Effect of Reducing Sedentary Behavior on Blood Pressure

减少久坐行为对血压的影响

• 批准号: 9382502
• 负责人: Bethany Barone Gibbs
• 金额: $ 76.88万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-15 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9382502
• 关键词: Accelerometer; Accounting; Acute; Address; Adherence; Adult; Affect; Aldosterone; American; Attention; Behavior; Behavior Therapy; Behavioral; Blood Pressure; Blood Vessels; Cardiovascular Diseases; Cessation of life; Clinical; Computers; Counseling; Coupled; Cross-Over Studies; Data; Diastolic blood pressure; Distal; Dose; Energy Metabolism; Evaluation; Exercise; Future; Goals; Guidelines; Health; Health Benefit; Health Care Costs; Hour; Hypertension; Individual; Interruption; Intervention; Intervention Studies; Laboratories; Laboratory Study; Lead; Leisures; Light; Link; Measures; Mediating; Modification; Monitor; Morbidity - disease rate; Movement; Obesity; Observational Study; Occupational; Occupations; Outcome; Perception; Persons; Pharmacotherapy; Phonation; Physical activity; Physiologic pulse; Plasma; Population; Posture; Public Health; Randomized Clinical Trials; Recommendation; Recruitment Activity; Renin; Renin-Angiotensin-Aldosterone System; Research; Research Design; Rest; Risk; Risk Factors; Stream; Structure; Telephone; Testing; Text; Time; Walking; Wrist; adverse outcome; arm; arterial stiffness; base; blood pressure reduction; blood pressure regulation; cardiometabolic risk; cardiorespiratory fitness; cardiovascular disorder risk; cardiovascular health; cardiovascular risk factor; fight against; fitness; improved; innovation; insulin sensitivity; intervention effect; light intensity; moderate-to-vigorous physical activity; mortality; novel; novel strategies; novel therapeutic intervention; prehypertension; primary outcome; prognostic; programs; randomized trial; response; secondary outcome; sedentary lifestyle; therapy design; tool; trial comparing; vigorous intensity

PROJECT ABSTRACT Elevated blood pressure (BP), including hypertension (HTN) and preHTN, affects 2 in 3 American adults and is a major contributor to cardiovascular disease (CVD) morbidity, mortality, and healthcare costs. Despite widespread use of pharmacotherapy, only about half of HTN is controlled, highlighting a need for innovative strategies to decrease the burden of elevated BP. Though regular exercise in the form of moderate-to-vigorous physical activity (MVPA) occurring in bouts of at least 10 minutes is recommended to decrease BP, we propose that reducing time spent sitting or `sedentary behavior' (SED) is a distinct, novel strategy that could lower BP in individuals with preHTN and HTN. Recent occupational and leisure changes (e.g., computers, video streaming) have resulted in more than half of the American day being spent in SED. At the same time, many observational studies have linked excessive SED with adverse outcomes, including HTN and CVD. Moreover, same day laboratory studies suggest that reducing or interrupting SED decreases BP acutely and our preliminary data suggest that systolic BP (SBP) is reduced by 4-6 mmHg after a 12-week SED intervention. Yet, there have been no robust, randomized trials of sufficient size and duration to demonstrate that reducing SED has sustained benefits on BP. Before clinical or public health SED recommendations can be made, such experimental evidence is imperative. Thus, the goal of this application is to demonstrate the efficacy of SED reduction to decrease BP in a 3-month randomized, clinical trial (intervention vs. control) in 300 adults (150 per group) with pre-to-Stage I HTN who have structured, prolonged SED as desk workers. We will use our proven approach that intervenes on multiple levels (individual, environmental modification with a sit-stand desk attachment) and utilizes behavioral strategies (individual counseling, self-monitoring, external prompting with a wrist-worn monitor light-intensity physical activity (LPA) (standing, light movement) and short spurts (<10 min) of activity (sporadic MVPA) as replacement behaviors. We will comprehensively study the effects of our intervention on vascular health by assessing resting BP, ambulatory BP, and carotid-femoral pulse wave velocity (cfPWV) (Aim 1) and key potential mechanisms (plasma renin activity, aldosterone) (Aim 2). We will use objective activity monitoring to evaluate dose-response relationships between amount of achieved SED reduction (and resulting increases in LPA and sporadic MVPA) with changes in outcomes (Aim 3). We will also study adiposity, fitness, and insulin sensitivity as exploratory outcomes that could change with our intervention, and if so, might relate to BP. Results from this study will determine whether decreasing SED can improve BP and vascular health and inform the necessary dose of SED reduction for clinically meaningful benefits. Also, evaluation of our novel intervention approach will inform future interventions for SED research and for designing translatable, population-level programs. If SED reduction improves BP, it could provide an important additional tool in the fight against elevated BP and CVD. and text messaging). These strategies will facilitate a targeted 2-4 hr/day SED reduction by increasing

项目摘要 高血压（BP），包括高血压（HTN）和前HTN，影响2/3的美国成年人， 心血管疾病（CVD）发病率、死亡率和医疗费用的主要贡献者。尽管 广泛使用的药物治疗，只有大约一半的HTN得到控制，突出了创新的需要。 降低血压升高负担的策略。虽然有规律的运动形式， 我们建议，至少10分钟的体力活动（MVPA）可以降低血压， 减少坐着的时间或“久坐行为”（SED）是一种独特的，新颖的策略，可以降低血压， 前HTN和HTN患者。最近的职业和休闲变化（例如，计算机、视频流） 导致美国人一天中有一半以上的时间都花在了SED上。与此同时，许多观察 研究表明，过度的SED与不良后果有关，包括HTN和CVD。此外，同一天 实验室研究表明，减少或中断SED可急剧降低血压，我们的初步数据显示， 表明12周SED干预后收缩压（SBP）降低4-6 mmHg。然而， 没有足够规模和持续时间的强有力的随机试验来证明减少SED可以持续 BP的好处在提出临床或公共卫生SED建议之前，这些实验证据 是必须的因此，本申请的目的是证明SED减少降低BP的有效性 在一项为期3个月的随机临床试验（干预与对照）中，300名（每组150名）患有I期前 HTN，他们将SED结构化并延长为案头工作人员。我们将使用经过验证的方法， 多层次（个人，环境改造与坐站办公桌附件），并利用行为 策略（个人咨询，自我监测，外部提示与腕戴式监测器光强度 身体活动（LPA）（站立，轻微运动）和短时间（<10分钟）的活动（零星MVPA）， 替代行为。我们将全面研究我们的干预对血管健康的影响， 评估静息血压、动态血压和颈动脉-股动脉脉搏波速度（cfPWV）（目标1）和关键电位 机制（血浆肾素活性，醛固酮）（目的2）。我们将使用客观的活动监测来评估 实现的SED减少量（以及由此导致的LPA增加和 散发性MVPA），结果发生变化（目标3）。我们还将研究肥胖、健康和胰岛素敏感性 作为探索性的结果，可能会随着我们的干预而改变，如果是这样，可能与BP有关。结果从这个 研究将确定减少SED是否可以改善BP和血管健康，并提供必要的信息。 降低SED剂量以获得有临床意义的获益。此外，对我们新的干预方法的评估将 为未来的SED研究和设计可翻译的人口水平计划提供信息。如果SED 降低血压可以改善血压，它可以提供一个重要的额外工具，在对抗血压升高和心血管疾病。 和文本消息）。这些策略将通过增加