Mindful Steps: A Web-Based Mind-Body Exercise Intervention to Promote Physical Activity in Chronic Cardiopulmonary Disease

正念步骤：基于网络的身心运动干预，促进慢性心肺疾病的体力活动

基本信息

批准号：
10732824
负责人：
GLORIA Y YEH
金额：
$ 86.6万
依托单位：
BETH ISRAEL DEACONESS MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-05 至 2028-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10732824
关键词：
Activities of Daily Living Address Adherence Adverse event Anxiety Area Awareness Behavior Behavioral Breathing Exercises Cardiac rehabilitation Cardiopulmonary Chronic Chronic Disease Chronic Obstructive Pulmonary Disease Chronic lung disease Chronic pulmonary heart disease Cognitive Congestive Heart Failure Coupled Coupling Data Data Collection Development Disease Disease Management Dose Dyspnea Education Educational process of instructing Exercise Fatigue Feasibility Studies Fostering Frequencies Functional disorder Funding Goals Grant Habits Health Health Promotion Health behavior change Heart Diseases Heart failure Home Hospitalization Hospitals Instruction Internet Intervention Interview Literature Logistics Measures Mediating Mental Depression Mind-Body Intervention Moods Motivation Movement Musculoskeletal National Center for Complementary and Integrative Health Online Systems Outcome Outpatients Patients Personal Satisfaction Persons Physical activity Pilot Projects Population Procedures Pulmonary Heart Disease Quality of life Research Self Efficacy Self-Examination Social support Syndrome Tai Ji Technology Theoretical model Time Transportation Travel United States National Institutes of Health Walking Work acceptability and feasibility adverse event risk behavior change behavior measurement behavioral construct clinical center comorbidity curriculum enhancement efficacy evaluation efficacy testing efficacy trial empowerment exercise capacity exercise intervention exercise intolerance exercise program experience fitbit health related quality of life high risk improved improved outcome individualized feedback interest intrinsic motivation mind/body mindfulness modifiable behavior multi-component intervention multimodality novel novel strategies online community patient oriented pedometer physical conditioning primary outcome programs pulmonary rehabilitation recruit remote delivery risk minimization sedentary sedentary lifestyle standard of care success symptomatology treatment as usual web platform web-based intervention

项目摘要

Physical activity (PA) is an important modifiable behavior that has enormous impacts on chronic cardiopulmonary health. Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are similar systemic syndromes where patients are often deconditioned and suffer exercise intolerance and dyspnea. Importantly, these patients share a dramatically high risk of sedentary behavior that portend poor outcomes. While PA is paramount in disease management (with improvements in exercise capacity, quality-of-life, and hospitalizations) available exercise programs are underutilized and inaccessible, and long-term adherence to PA is universally problematic. Novel strategies to increase PA in these populations are greatly needed. In recent years, there is rapidly emerging interest in use of internet/technology-mediated interventions to promote health behavior change in chronic disease populations. Our prior work investigated a web-based PA platform with motivational and educational content coupled with a wearable step tracker with individualized step goals that demonstrated increases in PA in patients with cardiopulmonary disease in the short term. At the same time, there is also a growing and robust literature on the benefits of mind-body exercise for health behavior change. In HF and COPD, we have shown improvements in quality-of-life, exercise capacity, and PA, with data suggesting that self-efficacy may be an important factor to facilitate long-term behavior change. In a previously funded NIH developmental grant (R34AT009354) we leveraged our experience in web- based PA interventions together with our expertise in mind-body therapies to develop a novel multi-modal intervention (Mindful Steps) for patients with COPD and HF to foster longer-term PA adherence. Our theoretical model posits that the integration of a mind-body curriculum enhances key behavioral constructs in the existing intervention and also targets new areas that will lead to enhanced self-efficacy and increased, sustained PA. In a pilot study, we have demonstrated study feasibility (recruitment, retention, all-remote data collection), and intervention feasibility/acceptability (including online, synchronous mind-body classes). In this R01, we propose the next step RCT (N=136) to test the efficacy of Mindful Steps, compared to usual care, to promote PA (objectively measured by daily step counts) in patients with COPD and/or HF (primary aim). Secondary aims will examine cognitive-behavioral measures within our theoretical model (self- efficacy for exercise and for disease management, intrinsic motivation, mindfulness, interoceptive awareness) and patient-centered clinical outcomes (disease-specific quality of life, exercise engagement, dyspnea, fatigue). Coupling technology with traditional mind-body exercise principles, Mindful Steps emphasizes a whole person approach that aligns well with NCCIH’s strategic priorities. Based on a compelling rationale and rigorous feasibility data, a larger-scale remotely-delivered efficacy trial is the next step in evaluating this accessible, web-based PA intervention that may provide broader reach in COPD and HF.

体力活动（PA）是一种重要的可改变行为，对慢性病有巨大影响心肺健康状况与慢性阻塞性肺疾病（COPD）和心力衰竭（HF）相似。患者经常出现身体状况不佳、全身运动不耐受和呼吸困难的综合征。重要的是，这些患者久坐行为的风险极高，这预示着不良结果。虽然 PA 在疾病管理中至关重要（通过改善运动能力、生活质量和住院）可用的锻炼计划未得到充分利用且无法获得，并且长期坚持 PA 是一个普遍存在的问题，迫切需要新的策略来增加这些人群的 PA 水平。近年来，人们对使用互联网/技术介导的干预措施的兴趣迅速兴起我们之前的工作调查了基于网络的健康行为改变。 PA 平台包含激励和教育内容，以及具有个性化功能的可穿戴步数跟踪器证明心肺疾病患者的 PA 在短期内有所增加的步骤目标。与此同时，关于身心锻炼对健康益处的文献也越来越多在心力衰竭和慢性阻塞性肺病中，我们显示出生活质量、运动能力和 PA 的改善。数据表明自我效能可能是促进长期行为改变的重要因素。在之前资助的 NIH 发展拨款 (R34AT009354) 中，我们利用了我们在网络方面的经验—— 基于 PA 干预措施与我们在身心疗法方面的专业知识相结合，开发出一种新型的多模式疗法对慢性阻塞性肺病 (COPD) 和心力衰竭 (HF) 患者进行干预（正念步骤），以促进长期 PA 依从性。理论模型认为，身心课程的整合增强了关键的行为结构现有的干预措施还针对新的领域，这些领域将导致增强自我效能并增加，在一项试点研究中，我们证明了研究的可行性（招募、保留、全远程数据）。收集），以及干预的可行性/可接受性（包括在线同步身心课程）。在这个 R01 中，我们提出了下一步 RCT（N=136）来测试 Mindful Steps 的功效，与常规护理，以促进 COPD 和/或 HF 患者的 PA（通过每日步数客观测量）（主要目标）。次要目标将检查我们的理论模型（自我）中的认知行为测量。运动和疾病管理的功效、内在动机、正念、内感受意识）以及以患者为中心的临床结果（特定疾病的生活质量、运动参与、呼吸困难、 Mindful Steps 将技术与传统的身心锻炼原则相结合，强调整体。基于令人信服的理由和与 NCCIH 的战略重点高度一致的人员方法。严格的可行性数据、更大规模的远程交付功效试验是评估这一点的下一步可访问的、基于网络的 PA 干预可能会在慢性阻塞性肺病和心力衰竭方面提供更广泛的影响。