A Randomized Controlled Trial of Positive-Affect Induction to Promote Physical Activity After Percutaneous Coronary Intervention
A Randomized Controlled Trial of Positive-Affect Induction to Promote Physical Activity After Percutaneous Coronary Intervention
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DOI：
10.1001/archinternmed.2011.1311
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发表时间：
2012-02-27
影响因子：
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通讯作者：
Allegrante, John P.
中科院分区：
文献类型：
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作者：
Peterson, Janey C.;Charlson, Mary E.;Allegrante, John P.
背景：经皮冠状动脉介入治疗后 1 年内，超过 20% 的患者出现新的不良事件。体力活动可使死亡率降低 25%；然而，体力活动普遍未得到充分利用。因此，需要更强有力的行为干预来促进身体活动。我们的目标是激励患者在 12 个月内将支出增加 336 kcal/wk 或更多，根据 Paffenbarger 体力活动和运动指数评估。方法：2004 年 10 月至 2006 年 10 月期间，在经皮冠状动脉介入治疗后立即招募了 242 名患者。患者被随机分为 2 组中的 1 组。患者教育 (PE) 对照组 (n=118) (1) 收到教育工作簿，(2) 收到计步器，(3) 为身体活动目标制定行为契约。积极情绪/自我肯定 (PA) 干预组 (n=124) 接受 3 个 PE 控制组件，加上 (1) PA 工作簿章节、(2) 每两个月通过电话进行 PA 诱导，以及 (3) 小邮寄礼物。所有患者均接受为期 12 个月的标准化电话随访，每两个月进行一次。结果：流失率为 4.5%，2.1% 的患者死亡。与 PE 对照组相比，PA 干预组中有更多患者在 12 个月时每周增加 336 kcal/wk 或更多的支出，这是我们的主要结果（54.9% vs 37.4%，P=.007）。在控制人口和社会心理指标的情况下，PA 干预患者在 12 个月内达到每周增加 336 kcal 或更多的目标的可能性高出 1.7 倍。在多变量分析中，与 PE 对照患者相比，PA 干预患者在 12 个月时每周卡路里摄入量改善了近一倍（602 vs 328，P=.03）。结论：经皮冠状动脉介入治疗后接受 PA 干预的患者能够在 12 个月内实现持续且具有临床意义的体力活动增加。
Background: Within 1 year after percutaneous coronary intervention, more than 20% of patients experience new adverse events. Physical activity confers a 25% reduction in mortality; however, physical activity is widely underused. Thus, there is a need for more powerful behavioral interventions to promote physical activity. Our objective was to motivate patients to achieve an increase in expenditure of 336 kcal/wk or more at 12 months as assessed by the Paffenbarger Physical Activity and Exercise Index.Methods: Two hundred forty-two patients were recruited immediately after percutaneous coronary intervention between October 2004 and October 2006. Patients were randomized to 1 of 2 groups. The patient education (PE) control group (n=118) (1) received an educational workbook, (2) received a pedometer, and (3) set a behavioral contract for a physical activity goal. The positive-affect/self-affirmation (PA) intervention group (n=124) received the 3 PE control components plus (1) a PA workbook chapter, (2) bimonthly induction of PA by telephone, and (3) small mailed gifts. All patients were contacted with standardized bimonthly telephone follow-up for 12 months.Results: Attrition was 4.5%, and 2.1% of patients died. Significantly more patients in the PA intervention group increased expenditure by 336 kcal/wk or more at 12 months, our main outcome, compared with the PE control group (54.9% vs 37.4%, P=.007). The PA intervention patients were 1.7 times more likely to reach the goal of a 336-kcal/wk or more increase by 12 months, controlling for demographic and psychosocial measures. In multivariate analysis, the PA intervention patients had nearly double the improvement in kilocalories per week at 12 months compared with the PE control patients (602 vs 328, P=.03).Conclusion: Patients who receive PA intervention after percutaneous coronary intervention are able to achieve a sustained and clinically significant increase in physical activity by 12 months.