Evaluating the Impact of Singing Interventions on Markers of Cardiovascular Health in Older Patients with Cardiovascular Disease

评估歌唱干预对老年心血管疾病患者心血管健康指标的影响

• 批准号: 10462121
• 负责人: Jacquelyn P Kulinski
• 金额: $ 32.92万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-15 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10462121
• 关键词: Adverse event; Affective; Age; Arthritis; Arts; Attitude; Behavior; Biofeedback; Biological; Biological Markers; Cardiac; Cardiac rehabilitation; Cardiovascular Diseases; Cardiovascular system; Chronic; Chronic Obstructive Airway Disease; Chronic lung disease; Clinical; Clinical Trials; Clinical Trials Design; Complex; Coronary Arteriosclerosis; Data; Dropout; Elderly; Endothelium; Enrollment; Event; Exertion; Future; Gold; Heart; Heart Rate; Hormones; Hydrocortisone; Inflammatory; Instruction; Intervention; Knowledge; Lung diseases; Malignant Neoplasms; Measurement; Measures; Mediating; Mental Health; Microcirculation; Moods; Morbidity - disease rate; Music; Nerve; Participant; Patient Self-Report; Perception; Peripheral; Personal Satisfaction; Persons; Phase; Physical Exercise; Physical Rehabilitation; Physical activity; Pilot Projects; Population; Procedures; Process; Psyche structure; Randomized; Recording of previous events; Regulation; Research; Research Design; Resources; Rest; Risk; Salivary; Secondary Prevention; Single-Blind Study; Sinoatrial Node; Sinus; Stress; Students; Study Subject; Target Populations; Testing; Translating; Vascular Endothelium; Visit; Visual; Voice; aging population; arm; arterial tonometry; biobehavior; brachial artery; burden of illness; cardiovascular health; cardiovascular stress test; comorbidity; cytokine; design; experience; health care settings; heart rate variability; hemodynamics; improved; innovation; mortality; mortality risk; older patient; performing art; preference; prevent; primary outcome; professor; programs; respiratory; saliva sample; salivary assay; secondary outcome; stressor

Project Abstract Cardiovascular disease (CVD) claims more lives each year than cancer and chronic respiratory disease combined. Participation in cardiac rehabilitation (CR) reduces mortality and risk of a major cardiovascular event in secondary prevention populations, including older adults. Older adults are less likely to participate in CR, as comorbidities in this population, including arthritis and chronic obstructive pulmonary disease, make participation difficult. Singing is a physical activity that involves components of the vagal nerves manifested as changes in cardiac autonomic regulation. Unlike physical exercise, the effects of singing on cardiovascular health has not been well-studied. To our knowledge, no studies have evaluated the impact of singing on important cardiac biomarkers. Our hypothesis is that older patients with CVD will have favorable improvement in cardiovascular biomarkers, including, endothelial function and heart rate variability (HRV), after 30 minutes of singing. Our pilot data in 23 subjects provides proof of principle, with a small, but significant, improvement in peripheral vascular endothelial function (measured by peripheral arterial tonometry) after 10 minutes of singing. This pilot study has helped us optimize the clinical trial design for this proposal, which will include a more targeted population, incorporation of personal music preferences, increased duration of singing, inclusion of a music therapist and measurement of brachial artery flow-mediated dilation (FMD), the “gold standard” measurement for vascular endothelial function, as our primary outcome. Our proposal seeks to create, optimize and test two different singing interventions in older patients with CVD. The study will consist of three arms, according to a randomized, single-blind, crossover, sham procedure-controlled design. Sixty-five total participants will each have three visits on three different occasions for the following interventions: (1) a 30-minute period of guided singing from an in- person music therapist, (2) a 30-minute period of singing along to an instructional video including a professor of voice and “inexperienced, older singing student” and (3) a 30-minute rest period without any intervention. We will use biofeedback (target heart rate and BORG Rating of Perceived Exertion) to help subjects optimize the cardiovascular impact of the music interventions. The (2-year) R61 phase of this proposal will assess the feasibility (implementation, practicality, and acceptability) of executing the proposed study design (Aim 1). We anticipate that the R33 phase will take 3 years to complete. The combined R61/R33 phases will be statistically powered to assess changes in FMD and HRV (primary and secondary outcomes, Aims 2a and 2b). An alternative mechanism in Aim 3 will explore the impact of singing on mental health and well-being by measuring salivary cortisol and cytokines and by using a validated visual mood score designed to evaluate performing arts activities in healthcare settings. We will determine which singing intervention, if any, is superior to the other – as this would be important to guide longer and larger clinical trials in the field. Knowledge gained from this proposal will improve our understanding of biologic mechanisms of singing behaviors, as it relates to CVD.

项目摘要 心血管疾病(CVD)每年夺走的生命比癌症和慢性呼吸道疾病多 加在一起。参与心脏康复(CR)可降低死亡率和重大心血管事件的风险 在二级预防人群中，包括老年人。老年人不太可能参与CR，因为 这一人群中的共病，包括关节炎和慢性阻塞性肺疾病，使参与 很难。歌唱是一种体力活动，它涉及迷走神经的组成部分，表现为 心脏自主神经调节。与体育锻炼不同，唱歌对心血管健康的影响并不是 经过了很好的研究。据我们所知，还没有研究评估歌唱对重要心脏的影响。 生物标志物。 我们的假设是，老年心血管疾病患者的心血管功能将有良好的改善 包括内皮功能和心率变异性(HRV)在内的生物标记物，在歌唱30分钟后。 我们的飞行员 23名受试者的数据提供了原则性证据，外周血管有微小但显著的改善 歌唱10分钟后血管内皮功能(用外周动脉血压计测量)。这项初步研究已经 帮助我们优化了这项提案的临床试验设计，其中将包括更有针对性的人群， 纳入个人音乐偏好，增加唱歌时间，包括音乐治疗师和 测量肱动脉血流介导的扩张(FMD)--血管的“金标准”测量 内皮功能，作为我们的主要成果。我们的提案旨在创建、优化和测试两个不同的 老年脑血管病患者的歌唱干预。这项研究将由三个手臂组成，根据一个随机的， 单盲、交叉、假程序控制设计。总共65名参与者每人将有三次参观 在三个不同的场合进行以下干预：(1)30分钟的引导式演唱- 个人音乐治疗师，(2)30分钟的演唱，伴随着一段教学视频，包括一位 以及(3)30分钟的休息时间，不作任何干预。我们 将使用生物反馈(目标心率和感受到的劳累的博格评级)来帮助受试者优化 音乐干预对心血管的影响。本建议书的(2年)R61阶段将评估 执行拟议研究设计的可行性(实施、实用性和可接受性)(目标1)。我们 预计R33阶段将需要3年时间才能完成。合并的R61/R33相将在统计上 有能力评估FMD和HRV的变化(一级和二级结果，目标2a和2b)。一个 目标3中的替代机制将通过测量来探索唱歌对心理健康和幸福感的影响 唾液皮质醇和细胞因子，并使用经过验证的视觉情绪评分，旨在评估表演艺术 医疗保健环境中的活动。我们将确定哪种歌唱干预措施，如果有的话，比另一种更好- 因为这对指导现场更长时间和更大规模的临床试验将是重要的。从这个过程中学到的知识 这一建议将提高我们对歌唱行为生物学机制的理解，因为它与心血管疾病有关。