Improving outcomes from cardiac rehabilitation among older adults through exercise testing and individualized exercise intensity prescriptions

通过运动测试和个性化运动强度处方改善老年人心脏康复的结果

• 批准号: 10672281
• 负责人: Quinn Russell Pack
• 金额: $ 59.07万
• 依托单位: BAYSTATE MEDICAL CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10672281
• 关键词: Accelerometer; Acute; Address; Age; Aging; Anxiety; Benchmarking; Cardiac; Cardiac health; Cardiac rehabilitation; Cardiology; Cessation of life; Clinical; Counseling; Coupled; Data; Effectiveness; Elderly; Event; Exercise; Exercise Physiology; Exercise Test; Exertion; Expert Opinion; Face; Failure; Female; Fright; Geriatrics; Goals; Guidelines; Heart; Heart Diseases; Heart Rate; Hospitalization; Ischemia; Knowledge; Life; Life Style; Measures; Mediating; Metabolic; Methods; Myocardial Infarction; Operative Surgical Procedures; Outcome; Outpatients; Patients; Perception; Persons; Pharmaceutical Preparations; Physical Function; Physical Performance; Physical activity; Physicians; Positioning Attribute; Prevention program; Procedures; Prognosis; Psychological Factors; Psychology; Quality of life; Randomized, Controlled Trials; Recommendation; Recovery; Rehabilitation Centers; Rest; Role; SF-36; Scientist; Secondary Prevention; Self Efficacy; Strenuous Exercise; Stress Tests; Stroke; Techniques; Testing; Time; Training; United States; Walking; Workload; acceptability and feasibility; economic outcome; effectiveness outcome; efficacy evaluation; efficacy testing; evidence base; exercise adherence; exercise intensity; exercise prescription; exercise training; experience; fitness; healthy aging; implementation outcomes; improved; improved outcome; indexing; individual patient; individual response; loss of function; mortality; multidisciplinary; patient response; pilot trial; programs; psychologic; psychological outcomes; randomized trial; recruit; response; secondary outcome; sex; treatment as usual; trial comparing

PROJECT SUMMARY Heart disease and its treatments, including hospitalization, surgery, and procedures, can result in devastating loss of function, particularly in inactive older adults, who often face a prolonged recovery. Maximizing fitness and promoting adequate physical activity (PA) are critical targets for healthy aging and recovery after a cardiac event. Cardiac rehabilitation (CR) provides up to 36 supervised exercise training sessions and lifestyle counseling to these patients and is thus ideally positioned to promote full recovery, encourage regular PA, optimize cardiac health, and support more successful aging for these patients. However, many CR programs fail to meet established benchmarks for improving fitness among their patients. This failure is likely attributable to marked differences in exercise intensity prescription practices across CR programs, which have recently been identified. Specifically, the most common method for prescribing exercise intensity in CR is the use of ratings of perceived exertion (RPE) coupled with a “rule of thumb” approach to achieve an exercise training heart rate (HR) that is 20-30 bpm higher than resting HR. While easy to implement, these usual care (UC) techniques often result in a self-selected and suboptimal exercise intensity. This, in turn, leads to lower gains in fitness and failure to reach established benchmarks. Instead, societal guidelines recommend patients undergo a graded exercise test (GXT) to measure a peak exercise HR and be prescribed exercise intensity using a computed target heart rate range (THRR). This approach (GXT-THRR) allows tailoring of exercise based on the individual patient’s response to acute exercise. However, no studies to date have tested the efficacy of GXT- THRR compared to UC, and this critical knowledge gap is likely responsible for the marked differences in exercise intensity prescription techniques across programs. Our preliminary data suggest GXT-THRR will lead to greater gains in fitness in CR, boost self-efficacy, reduce fear of exercise, and improve outcomes. To address this fundamental question, we will perform a 320-person randomized trial comparing GXT- THRR to UC among older adults with heart disease attending CR. In Aim 1, we will measure improvements in fitness during CR. In Aim 2, we will assess the impact of GXT-THRR on psychological factors associated with exercise adherence (self-efficacy and fear). In Aim 3, we will evaluate how the use of GXT-THRR impacts long-term PA, quality of life, fitness, and clinical outcomes. Our multi-disciplinary team has broad experience in all aspects of this proposal, including exercise physiology, CR, cardiology, geriatrics, and psychology. Our approach is informed by a successful pilot trial which demonstrated the clear feasibility and potential effectiveness of GXT-THRR. Ultimately, we anticipate our results will promote evidence-based exercise intensity practices in CR programs, leading to greater improvements in fitness, PA, and exercise self-efficacy, and more successful aging.

项目摘要 心脏病及其治疗，包括住院，手术和手术，可能导致毁灭性 功能丧失，尤其是在不活跃的老年人中，他们经常面临长时间康复。最大化健身 促进足够的体育活动（PA）是心脏后健康衰老和恢复的关键目标 事件。心脏康复（CR）最多提供36次监督运动培训课程和生活方式 为这些患者提供咨询，因此理想的位置可以促进完全康复，鼓励常规PA， 优化心脏健康，并为这些患者提供更成功的衰老。但是，许多CR程序 无法满足既定基准来改善患者的健身。这种失败可能归因于 跨CR计划的运动强度处方惯例有明显的差异，最近 被确定。 具体而言，在CR中规定运动强度的最常见方法是使用评级 感知的劳累（RPE）以及“经验法则”的方法来实现运动训练心率 （HR）比静息HR高20-30 bpm。虽然易于实施，但这些通常的护理（UC）技术 通常会导致自选择和次优的运动强度。反过来，这导致健身和 未能达到建立的基准。相反，社会准则建议患者进行分级 运动测试（GXT）测量峰值运动HR，并使用计算 目标心率范围（THRR）。这种方法（GXT-thr）允许根据 患者对急性运动的反应。但是，迄今为止尚无研究测试GXT-的效率 与UC相比，THRR与UC相比，这种关键的知识差距很可能导致明显的差异 跨程序的运动强度处方技术。我们的初步数据表明GXT-thr将领导 为了提高CR的健身，提高自我效能感，减少对运动的恐惧并改善结果。 为了解决这个基本问题，我们将进行320人的随机试验，以比较GXT- 在患有CR的患有心脏病的老年人中，到UC。在AIM 1中，我们将衡量改进 CR期间的健身。在AIM 2中，我们将评估GXT-thr对与心理因素相关的影响 遵守（自我效能和恐惧）。在AIM 3中，我们将评估GXT-THRR的使用如何影响 长期PA，生活质量，健身和临床结果。 我们的多学科团队在该提案的各个方面都有广泛的经验，包括锻炼 生理学，CR，心脏病学，老年医学和心理学。我们的方法是通过成功的试点审判来告知的 这表明了GXT-THRR的明显可行性和潜在有效性。最终，我们期望 我们的结果将在CR计划中促进基于证据的运动强度实践，从而使 改善健身，PA和行使自我效能感和更成功的衰老。