CENTER FOCI

The University of Maryland Older Americans Independence Center (UM-OAIC) has successfully conducted exercise rehabilitation research demonstrating that rehabilitation interventions which include aerobic and motor learning training improve ambulation and physiological function, and reduce cardiovascular disease (CVD) risk factors in older individuals disabled by stroke, and other chronic disabling diseases. These rehabilitation strategies are based on the premise that recovery of physical function in disabled older adults requires a rehabilitation approach that improves the function of multiple systems involved in ambulation, motor function and the activities of daily living.  The accelerated functional declines that occur due to an acute event superimposed on the weakness, sarcopenia, neuromotor and cardiovascular impairments associated with chronic disease in an older person reduces their physiological reserve capacity and ability to participate in physical and instrumental activities of daily living that require substantial effort.  This promotes the avoidance of physical activity, further reducing aerobic capacity and muscle strength and accelerates functional declines which impair the ability of these older people to live independently in the community. 

It is our hypothesis that cardiovascular and neuromotor deconditioning are fundamental to disability in older adults living with functional impairments, and that these impairments are modifiable by disease-specific exercise and motor learning based rehabilitation (figure 1).  Over the past several years, UM-OAIC investigators developed new methods to support our overall mission to 1) conduct innovative exercise and motor learning-based rehabilitation research; 2) determine the pathophysiology of the functional impairments associated with stroke, hip fracture and other chronic disabling diseases and investigate the mechanisms by which novel rehabilitation strategies improve functional and clinical outcomes; 3) mentor the career development of junior faculty and trainees; and 4) develop collaborations with investigators throughout the University of Maryland, nationally, and internationally to conduct interdisciplinary rehabilitation and aging research. 

The UM-OAIC has selected rehabilitation research in disability and aging as its focus because of its critical importance for the health and well-being of older adults living with chronic diseases. There is a dearth of mechanistic and translational research in this area of investigation, and the strength of the UM-OAIC Research Core Leaders in the conduct of mechanistic research across the domains of neuromotor, muscular, cardiovascular, and metabolic function in basic science and clinical laboratories.

Our objective is to develop a more general model to explain the effects of rehabilitation on functional impairments and disabilities that follow events such as stroke or hip fracture, or that accompany chronic disease (disability phenotype). This will help us design exercise and motor learning-based rehabilitation strategies to modify the disability phenotype and change the clinical and functional status of older persons with disabilities.

This model (figure2) integrates research conducted in the Research Cores examining pathophysiological mechanisms (e.g. inflammation, insulin resistance, mitochondrial dysfunction, decreased VO₂max, brain injury, etc) that contribute to functional impairments that characterize the disability phenotype.  These mechanisms impair physiological and neuromotor function, physiologic reserve capacity and muscle strength, thereby worsening comorbidities and associated psychosocial attributes that define the disability phenotype as measured in Research Cores 1-3. UM-OAIC Research Cores will define disease-specific disability phenotypes, use the characteristics to design disability specific rehabilitation strategies, and examine their effects on the pathophysiologic mechanisms and functional limitations associated with the disability phenotype. Functional and clinical outcomes will be reviewed, and the efficacious rehabilitation interventions modified in Research Core 1 for translation into community-based trials.