Exploring Tai Chi as a Behavioral Intervention for Heart Failure Patients

探索太极拳对心力衰竭患者的行为干预

基本信息

批准号：
7992923
负责人：
Laura S Redwine
金额：
$ 38.19万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-08-15 至 2014-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7992923
关键词：
Activities of Daily Living Aerobic Aerobic Exercise Affect Age American Anti-Inflammatory Agents Anti-inflammatory Area Attention Attenuated Awareness Behavior Therapy Behavioral Bicycling Biological Markers Blood Pressure Blood Vessels Breathing Cardiac Cardiomyopathies Cardiovascular system Catecholamines Cells Cessation of life Chemotaxis Chronic Disease Cities Clinical Comorbidity Counseling Disease EFRAC Epidemic Epinephrine Equilibrium Equipment and supply inventories Ergometry Event Exercise Exercise Tolerance Fatigue Frail Elderly Future Grant Health Health Policy Health education Healthcare Heart Rate Heart failure Hospitalization Immune Individual Infiltration Inflammation Inflammatory Inflammatory Response Insurance Intervention Intervention Studies Investigation Kansas Lead Leukocytes Light Literature Manuals Measures Medicare Mental Depression Moderate Exercise Mononuclear Moods Morbidity - disease rate Movement Norepinephrine Outcome Participant Patients Personal Satisfaction Physical Function Physical activity Pilot Projects Population Psychosocial Factor Publishing Quality of life Questionnaires Rehabilitation therapy Rest Risk Sample Size Selectins Self Efficacy Severity of illness Signal Transduction Sleep Sleep disturbances Social Interaction Specific qualifier value Speed Spiritual Therapies Spirituality Staging Stress Symptoms Tai Ji Techniques Tissues Training United States Walking Work acute stress age group behavior change chemokine comparison group cytokine depressive symptoms fitness improved indexing inflammatory marker lifestyle intervention meetings meter mindfulness mindfulness meditation mortality outcome forecast post intervention primary outcome programs psychologic public health relevance research study response

项目摘要

DESCRIPTION (provided by applicant): Heart failure (HF) affects 5-6 million Americans and, despite recent pharmacological and technological advances, is increasing in epidemic proportions as the population ages. Patients with HF suffer from debilitating symptoms and a loss of quality of life. Somatic symptoms such as fatigue and sleep disturbances are common among HF patients, which are ironically associated with physical inactivity and can create a spiraling decline in physical and cardiac function and even worse quality of life. Thus, behavioral/lifestyle interventions that increase physical activity may improve cardiac function and quality of life in this group. Historically, HF patients were counseled to limit physical activities, but recent studies show that moderate exercise can be performed safely in properly evaluated NYHA II-III HF patients. However, most traditional exercise intervention studies in HF have been conducted on relatively young patients with little comorbidity, and such programs are unsuitable for many older frail HF patients. Conversely, tai chi has been practiced for centuries by all age groups for wellness and to maintain health. Tai chi is ideal for HF patients because it is composed of mindfully meditative movements that generate an aerobic work-out, permits adjustable levels of intensity by using larger or smaller movements, improves balance, works the whole body, and is well tolerated in HF patients. Indeed, findings from our recently completed R21 pilot project indicate that tai chi leads to reductions in somatic symptoms, including fatigue, and increases physical function as measured by the distance walked in a 6-minute walk task. Until now, tai chi studies involving HF patients have been small more preliminary investigations and have not examined important clinical and functional measures relevant to HF. While standard exercise intervention studies in HF have found increases in ejection fraction (EF) and reduced end diastolic volume (EDV) and end systolic volume (ESV), tai chi's efficacy for improvements in cardiac functional capacity still need to be examined. Thus, the objective of our study is to determine if tai chi will benefit HF patients by increasing physical function, cardiac functional capacity, and HF related quality of life. The proposed study will consist of two groups (N = 68 HF patients/group), a 16-week, twice weekly tai chi class using a Manual developed by our R21 grant specifically for HF patients. A health education comparison group will meet for a comparable duration, and also have a standardized list of topics used for the classes. This group is created to control for attention and social interactions of the tai chi intervention. Although there is evidence that changes in specific behavioral activities improve quality of life in HF patients, most current healthcare insurance in the United States (including Medicare), does not pay for HF rehabilitation. The findings of our investigation will help identify the efficacy of tai chi as an option for current HF management and further our understanding of the mechanisms. Thus, this study also has the benefit of evaluating an intervention that will improve HF disease severity and related quality of life outcomes that could impact health policy. PUBLIC HEALTH RELEVANCE: This proposal seeks to further our pilot studies by investigating whether an exercise intervention such as tai chi can increase physical function, cardiac functional capacity and quality of life in HF patients. Historically, HF patients were counseled to limit physical activities. However, recent studies show that moderate exercise can be performed safely in properly evaluated NYHA II-III HF patients.

描述（由申请人提供）：心力衰竭 (HF) 影响着 5-600 万美国人，尽管近年来药理学和技术取得了进步，但随着人口老龄化，心力衰竭的流行比例仍在增加。心力衰竭患者会出现衰弱症状和生活质量下降。疲劳和睡眠障碍等躯体症状在心力衰竭患者中很常见，讽刺的是，这些症状与缺乏身体活动有关，并可能导致身体和心脏功能急剧下降，甚至导致生活质量下降。因此，增加体力活动的行为/生活方式干预可能会改善该群体的心脏功能和生活质量。历史上，心力衰竭患者被建议限制体力活动，但最近的研究表明，经过适当评估的 NYHA II-III 心力衰竭患者可以安全地进行适度运动。然而，大多数传统的心力衰竭运动干预研究都是针对相对年轻且几乎没有合并症的患者进行的，此类项目并不适合许多年长体弱的心力衰竭患者。相反，几个世纪以来，各个年龄段的人都练习太极拳以保持健康。太极拳是心力衰竭患者的理想选择，因为它由专注的冥想运动组成，可产生有氧锻炼，可以通过较大或较小的运动来调节强度水平，改善平衡，锻炼全身，并且心力衰竭患者的耐受性良好。事实上，我们最近完成的 R21 试点项目的研究结果表明，太极拳可以减少包括疲劳在内的躯体症状，并增强身体机能（以 6 分钟步行任务中的步行距离来衡量）。到目前为止，涉及心力衰竭患者的太极拳研究还只是小型的初步调查，尚未检查与心力衰竭相关的重要临床和功能指标。虽然心力衰竭的标准运动干预研究发现射血分数（EF）增加，舒张末期容积（EDV）和收缩末期容积（ESV）减少，但太极拳改善心脏功能的功效仍需检验。因此，我们研究的目的是确定太极拳是否能够通过提高身体功能、心脏功能能力和心力衰竭相关的生活质量而使心力衰竭患者受益。拟议的研究将包括两组（N = 68 名心力衰竭患者/组），为期 16 周、每周两次的太极课程，使用由我们的 R21 拨款专门为心力衰竭患者开发的手册。健康教育对照组将在相当的时间内举行会议，并且还有用于课程的标准化主题列表。该组的创建是为了控制太极干预的注意力和社交互动。尽管有证据表明特定行为活动的改变可以改善心力衰竭患者的生活质量，但美国目前的大多数医疗保险（包括医疗保险）并不支付心力衰竭康复费用。我们的调查结果将有助于确定太极拳作为当前心力衰竭治疗选择的有效性，并进一步加深我们对其机制的理解。因此，这项研究还有一个好处是评估一种干预措施，该干预措施将改善心力衰竭疾病的严重程度和可能影响卫生政策的相关生活质量结果。公共健康相关性：该提案旨在通过调查太极拳等运动干预是否可以提高心力衰竭患者的身体功能、心脏功能和生活质量来进一步推进我们的试点研究。从历史上看，心力衰竭患者被建议限制体力活动。然而，最近的研究表明，经过适当评估的 NYHA II-III 心力衰竭患者可以安全地进行适度运动。