A novel psychological-behavioral intervention to promote physical activity after acute coronary syndrome

一种促进急性冠脉综合征后身体活动的新型心理行为干预措施

• 批准号: 10809839
• 负责人: Jeff C Huffman
• 金额: $ 81.01万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10809839
• 关键词: novel; psychological; behavioral; intervention; promote

Despite the clear benefits of physical activity on recovery and survival following an acute coronary syndrome (ACS), most of the 1 million Americans suffering an ACS each year are unable to reach adequate levels of activity. Comprehensive in-person programs to promote activity after an ACS can be effective, but they are attended by relatively few patients. Telephone-delivered motivational interviewing (MI), which has led to increased physical activity in cardiac patients, is a promising evidence-based alternative to in-person programs. However, the overall magnitude of MI’s effects on physical activity has been relatively modest in cardiac-related populations, and additional content may be needed. Psychological well-being (e.g., optimism, positive affect) is prospectively and independently associated with greater physical activity, and therefore cultivating well-being in post-ACS patients could provide an additional method to promote activity in this population. Positive psychology (PP) interventions utilize specific activities (e.g., reflecting on positive events, using personal strengths, imagining a better future) to increase well-being, and they have led to increased physical activity in patients with m edical illness. A combined PP-MI intervention could be a powerful, synergistic approach to promoting activity after an ACS. PP could increase physical activity by improving well-being, while participants set and achieve personalized activity goals. PP could also boost participant engagement in M I could enhance motivation and help M I by fostering optimism and self-efficacy, both of which are linked to greater uptake of interventions like MI. In an NHLBI-funded multiphase project, our team has developed and piloted a new, remotely-delivered PP-MI program in post-ACS patients, and PP-MI led to substantial increases in physical activity in this initial work. Accordingly, we now propose a randomized controlled trial of this 24-week phone- and text-based PP- MI intervention, compared to contemporary treatment as usual, among 280 post-ACS patients with low baseline physical activity. PP-MI utilizes weekly phone sessions for 12 weeks and twice-weekly text messaging for a total of 24 weeks to provide ongoing content and support. We will conduct follow-up assessments at 12, 24, and 48 weeks. The primary outcome for this trial is improvement in moderate to vigorous physical activity (MVPA, measured via accelerometer), and the primary study hypothesis is that PP-MI will be associated with significantly greater improvement in MVPA than treatment as usual at 24 weeks. We will also examine the effects of PP-MI on multiple additional outcomes, including other measures of activity (light activity, sedentary time), psychological/functional measures, and health-related outcomes, including cardiac biomarkers and rates of major adverse cardiac events. Finally, we will systematically assess potential clinical implementation of the PP-MI intervention. If this new program is more successful than the current standard of care in increasing activity after ACS, it could be adopted in clinical practice to improve prognosis in these high-risk patients.

尽管体力活动对急性冠心病后的恢复和生存有明显的好处 综合症（ACS），每年有 100 万美国人患有 ACS，其中大多数人无法获得足够的营养 ACS 后促进活动的综合性面对面计划可能是有效的，但 参加这些活动的患者相对较少，因此采用电话进行动机访谈（MI）。 增加心脏病患者的体力活动，是一种有前途的基于证据的替代亲自治疗的方法 然而，MI 对体力活动的总体影响程度相对较小。 心脏相关人群，可能需要额外的内容。 心理健康（例如乐观、积极情绪）是前瞻性且独立相关的 进行更多的体力活动，因此培养 ACS 后患者的幸福感可以为 积极心理学（PP）干预措施利用特定的方法来促进该人群的活动。 活动（例如，反思积极事件、发挥个人优势、想象更美好的未来）以增加 健康，并且它们导致患者增加体力活动 米 医疗疾病。 PP-MI 联合干预可能是一种强有力的协同方法，可在 ACS 可以通过改善健康来增加体力活动，同时 参与者设定并实现个性化活动目标也可以提高参与者的参与度。 M 我可以增强动力并提供帮助 我由 培养乐观情绪和自我效能感，这两者都与更多地采用 MI 等干预措施有关。 NHLBI 资助的多阶段项目，我们的团队开发并试点了一种新的远程交付 PP-MI ACS 后患者的计划和 PP-MI 导致了这项初步工作中体力活动的大幅增加。 因此，我们现在提出一项为期 24 周的基于电话和文本的 PP- 随机对照试验 在 280 名 ACS 后患者中，MI 干预与常规治疗进行比较 PP-MI 采用为期 12 周的每周电话会议和每周两次短信。 我们将在 24 周内提供持续的内容和支持。 第 24 周和第 48 周，该试验的主要结果是中度至剧烈体力活动的改善。 （MVPA，通过加速度计测量），主要研究假设是 PP-MI 将与 24 周时，MVPA 的改善明显优于常规治疗。 PP-MI 对多种额外结果的影响，包括其他活动指标（轻度活动、久坐） 时间）、心理/功能测量和健康相关结果，包括心脏生物标志物和比率 最后，我们将系统地评估该计划的潜在临床实施情况。 PP-MI 干预是否比目前的护理标准更成功。 ACS 后的活动，可以在临床实践中采用，以改善这些高危患者的预后。