Advancement of Clinical Referral to Physical Activity for Cardiometabolic Disease Prevention

体力活动不足(PA)被认为是心脏代谢性疾病的主要危险因素。临床 建议支持在心血管疾病的一级预防和治疗中达到健康的PA水平 2型糖尿病。需要更广泛地开展初级预防工作，并将提高PA水平作为“中心” 元素“已被以前的研究提出。与临床实践相结合的PA改进计划 有可能接触到大量的高危人群。虽然为临床医生提供了一个框架 低PA水平患者的识别和治疗是由美国医学会开发的 运动医学(ACSM)和临床PA转诊现在得到了美国心脏协会(AHA)的认可， 识别和解决PA不足的做法在临床实践中并不常见。这项提议旨在 改善低PA和其他患者的临床PA转诊的重要方面 心脏代谢危险因素。提案的目标1将确定一种廉价、方便、 循证在线干预，以提高PA水平，适用于不符合 美国有氧PA的目标是每周150分钟的中等强度的有氧运动(例如，快步走)PA还 至少有一个其他常见的心脏代谢危险因素(高血压，高血糖， 和/或超重/肥胖)。成人初级保健患者(n=54；年龄40-70岁)符合低PA和 可以在没有监督的情况下安全地增加活动的额外心脏代谢风险将被招募。 参与者将被随机分为积极对照组(接受商业性手腕佩戴的体力活动 Tracker；PAT)或基于社会认知理论的在线干预(每周3个月和9个月 月维护)外加PAT。主要结果将包括每天平均步数的变化和 达到每周150分钟活动目标的百分比；将在6个月和12个月的后续行动中进行评估。 次要结果将包括体重、腰围、血压、空腹血糖、胰岛素、 胆固醇、甘油三酯和患者报告的结果，包括自我效能、生活质量、成本和 体验/满意度。参与者使用在线平台和跟踪工具的统计数据 此外，还将收集有关维护策略的态度/信念和意见。我们将利用REAL 通过研究PA水平的变化和重要的心脏代谢之间的关联来提供世界证据 临床测量的结果，并通过确定预测患者特征的电子病历测量 PA水平的变化。将考虑处理丢失数据的方法。目标2的目标是发展 将PAT数据添加到基于EPIC的电子健康记录(EHR)的程序建议。 通过电子病历与临床团队沟通患者PA水平，使用现有的PATS是有价值的，但 关于如何实现这一点，目前还没有达成共识。我们将让主要利益攸关方参与制定 一套跨学科的程序，考虑到卫生专业人员、卫生系统、 研究人员和病人。完成这些目标将提供试点数据，为今后的开发工作提供参考 可行、有效的PA转诊计划，可以与临床护理相协调，并将建立重要的 与务实试验相关的协作关系和技能。

Inadequate physical activity (PA) is considered a major risk factor for cardiometabolic disease. Clinical recommendations endorse achieving healthy PA levels in the primary prevention of cardiovascular disease and type 2 diabetes. The need for wider reaching primary prevention efforts with increasing PA levels as a “central element” has been suggested by previous studies. PA improvement programs integrated with clinical practice have the potential to reach a large number of at-risk individuals. Although a framework for clinician identification and treatment of people with low PA levels has been developed by the American College of Sports Medicine (ACSM), and clinical PA referral is now endorsed by the American Heart Association (AHA), the practice of identifying and addressing inadequate PA is not common in clinical practice. This proposal aims to improve important aspects of clinical PA referral for primary care patients with low PA and additional cardiometabolic risk factors. Aim 1 of the proposal will determine the efficacy of an inexpensive, convenient, evidence-based online intervention for improving PA levels that is appropriate for adult patients not meeting the US aerobic PA goal of 150 minutes/ week of moderate-vigorous intensity (e.g., brisk walking) PA who also have at least one other common cardiometabolic risk factor (high blood pressure, elevated glucose levels, and/or overweight/obesity). Adult primary care patients (n=54; aged 40-70) meeting the criteria for low PA and additional cardiometabolic risk who can safely increase activity without supervision will be recruited. Participants will be randomized to an active control (to receive a commercial wrist-worn physical activity tracker; PAT) or an online social-cognitive theory-based intervention (3 months of weekly sessions and 9 months maintenance) plus PAT. Primary outcomes will include the change in average step counts/day and percentage meeting the 150 minutes/week activity goal; they will be assessed at 6 and 12 months of follow-up. Secondary outcomes will include body weight, waist circumference, blood pressure, fasting glucose, insulin, cholesterol, triglycerides, and patient-reported outcomes including self-efficacy, quality of life, cost, and experience/satisfaction. Statistics on participant usage of the online platform and tracking tools, participant attitudes/beliefs, and opinions regarding maintenance strategies, will also be collected. We will leverage real world evidence by examining associations between changes in PA levels and important cardiometabolic outcomes that are measured clinically and by identifying EHR measures of patient characteristics that predict changes in PA levels. Methods for dealing with missing data will be considered. The goal of Aim 2 is to develop procedural recommendations for adding PAT data to an Epic-based electronic health record (EHR). Communicating patient PA levels with clinical teams through the EHR, using existing PATs holds value, but there is no consensus on how to accomplish this. We will engage key stakeholders in developing an interdisciplinary set of procedures that considers the needs of health professionals, health systems, researchers, and patients. Completion of these aims will provide pilot data to inform future efforts to develop feasible, effective PA referral programs that can be coordinated with clinical care and will build important collaborative relationships and skills relevant to pragmatic trials.