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 two VA RR&D projects, one entitled, ?PCI Alternative using Sustained Exercise (PAUSE),? and the other entitled, ?Exercise to Prevent Muscle Mass and Functional Loss in Elderly Dialysis Patients (PERFECT).? The PAUSE project extends his work on the clinical applications of rehabilitation in patients with cardiovascular disease. Cardiovascular disease remains the leading cause of mortality in Veterans, and in addition to assessing the physiologic effects of exercise and lifestyle intervention as an alternative to invasive treatment of coronary artery disease, the study addresses the cost effectiveness of non-invasive (lifestyle intervention) vs. invasive (coronary stenting) strategies. The PERFECT trial focuses on the effects of exercise therapy on muscle mass and function in chronic renal failure. Renal failure is an important condition in the VA because of its cost (estimated to be the second most costly condition in the VA), its prevalence (estimated to be 34% higher than the general population), and its devastating effects on physical function and disability. Dr. Myers current work also includes three funded projects involving the effects of exercise therapy in patients with mild cognitive impairment. These studies are designed to evaluate the effectiveness of exercise augmentation strategies along with cognitive training interventions to improve cognitive performance in older Veterans with mild cognitive impairment. 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. 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 and physical activity patterns. Analyses 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.

Public Health Relevance

Dr. Myers' research projects address areas related to functional restoration in persons with chronic disease. His studies largely focus on applications of exercise therapy and other lifestyle factors to improve physical function, reduce disability, and lower health care costs in Veterans. These areas include studying the physiologic effects of rehabilitation in chronic diseases including chronic heart failure, coronary artery disease, spinal cord injury (SCI), and chronic kidney disease. This is an important area of research among Veterans because cardiovascular disease (CVD) is the leading cause of death and disability in Veterans, and SCI and chronic kidney disease are the two most costly health conditions in the VA system. Dr. Myers' studies are designed to reduce the overall burden of CVD and other chronic diseases by improving physical function, reducing disability, and thus reducing health care costs associated with them.

Agency
National Institute of Health (NIH)
Institute
Veterans Affairs (VA)
Project #
5IK6RX002477-02
Application #
9397992
Study Section
Rehabilitation Engineering & Prosthetics/Orthotics (RRD7)
Project Start
2016-10-01
Project End
2023-09-30
Budget Start
2017-10-01
Budget End
2018-09-30
Support Year
2
Fiscal Year
2018
Total Cost
Indirect Cost
Name
Veterans Admin Palo Alto Health Care Sys
Department
Type
DUNS #
046017455
City
Palo Alto
State
CA
Country
United States
Zip Code
94304