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

一种促进急性冠脉综合征后身体活动的新型心理行为干预措施

• 批准号: 10448080
• 负责人: Jeff C Huffman
• 金额: $ 82.06万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10448080
• 关键词: Accelerometer; Address; Adherence; Adopted; Adverse effects; Affect; American; Anxiety; Anxiety Disorders; Behavior Therapy; Behavioral; Biological; Biological Markers; Cardiac; Cardiac rehabilitation; Cardiovascular system; Clinical; Clinical Management; Death Rate; Event; Exercise; Expectancy; Fostering; Funding; Future; Goals; Group Interviews; Guidelines; Health; Health behavior; Intervention; Light Exercise; Link; Measures; Medical; Mental Depression; Methods; Motivation; Myocardial Infarction; National Heart, Lung, and Blood Institute; Outcome; Outcome Measure; Outcome Study; Participant; Pathway interactions; Patient Self-Report; Patients; Personal Satisfaction; Persons; Physical Function; Physical activity; Pilot Projects; Population; Prognosis; Psychological Factors; Psychology; Public Health; Randomized Controlled Trials; Recovery; Recurrence; Self Efficacy; Site; Telephone; Testing; Text; Text Messaging; Time; Time Study; Treatment Efficacy; Unstable angina; Visit; Well in self; Work; acute coronary syndrome; base; behavior change; cardiovascular health; clinical care; clinical implementation; clinical practice; design; evidence base; follow up assessment; gratitude; health difference; high risk; hospital readmission; improved; moderate-to-vigorous physical activity; mortality; motivational enhancement therapy; multi-site trial; novel; optimism; patient engagement; physical inactivity; primary outcome; programs; prospective; psychologic; remote delivery; sedentary; sociodemographics; standard of care; telephone delivery; telephone session; treatment as usual; uptake

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.

尽管体力活动对急性冠状动脉粥样硬化性心脏病后的恢复和生存有明显的益处， 在ACS综合征（ACS）中，每年患有ACS的100万美国人中的大多数无法达到足够的 活动水平。ACS后促进活动的全面面对面计划可能很有效，但 这些诊所的病人相对较少。电话激励面试（MI），这导致了 增加心脏病患者的身体活动，是一种有前途的基于证据的替代方案， 程序.然而，MI对体力活动的影响的总体幅度相对较小， 心脏相关人群，可能需要额外的内容。 心理健康（例如，乐观，积极的影响）是前瞻性和独立的相关 有更多的体力活动，因此培养ACS后患者的幸福感可以提供一个 另一种方法是促进这一群体的活动。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，他们已经导致增加体力活动的患者， M 医疗疾病。 PP-MI联合干预可能是一种强有力的协同方法，可促进活动后， ACS。PP可以通过改善幸福感来增加体力活动， 参与者设定并实现个性化的活动目标。PP还可以促进参与者参与 我可以增强动力， M I由 培养乐观主义和自我效能感，这两者都与更多地采用MI等干预措施有关。中 在NHLBI资助的多阶段项目中，我们的团队开发并试用了一种新的远程交付PP-MI 在ACS后患者中实施了PP-MI计划，并且在这项初步工作中PP-MI导致身体活动大幅增加。 因此，我们现在提出了一个随机对照试验，这个24周的电话和短信为基础的PP- MI干预，与常规治疗相比，在280例ACS后患者中， 基线体力活动。PP-MI利用每周电话会议12周和每周两次短信 为期24周，以提供持续的内容和支持。我们将在12点进行后续评估， 24和48周。这项试验的主要结果是改善中度到剧烈的体力活动 (MVPA，通过加速计测量），主要研究假设是PP-MI将与 在24周时，MVPA的改善显著大于常规治疗。我们亦会研究 PP-MI对多种其他结局的影响，包括其他活动指标（轻度活动、久坐 时间）、心理/功能测量和健康相关结局，包括心脏生物标志物和比率 严重心脏不良事件的风险最后，我们将系统地评估该方法的潜在临床实施 PP-MI干预。如果这项新计划比目前的护理标准更成功， ACS后的活动，它可以在临床实践中采用，以改善这些高危患者的预后。