Sitting Interruption and Whole-body Cardiovascular Health: Linking Physiological Responses to Risk Behaviors

久坐中断与全身心血管健康：将生理反应与危险行为联系起来

• 批准号: 10583500
• 负责人: Erik D Hanson
• 金额: $ 64.92万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-03 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10583500
• 关键词: Acute; Adherence; Adoption; Adult; Advisory Committees; Aorta; Behavior; Behavior Therapy; Behavioral; Behavioral Model; Benchmarking; Biological; Blood; Brain; Cardiovascular Diseases; Cardiovascular system; Chronic; Clinical Trials; Communities; Coronary heart disease; Cross-Over Trials; Data; Development; Dose; Environment; Exposure to; Femur; Focus Groups; Frequencies; Future; Goals; Guidelines; Heart; Hormonal; Hour; Individual; International Agencies; Interruption; Intervention; Intervention Studies; Laboratory Study; Level of Evidence; Link; Literature; Lower Extremity; Measures; Metabolic; Modeling; National Heart, Lung, and Blood Institute; Organ; Outcome; Participant; Persons; Physical activity; Physical environment; Physiologic pulse; Physiological; Policies; Policy Developments; Posture; Questionnaires; Randomized; Recommendation; Research; Risk Behaviors; Risk Factors; Social Environment; Stroke; Stroke Volume; Supination; Testing; Translations; Walking; Work; arm; arterial stiffness; behavior change; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular health; design; efficacy testing; endothelial dysfunction; feasibility testing; feasibility trial; hemodynamics; middle age; mortality; novel strategies; predictive marker; prevent; randomized, clinical trials; response; sedentary lifestyle; shear stress; social culture; therapy design

ABSTRACT Sedentary behaviors (SB) are biologically distinct but understudied cardiovascular disease (CVD) risk factors. National and international agencies have surmised that the level of evidence for an overall and dose-response association between SB and CVD mortality is moderate-strong. These agencies do not provide specific recommendations for breaking-up SB, though do call on the research community to facilitate policy development by establishing biological plausibility, identifying the optimal dose for SB substitution strategies, and conducting randomized clinical trials to test the efficacy of these strategies. Our goal is to identify mechanism-informed, socioecological-based SB substitution recommendations to mitigate CVD risk. Aim 1A will identify a feasible SB substitution strategy to prevent the adverse cardiovascular responses to prolonged SB. Adverse cardiovascular responses will be measured using aortic arterial stiffness (AS), a noninvasive test that predicts future CVD. To accomplish this aim, in 56 middle-aged (36-55 years) participants, we will measure aortic AS and associated mechanistic responses to the following over 4 hours: (i) SB with once/hour 5 min walk break; (ii) SB with once/hour 15 min stand break; (iii) SB with twice/hour breaks (alternating 5 min walk and 15 min stand); and (iv) SB with no breaks (control). These strategies were selected based on extensive prior work by our group, and because they are feasible, which is a key component of this proposal. SB reduction strategies will only decrease CVD risk if people are willing to adhere to future SB substitution recommendations. To increase the likelihood of feasibility and long-term adherence, Aim 1B will evaluate the determinants of SB using a socioecological model. This recognizes that behavior change is likely to be limited if the physical and sociocultural environments do not support the behavior change. To accomplish Aim 1B, a combined inductive-deductive qualitative approach will be used. Participants who complete Aim 1A will be participate in one of 6 focus groups (6-8 participants/group). Aim 2A will then test the feasibility of implementing the strategy in the real-world via an individualized single-arm 12-week intervention (n=40, 36-64 years). The mechanistic (Aim 1A) and qualitative (Aim 1B) data from Aim 1 will guide the intervention design. We will test the following feasibility domains: demand, acceptability, implementation, practicality, integration, and limited-efficacy. Lastly, Aim 2B will investigate which components of the intervention worked and which components did not work. All participants who complete Aim 2A will be asked to complete questionnaires pertaining to our behavioral model as well as participate in a focus group. The focus groups will be used to add context to the quantitative feasibility data. Specifically, we will address acceptability, adoption, appropriateness, sustainability, and the perceived socioecological determinants. Crucially, the outcomes from this proposal will be instrumental in facilitating the design of a subsequent clinical trial to test a mechanism-informed yet feasible SB reduction intervention, and in doing so directly support the development of SB policy.

抽象的 久坐行为（SB）在生物学上是独特的，但尚未得到充分研究的心血管疾病（CVD）危险因素。 国家和国际机构推测总体和剂量反应的证据水平 SB 与 CVD 死亡率之间的相关性为中强。这些机构并没有提供具体的 解散 SB 的建议，但确实呼吁研究界促进政策制定 通过建立生物学合理性、确定 SB 替代策略的最佳剂量来进行开发， 并进行随机临床试验来测试这些策略的有效性。我们的目标是确定 基于机制、基于社会生态学的 SB 替代建议，以减轻 CVD 风险。 目标 1A 将确定可行的 SB 替代策略，以防止心血管不良反应 延长SB。将使用主动脉僵硬度（AS）来测量不良心血管反应， 预测未来 CVD 的无创测试。为实现这一目标，在56个中年（36-55岁） 对于参与者，我们将在 4 小时内测量主动脉 AS 和相关的机械反应：(i) SB 每小时一次，步行 5 分钟休息； (ii) SB，每小时一次，每次 15 分钟站立休息； (iii) SB，每小时两次休息 （交替步行 5 分钟和站立 15 分钟）； (iv) SB 无间断（对照）。这些策略被选定 基于我们小组之前的大量工作，并且因为它们是可行的，这是本研究的关键组成部分 提议。如果人们愿意坚持未来的 SB，减少 SB 的策略只会降低 CVD 风险 替代建议。为了增加可行性和长期坚持的可能性，目标 1B 将 使用社会生态学模型评估 SB 的决定因素。这认识到行为改变是可能的 如果物理和社会文化环境不支持行为改变，则受到限制。为了完成 目标 1B，将使用归纳-演绎相结合的定性方法。完成目标 1A 的参与者 将参加 6 个焦点小组之一（6-8 名参与者/组）。目标2A将测试可行性 通过为期 12 周的个性化单臂干预在现实世界中实施该策略（n=40、36-64 年）。目标 1 的机制（目标 1A）和定性（目标 1B）数据将指导干预设计。 我们将测试以下可行性领域：需求、可接受性、实施、实用性、集成、 且功效有限。最后，目标 2B 将调查干预措施的哪些组成部分有效以及哪些组成部分有效 组件不起作用。所有完成目标 2A 的参与者都将被要求填写调查问卷 与我们的行为模型相关的内容以及参与焦点小组。焦点小组将用于添加 定量可行性数据的背景。具体来说，我们将解决可接受性、采用性、适当性、 可持续性和感知的社会生态决定因素。至关重要的是，该提案的结果将 有助于促进后续临床试验的设计，以测试机制知情且可行的 SB 减少干预，并以此直接支持 SB 政策的制定。