Tailored Exercise Support for Cardiac Patients

描述（由申请人提供）：心血管疾病占美国所有死亡人数的50%。虽然心脏康复（CR）的参与显著降低了心脏病患者的再住院率和死亡率，但CR结束后，由于健康行为，特别是身体活动的维持不良，CR对公共卫生的影响大大减弱。该项目的目标是测试量身定制的、动机匹配的干预措施的有效性，以增强CR后身体活动的维持。该项目提出的总体科学问题是：通过计算机专家系统提供的低成本、动机定制的干预措施能否显著提高患者在II期心脏康复后一年的身体活动参与度？两组设计将比较：1)定制支持的CR （Tailored Support）和2)常规CR （Standard Care）。该项目采用重复测量设计，包括基线（在II期CR完成时），以及1、3、6、9和12个月的随访。运动耐量试验将用于验证自我报告的运动参与的主要结果。对影响干预效果的重要认知行为中介因素进行分析，并进行成本效果分析。这一提议响应了NHLBI的建议，该建议呼吁进一步研究在大量人群中使用的具有成本效益的行为干预措施，其目标是确定加强坚持预防行为的因素（美国国土安全部，1995年；2001年），以及NIH的一项联合倡议，即调查通过改变行为来预防疾病的创新方法（1997年）。

DESCRIPTION (provided by applicant): Cardiovascular disease accounts for 50% of all deaths in the United States. While participation in Cardiac Rehabilitation (CR) significantly reduces re-hospitalization and mortality among cardiac patients, the impact of CR on public health is substantially weakened due to poor maintenance of health behaviors, particularly physical activity, after CR is ended. The goal of the proposed project is to test the efficacy of a tailored, motivation-matched intervention to enhance the maintenance of physical activity following CR. The overall scientific question posed by this project is: Can a low-cost, motivationally-tailored intervention delivered via computer expert system significantly improve patients' physical activity participation in the year following phase II cardiac rehabilitation? A two-group design will compare: 1) CR with Tailored Support (Tailored), versus 2) Care as usual following CR (Standard Care). This project utilizes a repeated measures design consisting of baseline (at completion of phase II CR), and follow-up at one, three, six, nine and twelve months. Exercise tolerance tests will be used to validate the primary outcome of self-reported exercise participation. Analyses of important cognitive-behavioral mediators of the intervention efficacy and cost efficacy analyses will be performed. This proposal responds to recommendations of the NHLBI calling for additional research into cost effective behavioral interventions for use in large populations and which target the identification of factors which enhance adherence to preventive behaviors (USDHHS, 1995; 2001), and an NIH joint initiative to investigate innovative approaches to disease prevention through behavior change (1997).