disease><coronary ischemia><decline in function><decline in functional status><develop therapy><developmental><disease model><disease risk><disorder model><disorder risk><enroll><exercise intervention><exercise program><exercise rehabilitation><exercise training><exercise treatment><experience><fitness program><functional decline><functional status><functional status decline><health related quality of life><health service access><health services availability><heart disease risk><heart disorder risk><heart ischemia><homes><implementation outcomes><implementation trial><improved><intervention development><interventional strategy><longitudinal, prospective study><myocardial ischemia/hypoxia><myocardium ischemia><novel><performance in walking><peripheral artery disease><physical activity intervention><pilot study><preference><programs><prospective><rehabilitative exercise><research and development><research study><satisfaction><sedentary lifestyle><service availability><services research><skills><social role><stem><study design><telehealth><therapy development><treated with exercise><treatment access><treatment development><under served group><under served individual><under served people><under served population><underserved group><underserved individual><underserved people><vascular supply><walking pace><walking performance><walking speed>