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
基本信息
- 批准号:10672281
- 负责人:
- 金额:$ 59.07万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 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:
- 关键词:AccelerometerAcuteAddressAgeAgingAnxietyBenchmarkingCardiacCardiac healthCardiac rehabilitationCardiologyCessation of lifeClinicalCounselingCoupledDataEffectivenessElderlyEventExerciseExercise PhysiologyExercise TestExertionExpert OpinionFaceFailureFemaleFrightGeriatricsGoalsGuidelinesHeartHeart DiseasesHeart RateHospitalizationIschemiaKnowledgeLifeLife StyleMeasuresMediatingMetabolicMethodsMyocardial InfarctionOperative Surgical ProceduresOutcomeOutpatientsPatientsPerceptionPersonsPharmaceutical PreparationsPhysical FunctionPhysical PerformancePhysical activityPhysiciansPositioning AttributePrevention programProceduresPrognosisPsychological FactorsPsychologyQuality of lifeRandomized, Controlled TrialsRecommendationRecoveryRehabilitation CentersRestRoleSF-36ScientistSecondary PreventionSelf EfficacyStrenuous ExerciseStress TestsStrokeTechniquesTestingTimeTrainingUnited StatesWalkingWorkloadacceptability and feasibilityeconomic outcomeeffectiveness outcomeefficacy evaluationefficacy testingevidence baseexercise adherenceexercise intensityexercise prescriptionexercise trainingexperiencefitnesshealthy agingimplementation outcomesimprovedimproved outcomeindexingindividual patientindividual responseloss of functionmortalitymultidisciplinarypatient responsepilot trialprogramspsychologicpsychological outcomesrandomized trialrecruitresponsesecondary outcomesextreatment as usualtrial comparing
项目摘要
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.
项目概要
心脏病及其治疗,包括住院、手术和手术,可能会导致毁灭性的后果
功能丧失,尤其是不活动的老年人,他们通常面临长期的健康恢复。
和促进充足的体力活动 (PA) 是健康老龄化和心脏病后恢复的关键目标
心脏康复 (CR) 提供多达 36 次监督运动训练和生活方式。
为这些患者提供咨询,因此非常适合促进完全康复,鼓励定期 PA,
优化心脏健康,并支持这些患者更成功地老龄化。然而,许多 CR 计划。
未能达到改善患者健康状况的既定基准。这种失败可能是由于。
各个 CR 项目的运动强度处方实践存在显着差异,这些项目最近
已被识别。
具体来说,在 CR 中规定运动强度的最常见方法是使用评级
感知用力 (RPE) 结合“经验法则”方法来实现运动训练心率
这些常规护理 (UC) 技术虽然易于实施,但比静息心率高 20-30 bpm。
通常会导致自我选择和次优的运动强度,这反过来又会导致健身效果和收益降低。
相反,社会指南建议患者接受分级治疗。
运动测试 (GXT) 用于测量峰值运动心率并使用计算得出的运动强度来规定运动强度
目标心率范围 (THRR) 该方法 (GXT-THRR) 允许根据目标心率范围定制运动。
然而,迄今为止还没有研究测试过 GXT- 的功效。
THRR 与 UC 相比,这种关键的知识差距可能是造成
我们的初步数据表明 GXT-THRR 将领先。
更大程度地提高 CR 健康水平、提高自我效能、减少对运动的恐惧并改善结果。
为了解决这个基本问题,我们将进行一项 320 人的随机试验,比较 GXT-
在目标 1 中,我们将衡量患有心脏病的老年人的 THRR 至 UC 的改善情况。
在目标 2 中,我们将评估 GXT-THRR 对与 CR 相关的心理因素的影响。
在目标 3 中,我们将评估 GXT-THRR 的使用如何影响运动依从性(自我效能和恐惧)。
长期 PA、生活质量、健康和临床结果。
我们的多学科团队在该提案的各个方面都拥有丰富的经验,包括练习
我们的方法基于成功的试点试验。
这证明了 GXT-THRR 的明确可行性和潜在有效性,最终符合我们的预期。
我们的结果将促进 CR 计划中基于证据的运动强度实践,从而带来更大的效果
健身、体能活动和运动自我效能的改善,以及更成功的老龄化。
项目成果
期刊论文数量(0)
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- 批准号:
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- 资助金额:
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