Goal 2: Reduce Human Disease

Measuring and Improving Physical Fitness to improve outcomes after Hematopoietic Stem Cell Transplantation

Can cardiorespiratory fitness prior to hematopoietic cell transplantation be improved and will this limit morbidity and mortality following transplantation?

Submitted by (@sheat0)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

HCT is associated with high rates of morbidity and mortality from transplant-related complications, the reduction of which would lead to higher transplant-mediated cure rates for life-threatening benign and malignant hematologic disorders. Comorbidity and patient-reported functional status impairment are known to increase the risk for transplant-related mortality, but unlike comorbidity, cardiorespiratory fitness is potentially modifiable. The optimal way to improve fitness through pre-transplant exercise and lifestyle interventions is not known, however, and understanding how to affect through a short term intervention would also benefit other cancer and non-cancer health conditions in which future treatment is intensive and associated with significant risk.

Feasibility and challenges of addressing this CQ or CC :

Feasibility and Challenges of Addressing the CG or CC:

 

Understanding how to improve cardiorespiratory fitness in a short period of time will require a research agenda that addresses the following challenges: how to measure cardiorespiratory fitness in a generalized and scalable way, which may or may not require maximal exercise testing for all participants; how to design intensive exercise interventions that are at least partially home-based in order to minimize resource burden on patients and centers; and how to personalize intervention delivery and testing in a way that is tailored to the baseline fitness levels and capabilities of each participant. Meeting these challenges will enable large-scale, personalized exercise testing and intervention delivery in other non-transplant populations.

Name of idea submitter and other team members who worked on this idea : Thomas Shea and William Wood

Voting

47 net votes
69 up votes
22 down votes
Active

Goal 3: Advance Translational Research

Need to Determine the Basis for Difference in Response to Weight Management Approaches

Why does the response to weight loss regimen in terms of weight loss and its sustainability, and improvement in health outcomes vary considerably?

Submitted by (@mturner)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Past research focused on using variations of diet and exercise has revealed important information about the health benefits of weight loss. The limitations of such approaches in producing biologically meaningful and sustained weight loss for the majority have also been recognized. Even within a study population, compliance to weight loss regimen, weight loss and its sustainability, and improvement in health outcomes vary considerably. Research is needed to identify the basis for this variation, which may lead to enhanced outcome and applicability of such approaches.

Feasibility and challenges of addressing this CQ or CC :

Identifying factors that enhance weight management response may lead to translational studies that yield more effective results. A strong support of promising clinical translational research may promote a conducive environment for developing more practical applications.

Name of idea submitter and other team members who worked on this idea : The Obesity Society

Voting

8 net votes
14 up votes
6 down votes
Active

Goal 2: Reduce Human Disease

Additional research needed to identify various contributors of obesity

What are the specific contributors of obesity that lead to chronic positive energy balance and surplus energy storage?

Submitted by (@mturner)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Obesity is a health crisis of epic proportions. About 34% of adults in the US have obesity, up from 31 % in 1999 and about 15% in the years 1960 to 1980. The chronic diseases that result from obesity annually cost over $150 billion in weight-related medical bills. Reduction of obesity improves cardiovascular and other health outcomes, yet what is currently known about obesity is inadequate to combat the global obesity epidemic. A comprehensive understanding about the mechanics of obesity may help in developing more effective preventive and treatment strategies, which in turn will substantially improve cardiovascular and other health measures.

Feasibility and challenges of addressing this CQ or CC :

Years of obesity research have revealed the complex nature of this disease and its multi-factorial etiology. While research has firmly established the role of energy balance in weight gain and weight loss, it is important to discover upstream factors that predispose only certain individuals to energy imbalance. This may be addressed by further focusing on newly identified putative contributors of obesity, including but not limited to the impact of sleep deprivation, ambient temperature, age at first pregnancy, intrauterine and intergenerational factors, neuro-endocrine factors, epigenetics, environmental chemicals and endocrine disruptors, gut microbes, infections and the immune system, and social and behavioral factors associated with obesogenic behaviors. These studies may provide mechanistic insight that may also lead to the development of new pharmacological approaches. It is possible that cause-specific prevention or treatment approaches may yield more effective results than generic approaches that do not necessarily consider upstream modulators of energy imbalance, or inter-individual differences.

Name of idea submitter and other team members who worked on this idea : The Obesity Society

Voting

8 net votes
18 up votes
10 down votes
Active

Goal 1: Promote Human Health

What motivates adults to exercise?

Getting people to change from a sedentary to active lifestyle is difficult. What institutional supports are most effective? What is the cost benefit of prevention versus treating cardiovascular disease.

Submitted by (@heartpathacupuncture1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Reducing the costs of treating cardiovascular disease (and possibly some cancers)

Feasibility and challenges of addressing this CQ or CC :

Considering the money spent on treatment this strategy should be feasible.

Name of idea submitter and other team members who worked on this idea : Shoshana

Voting

21 net votes
39 up votes
18 down votes
Active

Goal 3: Advance Translational Research

Epigenomic Impacts of Exercise and Nutrition

Epigenomic Impacts of Exercise and Nutrition

Submitted by (@s0tyag01)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Epigenomic Impacts of Exercise and Nutrition

Feasibility and challenges of addressing this CQ or CC :

Epigenomic Impacts of Exercise and Nutrition

Voting

14 net votes
21 up votes
7 down votes
Active

Goal 2: Reduce Human Disease

Improving cardiorespiratory fitness prior to hematopoietic cell transplantation

Can cardiorespiratory fitness prior to hematopoietic cell transplantation be improved and will this limit morbidity and mortality following transplantation?

Submitted by (@wawood)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

HCT is associated with high rates of morbidity and mortality from transplant-related complications. Reduction in transplant-related mortality would lead to more favorable risk/benefit assessments for the ability of transplant to cure life-threatening hematologic disorders including non-malignant conditions. Comorbidity and patient-reported functional status impairment are known to increase the risk for transplant-related mortality. Single institution studies suggest that cardiorespiratory fitness may serve a similar role as a predictive pre-transplant variable. Unlike comorbidity, cardiorespiratory fitness is potentially modifiable. However, the optimal way to improve cardiorespiratory fitness through pre-transplant exercise and lifestyle interventions is not known. Understanding how to improve cardiorespiratory fitness through a short term intervention would also benefit other health conditions relevant to the NHLBI in which future treatment is intensive and associated with significant risk.

Feasibility and challenges of addressing this CQ or CC :

Understanding how to improve cardiorespiratory fitness in a short period of time will require a research agenda that addresses the following challenges: how to measure cardiorespiratory fitness in a generalized and scalable way, which may or may not require maximal exercise testing for all participants; how to design intensive exercise interventions that are at least partially home-based, in order to minimize resource burden on patients and centers; and how to personalize intervention delivery and testing in a way that is tailored to the baseline fitness levels and capabilities of each participant. Meeting these challenges will enable large-scale, personalized exercise testing and intervention delivery in other non-transplant populations.

Name of idea submitter and other team members who worked on this idea : William Wood, Thomas Shea

Voting

21 net votes
42 up votes
21 down votes
Active

Goal 1: Promote Human Health

Establishment of a permanent exercise study section

Funding opportunities explicitly for studies of exercise have not been a major NIH priority. The NHLBI has been an exception to this, but the non-existence of a true exercise study section still makes funding a challenge for individuals in the field of Exercise Science. Exercise, along with sleep and diet, is one of the pillars of health and has been shown to be highly beneficial for a number of medical conditions. However, ...more »

Submitted by (@mschubert2)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Name of idea submitter and other team members who worked on this idea : MattS

Voting

202 net votes
290 up votes
88 down votes
Active

Goal 1: Promote Human Health

Reduce burden of vascular disease

How can we reduce the burden of vascular disease by promoting healthy lifestyle including diet, exercise, and smoking cessation?

Submitted by (@societyforvascularsurgery)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

­Conduct community level and scale studies in higher risk populations, identify effective tools to achieve healthy lifestyle and prevent or retard the progression of vascular disease. Determine which interventions work.

Name of idea submitter and other team members who worked on this idea : Society for Vascular Surgery

Voting

0 net votes
1 up votes
1 down votes
Active

Goal 2: Reduce Human Disease

exercises for asthmatics

There are lots of exercise regimens for COPD, but none that I can find for asthmatics

Submitted by (@bluemizloo)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

ASthma regimens are entirely environment and drug focused. Surely there is room for personal action.

Name of idea submitter and other team members who worked on this idea : Lou Phillips

Voting

-12 net votes
8 up votes
20 down votes
Active

Goal 2: Reduce Human Disease

Exercise in congenital heart disease and arrhythmia syndromes

What are the true risks of physical activity and competitive sports for children/young adults with congenital heart disease and arrhythmia syndromes?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Improve the quality of life of patients with congenital heart disease or arrhythmia syndromes who are currently restricted from competitive sports.

Feasibility and challenges of addressing this CQ or CC :

While we previously restricted many of these patients, the pendulum seems to be swinging back in terms of our thinking about this. While some preliminary data has suggested safety, more data is needed.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

Voting

4 net votes
15 up votes
11 down votes
Active

Goal 2: Reduce Human Disease

Implications of Sickle Cell Trait

What are the healthcare implications of sickle cell trait?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Millions of people in the U.S and throughout the world have sickle cell trait, yet other than its impact on athletes and the recent finding that it may significantly raise the risk of chronic kidney disease, little is known about the trait’s effect on the health of those who carry it. Additional research is needed to further elucidate the implications of sickle cell trait alone, in combination with other genetic tendencies or in response to certain environmental factors. Findings can be used to provide evidence-based clinical guidance for the millions of people who may be affected

Feasibility and challenges of addressing this CQ or CC :

Addressing this question is feasible. Obtaining sufficient long-term data to answer these questions may be challenging.

Name of idea submitter and other team members who worked on this idea : The Sickle Cell Association of New Jersey

Voting

6 net votes
6 up votes
0 down votes
Active

Goal 3: Advance Translational Research

Definitive Evidence of the Effectiveness of Pulmonary Rehabilitation

What is the clinical effectiveness of pulmonary rehabilitation in reducing hospital admissions and readmissions, improving health outcomes such as exercise tolerance and dyspnea, and positively impacting patient centered outcomes. Does this effectiveness vary based on the types of settings rehab is conducted in, urban vs rural environments, the components to the program, the timing of the program and the overall support ...more »

Submitted by (@gacdk0)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Pulmonary rehabilitation is a critical component in the treatment of COPD patients but several barriers persist that have resulted in very limited access to rehab, low referral rates for eligible patients and limited standardization of best practices within the rehab facilities that do exist. Large, definitive studies accounting for patient subgroups, site characteristics and program components can generate the level of evidence needed to expand access, educate providers and improve referral systems and create quality programs. This level of evidence is necessary to change policy to properly value the role of pulmonary rehabilitation and to convince integrated health systems in a value based market that pulmonary rehabilitation is beyond a doubt, a requirement of providing quality COPD care.

Name of idea submitter and other team members who worked on this idea : Grace Anne Dorney Koppel, COPD Foundation Board of Directors, COPD Patient Advocate

Voting

9 net votes
12 up votes
3 down votes
Active