Tai Chi Exercise and Wearable Feedback Technology to Promote Physical Activity in ACS Survivors

太极拳运动和可穿戴反馈技术促进 ACS 幸存者的身体活动

• 批准号: 10510577
• 负责人: Elena Salmoirago-Blotcher
• 金额: $ 61.89万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-05 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10510577
• 关键词: Accelerometer; Adherence; Aerobic Exercise; Affect; American Heart Association; Anxiety; Awareness; Behavioral; Blood Pressure; Body Weight; Cardiac rehabilitation; Cardiometabolic Disease; Cardiovascular system; Chronic; Chronic Disease; Cognition; Cognitive; Communities; Coronary heart disease; Data; Development; Devices; Education; Emotional; Energy Metabolism; Enrollment; Equilibrium; Event; Exercise; Feasibility Studies; Feedback; Focus Groups; Fostering; Future; Glucose; Goals; Guidelines; Health; Home; Individual; Intervention; Interview; Light; Lipids; Measures; Meditation; Mental Depression; Meta-Analysis; Morbidity - disease rate; Motivation; Musculoskeletal Pain; Patient-Focused Outcomes; Patients; Physical Exercise; Physical activity; Population; Preparation; Prognosis; Provider; Pulmonary Heart Disease; Qualitative Methods; Quality of life; Randomized; Randomized Controlled Trials; Rehabilitation therapy; Risk Factors; Safety; Secondary Prevention; Self Efficacy; Site; Social support; Strenuous Exercise; Stress; Structure; Survivors; Tai Ji; Techniques; Technology; Time; Training; Weight; Work; acceptability and feasibility; acute coronary syndrome; base; behavior change; behavioral construct; body-mind; cardiometabolic risk; cardiometabolism; cardiovascular health; cardiovascular risk factor; data collection site; deconditioning; evidence base; exercise capacity; exercise intervention; exercise program; exercise training; experience; fasting plasma glucose; fitbit; heart disease risk; high risk; improved; instructor; interest; intrinsic motivation; mindfulness; moderate-to-vigorous physical activity; monitoring device; mortality; multi-component intervention; novel; participant retention; patient population; peer support; physical inactivity; pragmatic trial; programs; public health priorities; recruit; remote delivery; sedentary; skills; stress management; treatment as usual; uptake; virtual; wearable device

Project Summary/Abstract Physical activity (PA) is a cornerstone of secondary prevention after an acute coronary syndrome (ACS) with associated improvements in cardiovascular risk, morbidity, and mortality. Unfortunately, over 80% of these cardiovascular patients remain sedentary after an event. Participation in cardiac rehabilitation programs is poor, and long-term adherence to PA remains problematic. There is a critical need for the development of novel exercise programs to improve PA in this high-risk patient population. Tai Chi (TC) is a multi-dimensional intervention that integrates low-moderate intensity physical exercise with meditative components that have been shown to improve important self-regulatory skills and cognitive- behavioral determinants of behavior change, such as self-efficacy, motivation, and emotional health. Because it is delivered in a class format, TC also fosters social support. Preliminary evidence suggests that TC may positively impact PA and selected cardiovascular risk factors. TC is an attractive exercise option for ACS survivors, who are often sedentary or deconditioned. There is also growing evidence supporting the use of wearable technology (e.g., Fitbit) as an effective behavioral strategy to promote PA. Wearable devices can utilize evidence-based techniques such as individualized goal setting and feedback in increasing motivation and self-efficacy for exercise. In patients with cardiometabolic disease, the addition of wearable technology to structured exercise has been promising to increase moderate-vigorous PA and improve cardiovascular risk. This application leverages our prior work with TC to promote PA among sedentary ACS survivors, experience with remote delivery of group-based TC, and experience combining mind-body exercise with wearables (Fitbit). We propose a multi-site feasibility study as a necessary step in preparation for a future, fully-powered trial investigating the efficacy of a multi-modal intervention (TC+Wearable) that combines virtual, group TC classes with an individual wearable device to support overall PA, and thus impact downstream cardiometabolic risk. The specific aims are: 1) To assess feasibility of a multi-site randomized controlled trial of TC+Wearable plus enhanced usual care (with cardiovascular risk factor education materials) vs. enhanced usual care alone among inactive ACS survivors. Feasibility measures will include recruitment and retention; intervention acceptability, adherence, and fidelity; and coordination/management of multi-site data collection. Patient- centered outcomes will include accelerometry-assessed PA and sedentary time, cognitive-behavioral constructs (self-efficacy, intrinsic motivation, awareness, anxiety/depression, stress), and cardiometabolic measures (exercise capacity, weight, lipids, blood pressure, glucose). 2) To obtain qualitative feedback from multiple stakeholders to inform future study conduct. We will engage patients, providers, and TC instructors in interviews/focus groups on acceptability of TC+Wearable (content, facilitators/barriers, integration of TC and device); technical aspects of remote delivery; and openness for future provider and TC instructor engagement.

项目摘要/摘要 体育锻炼（PA）是急性冠状动脉综合征（AC）的次级预防的基石 心血管风险，发病率和死亡率的相关改善。不幸的是，其中80％以上 事件发生后，心血管患者仍然久坐。参加心脏康复计划是 贫穷和对PA的长期依从性仍然有问题。迫切需要开发 在这个高风险患者人群中改善PA的新颖锻炼计划。 Tai Chi（TC）是一种多维干预措施，将低压强度的体育锻炼与 冥想成分已被证明可以提高重要的自我调节能力和认知能力 - 行为改变的行为决定因素，例如自我效能，动机和情感健康。因为 它以班级格式交付，TC还促进了社会支持。初步证据表明TC可能 积极影响PA和选定的心血管危险因素。 TC是ACS的吸引人运动选择 幸存者，他们经常久坐或衰落。越来越多的证据支持使用 可穿戴技术（例如Fitbit）是促进PA的有效行为策略。可穿戴设备可以 利用基于证据的技术，例如个性化目标设定和反馈，以增加动力 和运动的自我效能。在心脏代谢性疾病的患者中，将可穿戴技术添加到 结构化的运动已经有望增加中度剧烈的PA并改善心血管风险。 该应用程序利用了我们先前在TC的工作来促进久坐的ACS幸存者中的PA，经验 通过远程交付基于小组的TC，并经验将身心运动与可穿戴设备（Fitbit）相结合。 我们提出了一项多站点可行性研究，作为准备未来，全力以赴的试验的必要步骤 调查结合虚拟，小组TC类的多模式干预（TC+可穿戴）的功效 使用单独的可穿戴设备来支持整体PA，从而影响下游心脏代谢风险。 具体目的是：1）评估TC+可耐磨性多站点随机对照试验的可行性 增强常规护理（具有心血管危险因素教育材料）与仅增强常规护理 在非活动的ACS幸存者中。可行性措施将包括招聘和保留；干涉 可接受，依从性和忠诚；以及多站点数据收集的协调/管理。病人- 集中的结果将包括通过加速度计量计的PA和久坐时间，认知行为 结构（自我效能，内在动机，意识，焦虑/抑郁，压力）和心脏代谢 措施（运动能力，体重，脂质，血压，葡萄糖）。 2）从 多个利益相关者为未来的研究行为提供信息。我们将吸引患者，提供者和TC讲师 访谈/焦点小组关于可接受性+可穿戴设备（内容，促进者/障碍，TC的整合和 设备）;远程交付的技术方面；以及未来提供商和TC讲师参与的开放性。