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

尽管体力活动对急性冠状动脉病变后的恢复和生存有明显的好处 综合征(ACS)，每年有100万美国人患有ACS，其中大多数人无法达到足够的 活跃度。全面的面对面计划在ACS之后促进活动可能是有效的，但 参加这些活动的病人相对较少。电话传递的激励性面试(MI)，它已经导致 对心脏病患者增加体力活动，是一种有前景的循证替代面对面的方法 程序。然而，MI对体力活动的总体影响在#年相对较小 与心脏相关的人群，并可能需要额外的内容。 心理健康(例如，乐观、积极的情感)与预期和独立相关 有更多的体力活动，因此培养急性冠脉综合征患者的幸福感可以提供 促进这一人群活动的另一种方法。积极心理学(PP)干预利用特定的 活动(例如，反思积极的事件，利用个人优势，想象更美好的未来)以增加 健康，并导致患者的体力活动增加 M 内科疾病。 PP-MI联合干预可能是一种强大的、协同的方法，以促进在 ACES。PP可以通过改善幸福感来增加体力活动，而 参与者设定并实现个性化的活动目标。PP还可以提高参与者在以下方面的参与度 我可以增强动力和帮助 M I BY 培养乐观和自我效能感，这两者都与更多地接受像MI这样的干预措施有关。在一个 在NHLBI资助的多阶段项目中，我们的团队开发并试验了一种新的远程交付的PP-MI 在这项初步工作中，在急性冠脉综合征后患者中，PP-MI导致体力活动大幅增加。 因此，我们现在建议对这项为期24周的电话和短信PP进行随机对照试验- 280例急性冠脉综合征后低血压患者的MI干预与同期常规治疗的比较 基线体力活动。PP-MI使用为期12周的每周电话会话和每周两次的短信发送 共24周，提供持续的内容和支持。我们将在12点进行后续评估， 24周和48周。这项试验的主要结果是改善了中等到剧烈的体力活动。 (MVPA，通过加速度计测量)，主要研究假设是PP-MI将与 治疗24周时，MVPA较治疗前有明显改善。我们还将研究 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/功能测量以及与健康相关的结果，包括心脏生物标志物和心率 严重的心脏不良事件。最后，我们将系统地评估潜在的临床实施 PP-MI干预。如果这一新计划比目前的护理标准更成功地增加了 急性冠脉综合征后的活动，可用于临床实践，以改善这些高危患者的预后。

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.