Mobile Intervention to Enhance Physical Activity in the Chronically Ill

项目总结 该项目旨在满足对促进体力活动的安全和参与性干预的迫切需求。 在患有慢性病(例如，糖尿病、哮喘、骨关节炎和慢性心脏病)的患者群体中 失败)。令人信服的证据表明，体力活动是一种有效的治疗干预措施 无数的慢性病。然而，尽管人们普遍认为体育锻炼应该是一种 许多慢性病的综合治疗组成部分，大多数患者由于各种原因而保持不活跃。 他们经常遇到的障碍和障碍。 因此，我们建议创新地采用一种有效的运动促进干预措施，以 久坐不动的员工2向有特定需求和限制的人群提供服务，这些需求和约束源于慢性病和 将此干预作为可通过智能手机、平板电脑或计算机访问的移动应用程序提供。 我们提出了一项计划设计，该计划设计遵循了NIH最近资助的一项荟萃项目的建议。 促进慢性病患者体力活动干预措施的分析综述 强调行为激活的重要性，而不是认知-行为干预特征。 因此，我们的全面移动应用程序包括(A)初始筛选；(B)基准物理 通过无线加速度计设备记录的活动(PA)水平；(C)获取信息的评估 关于对绩效目标的偏好和障碍；(D)目标设定；(E)每天发电子邮件或短信说明目标 当天的运动类型，以及演示运动的视频的链接；(F)简短的登机手续 确定用户当前是否遇到障碍(疼痛、疲劳等)和量身定做的补救措施 通过社交媒体功能和专家建议设置障碍；(G)提示执行日常锻炼；(H) 集成无线加速度计设备(例如，Fitbit(R))以补充自我报告的运动数据和 推动量身定制的反馈和目标设定；(I)关于活动完成情况的签到(例如，“你有没有 完成练习？，“你喜欢这个练习吗？”，“这个练习后你感觉好些了吗？”；(J) 关于已执行的体育活动如何有助于目标进展的即时、个性化的反馈；以及(K) 给初级保健医生的反馈报告。这些设计功能结合在一起将促进和支持 在这一弱势群体中，常规PA的可持续习惯。 在为期30天的前期研究中，我们将测试这种原型干预的初步有效性和可行性。 38例成人慢性骨性关节炎患者。第一阶段原型计划将限于 向骨性关节炎患者演示控制第一阶段总体范围的可行性 项目。我们假设，这一干预措施将使这些人群参与进来，并使受试者的PA水平从 从评估前到评估后。如果这一试点疗效试验取得令人满意的结果，第二阶段项目将扩大 该计划的范围包括所有患有其他慢性病的患者(例如，骨关节炎， 高血压、糖尿病、肺部疾病)。

PROJECT SUMMARY This project aims to fill the urgent need for a safe and engaging intervention that promotes physical activity in a population of patients with chronic diseases (e.g., diabetes, asthma, osteoarthritis, and chronic heart failure). Compelling evidence suggests that physical activity is an effective therapeutic intervention for numerous chronic diseases. However, in spite of the wide consensus that physical activity should be an integral treatment component for many chronic diseases, most patients remain inactive1 due to a variety of barriers and obstacles they regularly encounter. We therefore propose to innovatively adapt an efficacious exercise-promoting intervention that targets sedentary employees2 to a population with specific needs and constraints that result from chronic disease and deliver this intervention as a mobile application that can be accessed via smartphone, tablet, or computer. We propose a program design that follows recommendations derived from a recent NIH-funded meta- analytic review of interventions to promote physical activity in patients with chronic diseases, which emphasizes the importance of behavioral activation as opposed to cognitive-behavioral intervention features.3 Our comprehensive mobile application is therefore composed of (a) an initial screening; (b) baseline physical activity (PA) levels recorded via wireless accelerometer device; (c) an assessment that elicits information regarding preferences for and barriers to PA; (d) goal setting; (e) daily e-mail or text messages stating the goal for the day, the type of exercise, and a link to a video demonstrating the exercise; (f) a brief check-in to determine whether the user is currently encountering a barrier (pain, fatigue, etc.) and tailored remediation for the barrier through social media functionality and expert advice; (g) prompts to execute the daily exercise; (h) integration of a wireless accelerometer device (e.g., Fitbit(R)) to supplement self-reported exercise data and to drive tailored feedback and goal setting; (i) check-in regarding activity completion (e.g., "have you completed the exercise?," "did you enjoy this exercise?," "do you feel better after this exercise?"); (j) immediate, personalized feedback on how executed physical activities contribute to goal progress; and (k) feedback reports for the primary care physician. Together these design features will promote and support a sustainable habit of regular PA in this vulnerable population. In a 30-day pre-post study, we will test preliminary efficacy and feasibility of this prototype intervention in a population of 38 adult patients with chronic osteoarthritis. The Phase I prototype program will be limited to demonstrating feasibility with individuals with osteoarthritis to control the overall scope of the Phase I project. We hypothesize that this intervention will engage this population and increase subjects' PA level from pre- to post-assessment. If this pilot efficacy trial yields satisfactory results, the Phase 2 project will expand the scope of the program to include all patients with additional chronic diseases (e.g., osteoarthritis, hypertension, diabetes, pulmonary disease).