A tailored exposure intervention targeting exercise anxiety and avoidance in cardiac rehabilitation

针对心脏康复中运动焦虑和回避的量身定制的暴露干预措施

• 批准号: 10298686
• 负责人: Samantha Gwen Farris
• 金额: $ 58.33万
• 依托单位: RUTGERS, THE STATE UNIV OF N.J.
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10298686
• 关键词: Accelerometer; Acute; Adherence; Adult; Adverse event; Age; Age-Years; Aging; Alzheimer' s Disease; Anxiety; Awareness; Behavior; Behavioral; Belief; Blood Pressure; Cardiac; Cardiac rehabilitation; Cardiovascular Diseases; Cardiovascular system; Chest; Clinical; Cognition; Cognitive; Cognitive Therapy; Coronary heart disease; Data; Dementia; Disease; Dizziness; Electrocardiogram; Enrollment; Ensure; Esthesia; Event; Exercise; Exertion; Exposure to; Fatigue; Feedback; Female; Fright; Future; Goals; Grant; Health; Health education; Heart; Heart Rate; Heart failure; Individual; Informal Social Control; Intervention; Knowledge; Lead; Life Style; Link; Longevity; Lung; Maintenance; Measures; Mediating; Monitor; Operative Surgical Procedures; Outcome; Outpatients; Pain; Patients; Physical Exercise; Physical activity; Physiological; Physiological Processes; Pilot Projects; Population; Prevention; Procedures; Psychologist; Public Health; Quality of life; Race; Randomized; Randomized Controlled Trials; Research; Risk; Safety; Science; Seeds; Shortness of Breath; Specific qualifier value; Strenuous Exercise; Stroke; Structure; Supervision; Sweating; System; Testing; Time; Treatment Efficacy; Uncertainty; United States National Institutes of Health; Work; Wrist; age related; aging population; anxious; base; behavior change; bodily sensation; cognitive process; deconditioning; design; disability; efficacy testing; exercise intensity; exercise physiologist; exercise prescription; exercise rehabilitation; experience; falls; fitbit; frailty; health related quality of life; heart function; improved; intervention effect; novel; patient population; preservation; programs; psychological distress; theories; uptake

PROJECT SUMMARY/ABSTRACT Regular exercise and lifestyle physical activity (PA) are critical for quality of life and longevity among a growing aging population. Aging produces changes to the structure and function of the heart, which increases vulnerability to cardiovascular disease (e.g., coronary heart disease, heart failure, and stroke), frailty and falls, dementia, and Alzheimer disease. Exercise helps to slow the progression of aging-associated changes to the heart by promoting adaptations to the cardiovascular and pulmonary system, however exercise initiation and maintenance can be difficult in aging adults due to deconditioning, pain, frailty, and disability. Exercise anxiety is a novel mechanism related to non-adherence to exercise and lifestyle PA, that is characterized by cognitive, behavioral, and physiological underpinnings. Exercise anxiety is particularly elevated in individuals with cardiovascular disease given that the physical sensations of exercise often feel similar to the sensations experienced or attributed to cardiovascular disease (e.g., shortness of breath, chest tightness, dizziness, fatigue, pain). We developed a mechanistically-informed cognitive-behavioral intervention to target exercise anxiety, called Behavioral Exposure For Interoceptive Tolerance (BE-FIT). In our Stage I pilot study, we developed and demonstrated initial support for BE-FIT in low active patients with elevated exercise anxiety enrolled in outpatient cardiac rehabilitation. The intervention was six sessions delivered as an adjunctive treatment during the initial weeks of cardiac rehabilitation, and involved behavioral exposure to feared bodily sensations and exercise situations, elimination of false safety behaviors and avoidance, and use of a wrist- worn activity monitor for PA feedback and activity goal-setting. Our preliminary work established the feasibility, acceptability and safety of BE-FIT. We also found evidence of target engagement (large-sized reductions in exercise anxiety) and initial evidence for the effect of BE-FIT on exercise outcomes, including significant increases in steps/day and moderate-vigorous PA minutes/day at the end of treatment. Given these very promising data, we propose to take the next step by conducting a fully-powered Stage II randomized controlled trial (RCT) to test the efficacy of BE-FIT, compared to a Health Education Control (HEC) intervention, for adults (N=146) who are ≥40 years of age, cleared for outpatient CR, low active and have elevated exercise anxiety, and to test whether changes in exercise anxiety are associated with subsequent changes in exercise outcomes at EOT and follows-ups (Week 12, 18, and 24). We will evaluate intervention effects on exercise anxiety and its components, including cognitive processes (catastrophizing, uncertainty, discomfort intolerance), behavior (avoidance/safety behaviors), and physiological function (cardiac vagal control). This project will contribute scientific and clinical understanding of anxiety and PA. If the efficacy of the BE-FIT can be established, this intervention could serve as an adjunctive treatment to cardiac rehabilitation and be adapted for other patient populations and treatment settings, for PA promotion in support of successful aging.

项目摘要/摘要 定期运动和生活方式体育锻炼（PA）对于增长的生活质量和寿命至关重要 人口老龄化。衰老会改变心脏的结构和功能，这会增加 患心血管疾病的脆弱性（例如冠心病，心力衰竭和中风），脆弱和跌倒， 痴呆症和阿尔茨海默氏病。锻炼有助于减慢与衰老相关的变化的进展 通过促进对心血管和肺部系统的适应，心脏的心脏，但是运动倡议和 由于衰老，疼痛，脆弱和残疾，维护可能很困难。运动动画 是与不遵守运动和生活方式PA的不遵守性有关的新型机制，其特征是认知， 行为和身体基础。运动动画在患有的个人中特别提升 心血管疾病鉴于运动的身体感觉通常与感觉相似 经历或归因于心血管疾病（例如，呼吸短，胸部紧绷，头晕， 疲劳，疼痛）。我们开发了一种机械信息的认知行为干预来锻炼 焦虑，称为互感耐受性的行为暴露（拟合）。在我们的舞台上，我的试点研究，我们 在低活性患者中，开发并证明了对运动动画升高的低活性患者的最初支持 参加门诊心脏康复。干预措施是六个会议作为辅助手术 在心脏康复的最初几周内进行治疗，并涉及行为暴露于假身体 感觉和运动情况，虚假的安全行为的演变和避免以及手腕的使用 - PA反馈和活动目标设定的磨损活动监视器。我们的初步工作确立了可行性， 拟合的可接受性和安全性。我们还发现了目标参与的证据（大型减少 运动动画）和最初证据表明拟合对运动结果的影响，包括重要的 在治疗结束时，步骤/天和中等剧烈的PA分钟/天增加。鉴于这些 有希望的数据，我们建议通过进行完全动力的II期随机控制来迈出下一步 与健康教育控制（HEC）干预相比，试验（RCT）测试拟合效率 （n = 146）年龄≥40岁，用于门诊CR，活动较低，运动动画升高， 并测试运动动画的变化是否与随后的运动结果变化有关 在EOT和后续行动（第12、18和24周）。我们将评估干预对运动动画及其的影响 组成部分，包括认知过程（灾难性，不确定性，不适感），行为 （避免/安全行为）和身体功能（心脏迷走神经控制）。这个项目将做出贡献 对焦虑和PA的科学和临床理解。如果可以确定拟合的效率，那么 干预措施可以作为心脏康复的辅助治疗，并适合其他患者 人群和治疗环境，用于促进PA以支持成功衰老。