Exploring Tai Chi as a Behavioral Intervention for Heart Failure Patients

描述（由申请人提供）：心力衰竭（HF）影响500 - 600万美国人，尽管最近的药理学和技术进步，但随着人口老龄化，其流行比例正在增加。患有HF的患者遭受衰弱症状和生活质量的损失。HF患者中常见的躯体症状如疲劳和睡眠障碍，具有讽刺意味的是，这些症状与身体活动不足有关，并可能导致身体和心脏功能的螺旋式下降，甚至更差的生活质量。因此，增加体力活动的行为/生活方式干预可能会改善该组的心脏功能和生活质量。历史上，建议HF患者限制体力活动，但最近的研究表明，适当评估NYHA II-III级HF患者可以安全地进行适度运动。然而，大多数传统的HF运动干预研究都是在相对年轻且合并症较少的患者中进行的，这些方案不适合许多年老体弱的HF患者。相反，太极拳已经被所有年龄段的人练习了几个世纪，以保持健康。太极拳是HF患者的理想选择，因为它由正念冥想运动组成，可以产生有氧运动，允许通过使用更大或更小的运动来调节强度水平，改善平衡，锻炼全身，并且HF患者耐受性良好。事实上，我们最近完成的R21试点项目的研究结果表明，太极拳可以减少包括疲劳在内的躯体症状，并通过6分钟步行任务中步行的距离来增加身体功能。到目前为止，涉及HF患者的太极拳研究一直是小规模的初步调查，并没有检查与HF相关的重要临床和功能措施。虽然HF的标准运动干预研究发现射血分数（EF）增加，舒张末期容积（EDV）和收缩末期容积（ESV）减少，但太极拳对改善心脏功能能力的功效仍需检查。因此，我们研究的目的是确定太极拳是否会通过增加身体功能，心脏功能能力和HF相关生活质量而使HF患者受益。拟议的研究将包括两组（N = 68名HF患者/组），一个为期16周，每周两次的太极拳课程，使用我们的R21赠款专门为HF患者开发的手册。健康教育对照组将在可比的时间内开会，并有一个用于课程的标准化主题清单。这个小组是为了控制太极拳干预的注意力和社会互动而创建的。尽管有证据表明特定行为活动的改变可改善HF患者的生活质量，但美国目前的大多数医疗保险（包括Medicare）不支付HF康复费用。我们的调查结果将有助于确定太极拳作为当前HF管理选项的功效，并进一步了解其机制。因此，本研究还具有评估干预措施的益处，该干预措施将改善HF疾病严重程度和可能影响卫生政策的相关生活质量结局。 公共卫生相关性：该提案旨在通过调查太极拳等运动干预是否可以提高HF患者的身体功能，心脏功能能力和生活质量来进一步开展我们的试点研究。历史上，建议HF患者限制体力活动。然而，最近的研究表明，中度运动可以在适当评估的NYHA II-III级HF患者中安全进行。

DESCRIPTION (provided by applicant): Heart failure (HF) affects 5-6 million Americans and, despite recent pharmacological and technological advances, is increasing in epidemic proportions as the population ages. Patients with HF suffer from debilitating symptoms and a loss of quality of life. Somatic symptoms such as fatigue and sleep disturbances are common among HF patients, which are ironically associated with physical inactivity and can create a spiraling decline in physical and cardiac function and even worse quality of life. Thus, behavioral/lifestyle interventions that increase physical activity may improve cardiac function and quality of life in this group. Historically, HF patients were counseled to limit physical activities, but recent studies show that moderate exercise can be performed safely in properly evaluated NYHA II-III HF patients. However, most traditional exercise intervention studies in HF have been conducted on relatively young patients with little comorbidity, and such programs are unsuitable for many older frail HF patients. Conversely, tai chi has been practiced for centuries by all age groups for wellness and to maintain health. Tai chi is ideal for HF patients because it is composed of mindfully meditative movements that generate an aerobic work-out, permits adjustable levels of intensity by using larger or smaller movements, improves balance, works the whole body, and is well tolerated in HF patients. Indeed, findings from our recently completed R21 pilot project indicate that tai chi leads to reductions in somatic symptoms, including fatigue, and increases physical function as measured by the distance walked in a 6-minute walk task. Until now, tai chi studies involving HF patients have been small more preliminary investigations and have not examined important clinical and functional measures relevant to HF. While standard exercise intervention studies in HF have found increases in ejection fraction (EF) and reduced end diastolic volume (EDV) and end systolic volume (ESV), tai chi's efficacy for improvements in cardiac functional capacity still need to be examined. Thus, the objective of our study is to determine if tai chi will benefit HF patients by increasing physical function, cardiac functional capacity, and HF related quality of life. The proposed study will consist of two groups (N = 68 HF patients/group), a 16-week, twice weekly tai chi class using a Manual developed by our R21 grant specifically for HF patients. A health education comparison group will meet for a comparable duration, and also have a standardized list of topics used for the classes. This group is created to control for attention and social interactions of the tai chi intervention. Although there is evidence that changes in specific behavioral activities improve quality of life in HF patients, most current healthcare insurance in the United States (including Medicare), does not pay for HF rehabilitation. The findings of our investigation will help identify the efficacy of tai chi as an option for current HF management and further our understanding of the mechanisms. Thus, this study also has the benefit of evaluating an intervention that will improve HF disease severity and related quality of life outcomes that could impact health policy. PUBLIC HEALTH RELEVANCE: This proposal seeks to further our pilot studies by investigating whether an exercise intervention such as tai chi can increase physical function, cardiac functional capacity and quality of life in HF patients. Historically, HF patients were counseled to limit physical activities. However, recent studies show that moderate exercise can be performed safely in properly evaluated NYHA II-III HF patients.