BENEFIT OF TAI CHI AS AN ADJUNCT TO STANDARD CARE FOR PATIENTS WITH CHRONIC STA

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。心力衰竭（HF）是美国一个主要的公共卫生问题，影响着大约500万成年人。尽管最近在药物治疗和技术设备方面取得了进展，心衰仍然是医疗保险患者住院治疗的最常见原因，并且随着人口老龄化，心衰正在达到流行病的程度。需要新的和廉价的干预措施，以改善功能能力、生活质量以及影响疾病进展。太极拳是一种流行的身心锻炼形式，是心脏病的潜在治疗辅助手段。太极拳结合了温和的身体活动和冥想。它可能特别适用于虚弱和条件不良的HF患者，但从未在这一人群中进行过严格的研究。我们对HF患者进行了一项太极拳的可行性研究（n=30），发现与未参加太极拳的患者相比，那些随机参加太极拳项目的患者的运动能力（6分钟步行距离）、生活质量（明尼苏达州心衰生活评分）和神经激素状态（血清b型利钠肽水平）显著提高。作为资助的NCCAM研究的一部分，我们现在正在进行一项为期三年的随机对照试验（n=150），将12周的太极项目与常规护理进行比较（两组都接受HF教材）。慢性稳定型心衰患者（收缩功能不全，左室射血分数？）40%，纽约心脏协会I-IV级)将从门诊初级保健和心脏病诊所招募。我们的主要目的是研究太极拳对功能能力和生活质量的影响。次要目的是进一步阐明太极拳的作用机制，包括检查认知行为或社会心理影响（如情绪、社会心理功能、自我效能、身心医学的信念和期望）和冥想运动对高频特异性生理/代谢过程的反应（如神经激素状态、心率变异性和自主神经张力标记、心肌结构和功能）。我们提出的研究结果将有助于确定太极拳在当前心衰管理中的作用，进一步了解其作用机制，并提供治疗成本和收益的初步分析。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Heart Failure (HF) is a major public health problem in the United States, affecting approximately 5 million adults. Despite recent advances in pharmacological therapy and technological devices, HF is the most common reason for hospitalization among Medicare patients and is reaching epidemic proportions as the population ages. New and inexpensive interventions that can improve functional capacity, quality of life, as well as affect disease progression, are needed. Tai Chi is a popular mind-body exercise form that is a potential therapeutic adjunct for heart disease. Tai Chi incorporates both gentle physical activity and meditation. It may be particularly suited to frail and de-conditioned patients with HF, but has never been rigorously studied in this population. We conducted a feasibility study of Tai Chi in patients with HF (n=30) and found that those randomized to a Tai Chi program significantly improved their exercise capacity (six-minute walk distance), quality-of-life (Minnesota Living with Heart Failure score), and neurohormonal status (serum B-type natriuretic peptide levels) compared to patients who did not participate in Tai Chi. As part of a funded NCCAM study, we are now conducting a randomized controlled trial (n=150) over three years that compares a 12-week Tai Chi program with usual conventional care (both groups receiving HF educational materials). Patients with chronic stable HF (systolic dysfunction, left ventricular ejection fraction ?40%, New York Heart Association Class I-IV) will be recruited from outpatient primary care and cardiology clinics. Our primary aim will be to examine Tai Chi's effects on functional capacity and quality-of-life. Secondary aims are designed to further elucidate the mechanism of Tai Chi's effects, including examination of cognitive-behavioral or psychosocial influences (e.g., mood, psychosocial functioning, self-efficacy, beliefs and expectations of mind-body medicine) and HF-specific physiologic/metabolic processes in response to meditative exercise (e.g., neurohormonal status, heart rate variability and markers of autonomic tone, myocardial structure and function). The results of our proposed research will help define the role of Tai Chi in current HF management, further our understanding of the mechanism of action, and provide preliminary analyses of the costs and benefit of treatment.