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.!

项目摘要/摘要该建议是对NHLBI感兴趣的主题的回应：HL-132在运动治疗方面的研究慢性心力衰竭（R01）。该建议旨在优化依从性，以行使心力衰竭方案（HF），改善身体功能和生活质量，并减少发病率。 HF是主要的公共卫生令人担忧的是，尽管生存率在数十年中有所提高，但HF的绝对死亡率仍然很高。在初始诊断后的5年内约50％。大量研究表明，定期体育锻炼 / 运动可显着提高运动耐受性以及HF中的临床结果。锻炼作为可靠的然而，由于短期和长期依从性，辅助干预措施仍然有限。这拟议的研究将检查心脏运动和抵抗训练的有效性 - 同伴铅相比进行更标准的运动干预。心脏 - 游戏干预将从以前的 NHLBI资助的R01工作证明对古老的现代体育活动有持续的影响。这拟议的研究将使干预措施适应HF患者的安全，进行心脏病学干预诊所，并在18个月内测试遵守该计划。合适的诊所工作人员和HF患者榜样将接受培训，以与受过训练的健康教育者一起教干预活动。然后他们会负责在心脏病诊所维护该计划。心脏游戏计划和行为由于同伴和员工领导的存在，变革将是可持续的，并且因为IT员工来自社会认知理论和生态模型的验证策略，包括自我监测，社会支持，角色建模和预防救济。与具有固定时间表且有限的运动课程相反依从性的证据，心脏游戏教会患者如何在整个范围内积累有意义的体育活动这一天，提供了一个支持的社会基础设施来维持动力。在严格的集群中随机加州大学圣地亚哥分校（UCSD）医院的心脏病学诊所和VA的对照试验圣地亚哥医疗保健系统（VASDHS），我们将开发和评估心脏与游戏干预计划在264个社会经济和种族多样化的男女60岁以上，两名HF都保留射血分数（HFPEF）或HF的射血分数降低（HFREF）。心脏参与者在标准锻炼计划中，将获得有氧运动和抵抗训练的自我监控工具以及小组教育和材料。心脏游戏的参与者还将获得同伴和员工领导。我们将证明，以同伴为主导的心脏游戏计划将在诊所环境中显着提高了依从性的主要研究终点到150分钟/周的现代物理在18个月的随访中/周活动。我们设想研究的发现将为成功提供可以出口到诊所环境的干预模型。

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.