Developing a Mindfulness Movement Intervention Program for Post-MI Patients

描述（由申请人提供）：每年约有785，000名美国人患有首次心肌梗死（MI），470，000人将复发。美国心脏协会（AHA）建议以运动为基础的心脏康复（CR），以减少随后的心脏事件。尽管CR的益处，但只有14-35%的合格MI患者参与CR。合并症患者、女性、老年人和少数民族最不可能利用CR服务。许多医疗中心没有CR项目，患者必须前往遥远的地方接受CR。反过来，许多太极干预措施，已经在老年人群体中进行了研究，不需要昂贵的设备，可以在家里练习，并且在健身水平和合并症中耐受良好。太极拳增加心率（最大值的56%至65%），耗氧量和乳酸积累，这表明太极拳是一种低至中等强度的有氧运动。然而，在心肌梗死后患者中没有太极研究采用最先进的心脏功能和运动能力测量方法，因此尚不清楚太极在心肌恢复期间是否具有与CR相似的益处。拟议的研究将采用包括超声心动图、心率恢复和自行车测力计在内的工具，这些工具已在许多CR研究中用于评估治疗效果。这项研究的创新之处还在于，它专门针对首次MI后30天内未选择参加正式CR计划的患者，并强调招募年龄较大、身体功能能力、女性和少数民族的患者。共有75名首次MI的男性和女性将被随机分配到由20个冥想动作组成的4个月太极训练或标准护理（SOC）。临床评估将在6个月内进行，在治疗前、治疗中期和治疗4个月后以及8周随访时进行测试。我们目前的目标是收集研究可行性、可接受性的初步数据，并找到改善身体、心脏和心理/行为因素的指标。如果这项探索性/开发性研究达到了目标，未来将进行一项大规模研究，以确认太极拳对心肌梗死后患者的疗效。这样的研究是迫切需要的，以便为不同的MI患者制定适当的康复干预措施。

DESCRIPTION (provided by applicant): Each year around 785,000 Americans endure a first myocardial infarction (MI) and 470,000 will have a recurrent event. The American Heart Association (AHA) recommends exercise-based cardiac rehabilitation (CR) for reductions in subsequent cardiac events. Despite the benefits of CR, only 14-35% of eligible MI patients participate in CR. Patients with co-morbidities, women, older adults, and ethnic minorities are least likely to utilize CR services. Many medical centers do not have CR programs and patients have to travel to distant locations to undergo CR. In turn, many Tai Chi interventions, have been studied in elderly cohorts, require no expensive equipment, can be practiced at home, and is well tolerated across fitness levels, and co-morbidities. Tai Chi increases heart rate (56% to 65% of maximum), oxygen consumption and lactate accumulation, signifying that Tai Chi serves as an aerobic exercise of low to moderate intensity. However, no Tai Chi studies in post-MI patients have employed state-of-the-art measures of cardiac function and exercise capacity and therefore it is unclear whether Tai Chi has similar benefits as CR during a period of myocardial recovery. The proposed study would employ tools including echocardiograms, heart rate recovery, and bicycle ergometry, which have been used in many CR studies to assess the effectiveness of treatment. This study is also innovative in that it specifically targets patients who have not opted to participate in a formal CR program within 30 days of a first-time MI and emphasizes recruitment of patients spanning an older age range, physical function ability, women and minorities. A total of 75 men and women with a first time MI will be randomly assigned to 4 months of Tai Chi training composed of 20 meditative movements or to standard of care (SOC). Clinical assessments will be performed over a six-month period, with testing occurring before, mid-way, and after 4 months of treatments, and at an 8 week follow-up. Our current goal is to gather preliminary data on study feasibility, acceptability and to find indicatins of improvements in physical, cardiac and psychological/behavioral factors. If the aims are met from this exploratory/development study, a future large scale study will be undertaken to confirm Tai Chi's efficacy in post-MI patients. Such research is critically needed so adequate rehabilitative interventions can be developed for diverse MI patients.