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 血压升高 (BP)，包括高血压 (HTN) 和高血压前期 (preHTN)，影响着三分之二的美国成年人，并且 心血管疾病 (CVD) 发病率、死亡率和医疗费用的主要原因。尽管 尽管药物治疗广泛使用，但只有约一半的高血压得到控制，这凸显了创新的需要 减轻血压升高负担的策略。虽然定期进行适度至剧烈的运动 建议进行至少 10 分钟的体力活动 (MVPA) 以降低血压，我们建议 减少坐着的时间或“久坐行为”（SED）是一种独特的新颖策略，可以降低血压 患有 preHTN 和 HTN 的个体。最近的职业和休闲变化（例如计算机、视频流） 导致美国一天一半以上的时间都花在 SED 上。与此同时，许多观察 研究已将过度的 SED 与不良后果联系起来，包括高血压和心血管疾病。而且，同一天 实验室研究表明，减少或中断 SED 会急剧降低血压，我们的初步数据 建议经过 12 周的 SED 干预后，收缩压 (SBP) 降低 4-6 mmHg。然而，已经有 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 已经持续 对血压有好处。在提出临床或公共卫生 SED 建议之前，此类实验证据 势在必行。因此，本申请的目的是证明减少 SED 降低血压的功效 在一项为期 3 个月的随机临床试验（干预与对照）中，受试者为 300 名处于 I 期之前的成人（每组 150 名） HTN 作为办公室工作人员，拥有结构化、长期的 SED。我们将使用我们行之有效的方法来干预 多个级别（带有坐站式办公桌附件的个人环境改造）并利用行为 策略（个人咨询、自我监控、使用腕戴式监视器进行外部提示、光强度 体力活动 (LPA)（站立、轻微运动）和短时间活动（<10 分钟）（零星 MVPA） 替换行为。我们将通过以下方式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）和关键潜力 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控来评估 实现的 SED 减少量（以及由此导致的 LPA 和 LPA 增加）之间的剂量反应关系 零星的 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 探索性结果可能会随着我们的干预而改变，如果是这样，可能与血压有关。结果由此 研究将确定降低 SED 是否可以改善血压和血管健康，并为必要的治疗提供信息 减少 SED 剂量以获得具有临床意义的益处。此外，对我们新颖的干预方法的评估将 为 SED 研究和设计可转化的人口水平项目的未来干预措施提供信息。如果 SED 减少血压可以改善血压，它可以为对抗血压升高和心血管疾病提供重要的额外工具。 和短信）。这些策略将通过增加每日 2-4 小时的 SED 减少