Senior Research Career Scientist

Veterans Admin Palo Alto Health Care Sys, Palo Alto CA

Investigators

Linked publications & trials

Abstract

The overarching goals of Dr. Myers’ research program are to apply exercise therapy and lifestyle intervention to help restore function, reduce disability, and reduce health care costs in Veterans with chronic disease. These areas include diagnostic and prognostic applications of cardiopulmonary exercise testing, and the physiologic effects of multidisciplinary rehabilitation programs in patients with chronic heart failure, coronary artery disease, abdominal aortic aneurysm disease, spinal cord injury, mild cognitive impairment, and chronic renal failure. He is currently PI on a VA RR&D project entitled, “Telehealth Vs. Web-based deliveRed home-basEd walKing for Vets with Peripheral Artery Disease (TREK-PAD)”, and a PCORI-funded project entitled, “Prehabilitation and Rehabilitation in PAD: A Randomized Exercise Intervention Trial (PREPARE-IT)”. These projects extend his lengthy history of research on the clinical applications of rehabilitation in patients with cardiovascular disease. TREK-PAD applies novel telehealth applications of exercise therapy in patients with peripheral arterial disease (PAD), a poorly represented group in rehabilitation studies. PREPARE-IT assesses the impact of a prehabilitation strategy in patients with PAD scheduled to undergo endovascular stenting for leg pain due to PAD. These studies are impactful in Veterans because studies have shown that Veterans have a markedly higher prevalence of PAD than the general population; Veteran males between the ages of 45 and 64 undergo peripheral angioplasty at a rate that is nearly 10-fold higher than rates for the US male population. Prehabilitation is an emerging strategy recommended in numerous surgical guidelines but remains underutilized. Dr. Myers’ current projects also include studies involving rehabilitation in patients with mild cognitive impairment and patients with kidney disease awaiting transplantation. Dr. Myers initiated and manages a relational database of clinical, angiographic, and exercise test responses dating back to 1987. This database has been a resource for answering many epidemiologic questions affecting Veterans (termed the Veterans Exercise Testing Study, or VETS). The VETS study is an ongoing, prospective evaluation of Veteran subjects referred for exercise testing for clinical reasons, designed to address exercise test, clinical, and lifestyle factors and their association with health outcomes. The VETS data set has >750,000 subjects who have undergone a maximal exercise test in the VA system. Studies from the VETS cohort have addressed the prevalence, temporal trends, and health care costs associated with statin use, obesity, chronic heart failure, cardiac rhythm abnormalities and other chronic conditions, and how these conditions are influenced by fitness, physical activity and other lifestyle patterns. Published studies from the VETS cohort have influenced guidelines on exercise testing from major health organizations. He coordinates two other national data bases, a 7-center heart failure cardiopulmonary exercise test consortium, and the AHA/CDC-sponsored Fitness Registry and the Importance of Exercise: A National Data Base (FRIEND). The FRIEND initiative is designed to develop a national fitness registry in order to better inform clinicians and the public about the importance of physical activity and fitness and their role in the prevention of chronic disease. As Co-PI, he recently completed a 6-year NIH-funded Specialized Center of Clinically-Oriented Research (SCCOR) project entitled, “Exercise Therapy in Abdominal Aortic Aneurysm Disease.” The SCCOR program was initiated by the National Heart, Lung, and Blood Institute to foster multidisciplinary research on clinically relevant topics facilitating basic science findings to be more rapidly applied to clinical problems, with an emphasis on prevention, diagnosis, and treatment of a particular disease. This project has particular relevance to Veterans, since it has been shown that the prevalence of abdominal aortic aneurism disease in Veterans >60 years is 14.3%, with potentially lethal consequences if the disease is not treated.