BCCMA: Recovery of Aged Muscle After Disuse Atrophy (REMEDY): Exercise and Monitoring with Post-Hospitalization Muscle Atrophy to Sustain Intrinsic Capacity and Strength (EMPHASIS)

Va Eastern Colorado Health Care System, Aurora CO

Investigators

Abstract

The EMPHASIS arm of the overarching BCCMA REMEDY Project is dedicated to tackling the notable concern of muscle atrophy following hospitalization. This condition, known as disuse muscle atrophy, poses a substantial challenge to the health and well-being of individuals, particularly those hospitalized. To tackle this problem, the project focuses on a specific group of individuals particularly vulnerable to this issue: Veterans with chronic kidney disease (CKD). This disease affects a substantial population of over 500,000 Veterans, leading to a progressive decline in mobility, unfavorable changes in lean body mass, and heightened hospitalization rates. To comprehensively address this concern, the project intends to develop and implement assessment and intervention strategies tailored to the target cohort's needs. By concentrating on Veterans with CKD, the project seeks to generate approaches that can be widely applied to address muscle atrophy among individuals with similar conditions. To achieve this, the project will commence by establishing a baseline cohort of Veterans with Stage 3 and 4 CKD at two distinct Veterans Affairs sites located in Denver and Baltimore. Upon enrollment, the Veterans muscle health will be assessed, encompassing various dimensions such as strength, lean body mass, muscle composition, mobility, and intrinsic capacity. This comprehensive evaluation will provide a snapshot of their pre-hospitalization muscle health. Subsequently, the enrolled Veterans will be closely monitored for at least two years. The project's approach involves conducting regular assessments of their muscle health every six months. Additionally, the participating Veterans will provide information about their strength and functional status every quarter, facilitated through a smartphone application. A particularly noteworthy aspect of the project is its inclusion of a pragmatic rehabilitation intervention trial. Veterans who experience hospitalization during the study will have the opportunity to participate in this trial. They will be assigned to either a supervised flywheel strengthening exercise group or receive usual care over 16 weeks. This intervention trial aims to assess the effectiveness of targeted exercise in mitigating the effects of disuse muscle atrophy post-hospitalization. The overarching design of the project encompasses three main objectives. Aim 1: Identify effective muscle assessment sites for disuse muscle atrophy. Aim 2: Assess if standardized intrinsic capacity and physical resilience assessments predict hospital outcomes. We anticipate that physical resilience scores will improve hospitalization and strength outcomes predictions. Aim 3: Evaluate a supervised flywheel exercise program against usual care. Both groups are expected to improve, with the supervised group having better results. The project seeks to establish standardized measures for clinical trials. These insights will inform the development of standardized measures for future clinical trials. In conclusion, the EMPHASIS arm of the REMEDY Project represents a comprehensive and well-structured initiative to address post-hospitalization disuse muscle atrophy among Veterans with CDK. Through its multi-faceted approach encompassing cohort establishment, regular assessments, intervention trials, and measurement refinement, the project aims to significantly improve clinical strategies for combatting muscle atrophy and its adverse consequences.