Remotely Delivered Cardiac Rehabilitation for Adolescents with Congenital Heart Disease

为患有先天性心脏病的青少年提供远程心脏康复

• 批准号: 10448915
• 负责人: David A White
• 金额: $ 15.44万
• 依托单位: CHILDREN'S MERCY HOSP (KANSAS CITY, MO)
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-15 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10448915
• 关键词: 19 year old; Adolescent; Adult; Aerobic Exercise; Age; Alzheimer' s Disease; American Heart Association; Asthma; Cardiac; Cardiac rehabilitation; Cardiovascular Physiology; Caregivers; Characteristics; Child; Childhood; Clinical Trials; Clinics and Hospitals; Common Ventricle; Conduct Clinical Trials; Control Groups; Data; Demographic Impact; Development; Diabetes Mellitus; Diagnosis; Dissemination and Implementation; Down Syndrome; Dual-Energy X-Ray Absorptiometry; Echocardiography; Effectiveness; Evaluation; Exercise; Family; Financial Hardship; Financial cost; Funding; Goals; Health; Health Technology; Heart Rate; Heart Transplantation; Home; Hospitals; Impairment; Intellectual functioning disability; Intervention; Interview; Knowledge; Life; Mentors; Morbidity - disease rate; Movement; Operative Surgical Procedures; Outcome; Outcomes Research; Parents; Participant; Patients; Pediatric Hospitals; Personal Satisfaction; Physical Exercise; Physical Function; Physical activity; Physiological; Physiology; Population; Preparation; Prevention; Professional Organizations; Quality of life; Randomized; Randomized Controlled Clinical Trials; Research; Research Project Grants; Resistance; Resources; Schedule; Self Efficacy; Self-Direction; Severity of illness; Site; Social support; Structure; Supervision; Surveys; Tablet Computer; Tablets; Technology; Tetralogy of Fallot; Thinness; Time; Training; Transportation; Transposition of Great Vessels; Travel; United States National Institutes of Health; Videoconferencing; Youth; active control; arm; base; biological sex; boys; cardiorespiratory fitness; career; career development; comorbidity; congenital heart disorder; cost; d-transposition of the great arteries; design; disease diagnosis; effective intervention; effectiveness evaluation; exercise intensity; exercise intervention; exercise program; exercise rehabilitation; experience; fitbit; fitness; frailty; girls; heart function; hemodynamics; improved; lean body mass; mHealth; meetings; mortality; multidisciplinary; novel; obesity treatment; pediatric patients; peer; peer support; physiologic stressor; pilot trial; prevent; programs; psychosocial; remote delivery; repaired; resistance exercise; satisfaction; skills; training project

PROJECT SUMMARY/ABSTRACT Adolescents with congenital heart disease [CHD], including repair of tetralogy of Fallot [TOF], dextro-transposi- tion of the great vessels [d-TGA], or functionally univentricular heart physiology [Fontan], have lower cardiorespir- atory fitness [FIT] compared with healthy peers. FIT is a well-established predictor of morbidity, quality of life [QOL], and heart transplantation and is among the strongest predictors of mortality in this population. However, adolescents with CHD have significantly lower FIT when compared to cardio-typical peers, due to abnormal hemodynamics as well as low durations and intensities of physical activity [PA] and exercise. Pediatric cardiac rehabilitation [CR] programs which prescribe aerobic and resistance exercise over 12-wks. have demonstrated improvements in FIT for patients with CHD which persist months after completion of the program. Unfortunately, few hospitals/clinics offer CR programming for children and adolescents due to the financial costs of building and maintaining a CR facility, as well as the travel cost, time requirement, and burden for parents/caregivers to transport their child to/from a hospital for CR exercise sessions multiple times per week. In-home CR reduces barriers related to patient access and the financial burden for hospitals, though data supporting the effectiveness of in-home CR for youth is limited. The use of group video conferencing technology via tablet computer repre- sents a novel and potentially transformational strategy for delivering real-time, live, supervised CR to groups of adolescents with CHD in their homes. The goal of this K23 research plan is to evaluate the effectiveness of video conferencing for the delivery of real-time CR to groups of adolescents with CHD in their homes. We propose a 12-wk. randomized-controlled clinical trial assigning 74 adolescents [12-19 years old] with 1 of 3 CHD diagnoses [Fontan, TOF, or d-TGA] to Remote CR [RCR] [in-home, live, remote group exercise, 3-45-min sessions/week.] or Active control [in-home, self-directed exercise]. Our aims will assess the effectiveness of the RCR approach by comparing between-group changes [0-12 weeks] in: FIT, cardiac function, lean body mass, and frailty. Ex- ploratory aims will assess between group differences [0-12 weeks] in physical function, QOL, PA self-efficacy, and will evaluate the impact of demographic characteristics on program participation and satisfaction, and daily PA. We hypothesize the RCR intervention will elicit greater improvements in each outcome compared to the control group. The PI’s short term career development goal of enhancing knowledge, skills, and experiences in clinical trials research, CHD physiology, and implementation and dissemination [I&D] outcomes research in youth with CHD will be accomplished through a multidisciplinary team of mentors, formal programming/coursework, independent study, and scientific meetings. Career development training and experiences and data from the research plan will prepare the PI to accomplish his long-term career goals to 1] establish an independently funded research program conducting clinical trials to evaluate the impact of exercise, FIT on physical and psy- chosocial function in youth with CHD; and 2] I&D of CR programs across multiple sites.

项目摘要/摘要 先天性心脏病[CHD]的青少年，包括修复Fallot [Tof]的四边形，右旋 伟大的血管[D-TGA]或功能上的心脏生理学[Fontan]的心脏疾病较低 与健康的同龄人相比，艺术健身[适合]。拟合是良好的发病率，生活质量的预测指标 [QOL]和心脏移植，并且是该人群死亡率的有力预测指标之一。然而， 与心脏典型同行相比 血液动力学以及持续时间和运动强度[PA]和运动。小儿心脏 康复[CR]规定了12周以上有氧运动和抵抗运动的计划。已经证明了 该计划完成后数月持续数月的冠心病患者的适合改善。很遗憾， 由于建造的经济成本，很少有医院/诊所为儿童和青少年提供CR编程 并维护CR设施以及旅行成本，时间要求以及父母/护理人员的燃烧 每周多次将他们的孩子带到医院/从医院进行CR锻炼。在家中降低 尽管数据支持有效性 青年时代的室内CR是有限的。通过平板电脑计算机代表使用组视频会议技术 - 发送一种新颖的，潜在的变革性策略，以将实时，现场监督的CR交付给 有CHD的青少年在家中。该K23研究计划的目的是评估视频的有效性 会议将实时CR交付给家中有CHD的青少年团体。我们提出了一个 12周。随机控制的临床试验，分配了74名青少年[12-19岁]，其中1个CHD诊断中有1个 [Fontan，TOF或D-TGA]到远程CR [RCR] [在家中，实时，远程团体练习，3-45分钟/周/周。] 或主动控制[家庭中，自我指导的练习]。我们的目标将评估RCR方法的有效性 通过比较组间变化[0-12周]：拟合，心脏功能，瘦体重和脆弱。前任- 呈态目标将评估群体差异[0-12周]的身体功能，QOL，PA自我有效， 并将评估人口特征对计划参与和满意的影响，以及每天 PA。我们假设RCR干预将与相比 对照组。 PI的短期职业发展目标是增强知识，技能和经验 临床试验研究，冠状动脉生理学以及实施与传播[I＆D]成果研究青年的研究 与CHD的跨学科团队，正式的节目/课程工作，将与CHD一起完成 独立研究和科学会议。职业发展培训和经验以及来自 研究计划将为PI做好准备，以实现他的长期职业目标至1] 资助的研究计划进行临床试验，以评估运动的影响，适合身体和PSY- CHD青年的共同功能；和2]跨多个站点的CR程序的I＆D。