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5-6百万美国人，尽管最近的药理学和技术进步，但随着人口老龄化，心力衰竭（HF）的流行比例正在增加。心衰患者会出现衰弱症状，生活质量下降。身体症状如疲劳和睡眠障碍在心衰患者中很常见，具有讽刺意味的是，这些症状与缺乏身体活动有关，并可能导致身体和心脏功能的螺旋式下降，甚至导致生活质量下降。因此，增加身体活动的行为/生活方式干预可能会改善这一群体的心功能和生活质量。历史上，心衰患者被建议限制身体活动，但最近的研究表明，适当评估的NYHA II-III型心衰患者可以安全地进行适度运动。然而，大多数传统的心衰运动干预研究都是在相对年轻、合并症较少的患者身上进行的，这样的项目不适合许多年老体弱的心衰患者。相反，几个世纪以来，所有年龄段的人都在练习太极拳，以保持健康。太极拳是心衰患者的理想选择，因为它是由专注的冥想运动组成的，可以产生有氧运动，允许通过使用或大或小的运动来调节强度水平，改善平衡，锻炼全身，并且心衰患者耐受性良好。事实上，我们最近完成的R21试点项目的研究结果表明，太极拳可以减少身体症状，包括疲劳，并通过在6分钟的步行任务中步行的距离来增加身体功能。到目前为止，涉及心衰患者的太极研究都是小规模的初步调查，没有检查与心衰相关的重要临床和功能指标。虽然对心力衰竭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）降低，但太极对改善心功能容量的功效仍需进一步研究。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HF相关的生活质量而使HF患者受益。拟议的研究将包括两组（N = 68例HF患者/组），一个16周，每周两次的太极课程，使用我们的R21资助专门为HF患者开发的手册。一个健康教育比较小组将举行为期相当的会议，并制定一份用于课堂的标准化主题清单。这个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衰患者的生活质量，但目前美国大多数医疗保险（包括医疗保险）都不支付心衰康复费用。我们的研究结果将有助于确定太极拳作为当前心衰管理的一种选择的功效，并进一步了解其机制。因此，这项研究也有利于评估一种干预措施，该干预措施将改善心衰疾病的严重程度和相关的生活质量结果，从而影响卫生政策。

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.