Effect of Reducing Sedentary Behavior on Blood Pressure

项目摘要 高血压(BP)，包括高血压(HTN)和高血压前期，影响三分之二的美国成年人和 心血管疾病(CVD)发病率、死亡率和医疗成本的主要贡献者。尽管 药物疗法的广泛使用，只有大约一半的HTN得到控制，突显出创新的必要性 减轻血压升高负担的策略。虽然经常进行中等到剧烈的运动 我们建议，建议进行至少10分钟的体力活动以降低血压 减少坐着或久坐的时间(SED)是一种独特的、新颖的策略，可以降低 患有前HTN和HTN的个体。最近的职业和休闲变化(例如，计算机、视频流) 导致美国一天中有一半以上的时间是在SED度过的。与此同时，许多观测者 研究已经将过度的SED与不良后果联系在一起，包括HTN和CVD。而且，同一天， 实验室研究表明，减少或阻断SED可显著降低血压，我们的初步数据 建议在12周的SED干预后，收缩压(SBP)降低4-6毫米汞柱。然而，已经有了 没有足够大小和持续时间的可靠的随机试验来证明减少SED是持续的 对英国石油公司的好处。在提出临床或公共卫生SED建议之前，这些实验证据 势在必行。因此，本应用程序的目标是证明降低SED以降低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名成人(每组150人)接受了前期到I期的治疗 HTN作为办公室工作人员具有结构化、长时间的SED。我们将使用我们成熟的方法来干预 多层次(通过坐-立式办公桌附件进行个人环境改造)，并利用行为 策略(个人咨询、自我监控、外部提示和戴在手腕上的显示器-光线强度 体力活动(LPA)(站立，轻微运动)和短时间突发性活动(零星MVPA)，如 替换行为。我们将全面研究我们的干预措施对血管健康的影响 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)(目标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和 散发性MVPA)和预后改变(目标3)。我们还将研究肥胖、健身和胰岛素敏感性。 因为探索性结果可能会随着我们的干预而改变，如果是这样的话，可能与英国石油有关。由此产生的结果 研究将确定减少SED是否可以改善血压和血管健康，并向必要的 减少SED的剂量，以获得临床上有意义的好处。此外，对我们新的干预方法的评估将 为SED研究和设计可翻译的人口水平方案提供未来干预措施。如果是SED 降低血压可以改善血压，它可以为对抗升高的血压和心血管疾病提供一个重要的额外工具。 和文本消息)。这些战略将通过以下方式促进有针对性地减少2-4小时/天的SED

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