Advancement of Clinical Referral to Physical Activity for Cardiometabolic Disease Prevention

临床转介体力活动预防心血管代谢疾病的进展

基本信息

批准号：
10175021
负责人：
Bonny Rockette-Wagner
金额：
$ 13.47万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-06-01 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10175021
关键词：
Accelerometer Address Adoption Adult Advisory Committees Aerobic Affect American American Heart Association Attitude Behavior Behavior Therapy Belief Blood Pressure Body Weight Cardiometabolic Disease Cardiovascular Diseases Characteristics Cholesterol Clinical Cognitive Consensus Control Groups Data Development Diabetes Mellitus Dyslipidemias Electronic Health Record Elements Enrollment Epidemiologic Methods Exercise Funding Future Glucose Goals Guidelines Health Health Professional Health system Healthcare Systems Hypertension Individual Informatics Insulin Intervention Interview Knowledge Lead Learning Life Style Maintenance Measures Mentors Methods Monitor National Heart, Lung, and Blood Institute Non-Insulin-Dependent Diabetes Mellitus Obesity Outcome Outcomes Research Overweight Paper Participant Patient Care Patient Outcomes Assessments Patient-Focused Outcomes Patients Physical activity Population Prevention Preventive service Primary Health Care Primary Prevention Procedures Process Program Acceptability Program Evaluation Qualitative Research Quality of life Questionnaires Randomized Recommendation Reporting Research Research Methodology Research Personnel Resources Risk Risk Factors SECTM1 gene Self Efficacy Small Business Innovation Research Grant Sports Medicine Structure Supervision System Technology Telephone Testing Training Triglycerides Update Walking Wrist active control aged base behavior change burden of illness cardiometabolic risk cardiometabolism cardiovascular disorder prevention cardiovascular risk factor clinical care clinical outcome measures clinical practice college control trial cost design disorder prevention document outlines evidence base experience fasting glucose follow-up glycemic control improved interdisciplinary approach intervention program lifestyle intervention meetings modifiable risk novel strategies online intervention pragmatic trial primary outcome programs recruit routine care satisfaction secondary outcome skills social social cognitive theory standard care statistics success tool usability vigorous intensity waist circumference

项目摘要

Inadequate physical activity (PA) is considered a major risk factor for cardiometabolic disease. Clinical recommendations endorse achieving healthy PA levels in the primary prevention of cardiovascular disease and type 2 diabetes. The need for wider reaching primary prevention efforts with increasing PA levels as a “central element” has been suggested by previous studies. PA improvement programs integrated with clinical practice have the potential to reach a large number of at-risk individuals. Although a framework for clinician identification and treatment of people with low PA levels has been developed by the American College of Sports Medicine (ACSM), and clinical PA referral is now endorsed by the American Heart Association (AHA), the practice of identifying and addressing inadequate PA is not common in clinical practice. This proposal aims to improve important aspects of clinical PA referral for primary care patients with low PA and additional cardiometabolic risk factors. Aim 1 of the proposal will determine the efficacy of an inexpensive, convenient, evidence-based online intervention for improving PA levels that is appropriate for adult patients not meeting the US aerobic PA goal of 150 minutes/ week of moderate-vigorous intensity (e.g., brisk walking) PA who also have at least one other common cardiometabolic risk factor (high blood pressure, elevated glucose levels, and/or overweight/obesity). Adult primary care patients (n=54; aged 40-70) meeting the criteria for low PA and additional cardiometabolic risk who can safely increase activity without supervision will be recruited. Participants will be randomized to an active control (to receive a commercial wrist-worn physical activity tracker; PAT) or an online social-cognitive theory-based intervention (3 months of weekly sessions and 9 months maintenance) plus PAT. Primary outcomes will include the change in average step counts/day and percentage meeting the 150 minutes/week activity goal; they will be assessed at 6 and 12 months of follow-up. Secondary outcomes will include body weight, waist circumference, blood pressure, fasting glucose, insulin, cholesterol, triglycerides, and patient-reported outcomes including self-efficacy, quality of life, cost, and experience/satisfaction. Statistics on participant usage of the online platform and tracking tools, participant attitudes/beliefs, and opinions regarding maintenance strategies, will also be collected. We will leverage real world evidence by examining associations between changes in PA levels and important cardiometabolic outcomes that are measured clinically and by identifying EHR measures of patient characteristics that predict changes in PA levels. Methods for dealing with missing data will be considered. The goal of Aim 2 is to develop procedural recommendations for adding PAT data to an Epic-based electronic health record (EHR). Communicating patient PA levels with clinical teams through the EHR, using existing PATs holds value, but there is no consensus on how to accomplish this. We will engage key stakeholders in developing an interdisciplinary set of procedures that considers the needs of health professionals, health systems, researchers, and patients. Completion of these aims will provide pilot data to inform future efforts to develop feasible, effective PA referral programs that can be coordinated with clinical care and will build important collaborative relationships and skills relevant to pragmatic trials.

体力活动不足（PA）被认为是心脏代谢疾病的主要危险因素。赞同在心血管疾病一级预防中实现健康 PA 水平的建议，以及 2 型糖尿病需要更广泛的一级预防工作，以提高 PA 水平为“核心” PA 改善计划与临床实践相结合尽管是临床医生的框架，但仍有可能接触到大量高危人群。 PA 水平低的人的识别和治疗已由美国大学开发运动医学 (ACSM) 和临床 PA 转诊现已获得美国心脏协会 (AHA) 的认可，识别和解决 PA 不足的做法在临床实践中并不常见。改善低 PA 和其他初级保健患者的临床 PA 转诊的重要方面该提案的目标 1 将决定一种廉价、方便、基于证据的在线干预，用于改善 PA 水平，适用于未达到标准的成年患者美国有氧 PA 目标为每周 150 分钟中等强度（例如快走）的 PA 至少有一种其他常见的心脏代谢危险因素（高血压、血糖水平升高、和/或超重/肥胖）符合低 PA 标准的成人初级保健患者（n=54；年龄 40-70 岁）。将招募具有额外心脏代谢风险且无需监督即可安全增加活动的人。参与者将被随机分配到主动对照组（接受商业腕戴式体育活动追踪器；PAT）或基于社会认知理论的在线干预（每周 3 个月，每周 9 次）月维护）加上 PAT 主要结果将包括平均步数/天的变化和达到每周 150 分钟活动目标的百分比；将在随访 6 个月和 12 个月时对其进行评估。次要结果包括体重、腰围、血压、空腹血糖、胰岛素、胆固醇、甘油三酯和患者报告的结果，包括自我效能、生活质量、成本和参与者使用在线平台和跟踪工具的体验/满意度统计数据。我们还将收集有关维护策略的态度/信念和意见。通过检查 PA 水平变化与重要心脏代谢之间的关联来获取世界证据临床测量的结果，并通过确定预测患者特征的 EHR 测量结果目标 2 的目标是制定处理缺失数据的方法。将 PAT 数据添加到基于 Epic 的电子健康记录 (EHR) 的程序建议。使用现有的 PAT 通过 EHR 与临床团队沟通患者 PA 水平具有价值，但是对于如何实现这一目标尚未达成共识，我们将让主要利益攸关方共同制定一项计划。一套跨学科程序，考虑卫生专业人员、卫生系统、研究人员和患者的完成将提供试点数据，为未来的开发工作提供信息。可行、有效的 PA 转诊计划，可以与临床护理相协调，并将建立重要的与务实试验相关的协作关系和技能。