HL-132: Increasing Adherence to Guideline-Based Exercise Therapy For Chronic Heart Failure

HL-132：提高对慢性心力衰竭基于指南的运动疗法的依从性

基本信息

批准号：
10357590
负责人：
Paul J Mills
金额：
$ 75.24万
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：
2018
资助国家：
美国
起止时间：
2018-01-15 至 2023-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10357590
关键词：
Accelerometer Adherence Adopted Aerobic Affect Age American Biological Markers California Cardiac health Cardiology Clinic Clinical Congestive Heart Failure Cost Analysis Counseling Data Diagnosis EFRAC Education Educational Materials Effectiveness Elderly Ensure Environment Event Exercise Exercise Therapy Exercise Tolerance Feedback Funding Galectin 3 Goals Guidelines Hand Strength Health Health Educators Healthcare Systems Heart Heart Rate Heart failure Hospitals Individual Infrastructure Intervention Lead Leadership Measures Modeling Moderate Exercise Monitor Moods Morbidity - disease rate Motivation National Heart, Lung, and Blood Institute National Institute on Aging Outcome Participant Patients Physical Function Physical activity Public Health Quality of life Randomized Controlled Trials Regimen Request for Proposals Research Resistance Running Schedule Site Social support Specialist Support Groups Telephone Testing Training Universities Use Effectiveness Walking Woman Work base behavior change cost effectiveness design disorder later incidence prevention ethnic diversity exercise adherence exercise intervention exercise program exercise regimen exercise training follow-up health training implementation outcomes implementation strategy improved inclusion criteria interest intervention program life time cost markov model men mortality pedometer peer peer support preservation programs response role model sex sleep quality social social cognitive theory socioeconomics strength training successful intervention tool

项目摘要

PROJECT SUMMARY/ABSTRACT This proposal is in response to NHLBI Topics of Interest: HL-132 Advancing Research in Exercise Therapy for Chronic Heart Failure (R01). This proposal aims to optimize adherence to exercise regimens in heart failure (HF), improve physical functioning and quality of life, and reduce morbidity. HF is a major public health concern, and while survival has improved over the decades the absolute mortality rate for HF remains high at approximately 50% within 5 years of initial diagnosis. Numerous studies show that regular physical activity / exercise significantly improves exercise tolerance as well as clinical outcomes in HF. Exercise as a reliable adjunctive intervention, however, remains limited due to poor short- as well as long-term adherence. This proposed study will examine the effectiveness of the Heart Exercise And Resistance Training – Peer Lead ActivitY (HEART–PLAY) intervention to significantly sustain exercise adherence in HF patients, as compared to a more standard exercise intervention. The HEART–PLAY intervention will be adapted from previous NHLBI-funded R01 work shown to have a sustained impact on moderate physical activity in the elderly. This proposed study will adapt the intervention to be safe for HF patients, deliver the intervention in cardiology clinics, and test adherence to the program over 18 months. Clinic staff and HF patients who are appropriate role models will be trained to teach the intervention activities with trained health educators. They will then be responsible for maintaining the program in the cardiology clinics. The HEART–PLAY program and behavior change will be sustainable because of the presence of peer and staff leadership and because it employs proven strategies from social cognitive theory and ecological models including self monitoring, social support, role modeling, and relapse prevention. In contrast to exercise classes that have a fixed schedule and limited evidence for adherence, HEART-PLAY teaches patients how to accumulate meaningful physical activity across the day and provides a supportive social infrastructure to maintain motivation. In a rigorous cluster randomized controlled trial at cardiology clinics at the University of California, San Diego (UCSD) hospitals and at the VA San Diego Healthcare System (VASDHS), we will develop and assess the HEART–PLAY intervention program in 264 socioeconomically and ethnically diverse women and men 60+ years old with either HF with preserved Ejection Fraction (HFpEF) or HF with reduced Ejection Fraction (HFrEF). Participants in the HEART–PLAY and in the STANDARD exercise programs will receive self-monitoring tools for aerobic plus resistance training as well as group education and materials. Participants in HEART–PLAY will additionally receive peer and staff leadership. We will demonstrate that the peer-led HEART–PLAY program based in the clinic setting will significantly enhance the primary study endpoint of adherence to 150 min/week of moderate physical activity/week over an 18-month follow up. We envision the study’s findings will provide a successful intervention model that will be exportable to the clinic environment.!

项目概要/摘要该提案是对 NHLBI 感兴趣主题的回应：HL-132 推进运动治疗研究慢性心力衰竭 (R01)。该提案旨在优化心力衰竭患者对运动方案的依从性。 (HF)、改善身体机能和生活质量、降低心力衰竭发病率是一项重大公共卫生问题。尽管几十年来生存率有所提高，但心力衰竭的绝对死亡率仍然很高大约 50% 在初次诊断后 5 年内发生。大量研究表明，定期进行体力活动/ 运动可显着提高运动耐量以及心力衰竭的临床结果。然而，由于短期和长期依从性较差，辅助干预仍然有限。拟议的研究将检查心脏锻炼和阻力训练的有效性 – 同行领导相比之下，活动（HEART-PLAY）干预可显着维持心力衰竭患者的运动坚持 HEART-PLAY 干预措施将改编自之前的干预措施。 NHLBI 资助的 R01 工作显示对老年人的适度体力活动具有持续影响。拟议的研究将调整干预措施，使其对心力衰竭患者安全，并提供心脏病学干预措施诊所，并测试 18 个月内适当的诊所工作人员和心力衰竭患者的遵守情况。榜样将接受培训，与训练有素的健康教育者一起教授干预活动。负责维护心脏病诊所的计划和行为。变革将是可持续的，因为有同行和员工领导力的存在，并且因为它采用了来自社会认知理论和生态模型的经过验证的策略，包括自我监控、社会支持、与有固定时间表和有限的锻炼课程相反。坚持的证据，HEART-PLAY 教导患者如何在整个过程中积累有意义的身体活动并提供支持性的社会基础设施，以在严格的随机集群中保持动力。在加州大学圣地亚哥分校 (UCSD) 医院和 VA 心脏病诊所进行的对照试验圣地亚哥医疗系统 (VASDHS)，我们将开发和评估 HEART–PLAY 干预计划在 264 名 60 岁以上社会经济和种族多样化的女性和男性中，患有 HF 或保留 HEART-PLAY 中的射血分数 (HFpEF) 或射血分数降低的 HF (HFrEF)。在标准锻炼计划中将获得用于有氧加阻力训练的自我监控工具 HEART-PLAY 的参与者还将获得同伴和工作人员的帮助。我们将证明，基于临床环境的同行主导的 HEART-PLAY 计划将能够发挥领导作用。显着增强主要研究终点，即坚持每周 150 分钟的中等强度体力活动我们预计该研究的结果将在 18 个月的随访中取得成功。将可导出到临床环境的干预模型。！

项目成果

期刊论文数量（8）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Systemic Inflammation and Cognitive Decrements in Patients With Stage B Heart Failure.

B 期心力衰竭患者的全身炎症和认知能力下降。

DOI：
10.1097/psy.0000000000001033
发表时间：
2022
期刊：
Psychosomatic medicine
影响因子：
3.3
作者：
Redwine,LauraS;Hong,Suzi;Kohn,Jordan;Martinez,Claudia;Hurwitz,BarryE;Pung,MeredithA;Wilson,Kathleen;Pruitt,Christopher;Greenberg,BarryH;Mills,PaulJ
通讯作者：
Mills,PaulJ

Is Belonging to a Religious Organization Enough? Differences in Religious Affiliation Versus Self-ratings of Spirituality on Behavioral and Psychological Variables in Individuals with Heart Failure.

加入宗教组织就足够了吗？

DOI：
10.3390/healthcare8020129
发表时间：
2020
期刊：
Healthcare (Basel, Switzerland)
影响因子：
0
作者：
Saiz,Jesús;Pung,MeredithA;Wilson,KathleenL;Pruitt,Christopher;Rutledge,Thomas;Redwine,Laura;Taub,PamR;Greenberg,BarryH;Mills,PaulJ
通讯作者：
Mills,PaulJ

Current challenges in cardiac rehabilitation: strategies to overcome social factors and attendance barriers.