Exploring Tai Chi as a Behavioral Intervention for Heart Failure Patients

描述(由申请人提供)：心力衰竭(HF)影响着500-600万美国人，尽管最近在药物和技术上取得了进步，但随着人口老龄化，其流行比例正在增加。心力衰竭患者会出现衰弱症状和生活质量下降。疲劳和睡眠障碍等躯体症状在心力衰竭患者中很常见，具有讽刺意味的是，这些症状与缺乏身体活动有关，可能导致身体和心脏功能螺旋式下降，甚至生活质量下降。因此，增加体力活动的行为/生活方式干预可能会改善这一群体的心功能和生活质量。在历史上，心力衰竭患者被建议限制体力活动，但最近的研究表明，在正确评估NYHA II-III心力衰竭患者中，适度运动可以安全地进行。然而，大多数传统的运动干预研究都是在相对年轻的患者中进行的，很少有并发症，这样的计划不适合许多年龄较大的虚弱的心衰患者。相反，为了健康和保持健康，太极已经被所有年龄段的人练习了几个世纪。太极是心力衰竭患者的理想选择，因为它由冥想运动组成，产生有氧锻炼，通过使用较大或较小的运动来调整强度水平，改善平衡，锻炼全身，对心力衰竭患者具有良好的耐受性。事实上，我们最近完成的R21试点项目的研究结果表明，太极可以减少包括疲劳在内的躯体症状，并增加身体机能，以6分钟步行任务中的步行距离来衡量。到目前为止，涉及心力衰竭患者的太极研究规模较小，更多的是初步调查，还没有检查与心力衰竭相关的重要临床和功能指标。虽然标准的运动干预研究发现心衰患者的射血分数(EF)增加，舒张末容量(EDV)和收缩末期容量(ESV)减少，但太极对改善心功能容量的有效性仍需检验。因此，我们研究的目的是确定太极是否会通过增加身体功能、心功能容量和与心力衰竭相关的生活质量而使心力衰竭患者受益。建议的研究将包括两组(N=68名心力衰竭患者/组)，使用由我们的R21赠款专门为心力衰竭患者开发的手册，为期16周，每周两次的太极课。健康教育比较小组将在类似的持续时间内举行会议，并制定用于课程的标准化主题清单。这个小组是为了控制太极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以改善心力衰竭患者的生活质量，但美国目前的大多数医疗保险(包括联邦医疗保险)并不支付心力衰竭康复的费用。我们的调查结果将有助于确定太极作为目前心力衰竭治疗的一种选择的有效性，并加深我们对其机制的理解。因此，这项研究还具有评估干预措施的好处，该干预措施将改善可能影响卫生政策的心力衰竭严重程度和相关的生活质量结果。

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.