Targeting Physical Health in Schizophrenia: Physical Activity Can Enhance life (PACE-life)

针对精神分裂症患者的身体健康：身体活动可以增强生活（PACE-life）

• 批准号: 9917841
• 负责人: Claudio Battaglini
• 金额: $ 23.7万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-15 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9917841
• 关键词: Adoption; Alcohol or Other Drugs use; Behavior; Biological; Blood Pressure; Chronic; Clinic; Clinical Treatment; Communities; Community Mental Health Centers; Competence; Data; Development; Devices; Diet; Disease; Dose; Equipment; Exercise; Feedback; Frequencies; Goals; Guidelines; Health; Heart Rate; Home environment; Individual; Instruction; Intervention; Knowledge; Life; Link; Loneliness; Manuals; Measures; Medical; Mental Health; Metabolic syndrome; Mission; Modification; Monitor; Motivation; Outcome; Patients; Physical activity; Population; Population Group; Population Intervention; Premature Mortality; Prevalence; Preventive Intervention; Procedures; Quality of life; Randomized Controlled Trials; Research; Research Personnel; Resources; Rest; Risk; Risk Factors; Schizophrenia; Self Determination; Smoking; Social isolation; Standardization; Supervision; Symptoms; Testing; Translating; Translations; United States National Institutes of Health; Walking; base; cardiorespiratory fitness; design; disability; effectiveness trial; exercise intensity; exercise intervention; fitbit; follow-up; improved; intervention participants; metabolic rate; modifiable risk; mortality; physical conditioning; physical inactivity; pilot trial; premature; primary outcome; programs; psychotic symptoms; secondary outcome; sedentary lifestyle; service intervention; theories; walking intervention

Project Summary The presence of chronic physical and medical illnesses contributes significantly to premature mortality in individuals with schizophrenia spectrum disorders (SSDs). Physical inactivity, a modifiable risk factor that impacts all-cause mortality, has been identified as a critical target to improving health and quality of life. Further, cardiorespiratory fitness (CRF), an important health indicator linked with lowered risk of all-cause mortality, is reduced in individuals with SSDs. Despite the well-known benefits of exercise and the known sedentary lifestyle of this population, established and scalable interventions for this population are limited. Given that the majority of exercise interventions developed for individuals with SSDs require access to gym equipment and/or supervision from a trainer, it is unlikely that exercise adoption will occur upon study completion. As a result, our objective is to develop and test the feasibility of an accessible and scalable exercise intervention integrating home-based and group-based walking procedures, activity tracking, goal setting, and stepwise intensity progressions to improve CRF and associated health indicators. The central hypothesis is that an intervention that increases physical activity (PA) as measured by minutes spent walking (at the prescribed intensity) and steps/day will result in improved health and lowered risk for premature mortality as evidenced by superior CRF (primary outcome), and on a variety of secondary outcomes (e.g. blood pressure). Guided by strong preliminary data and grounded in Self-Determination Theory (SDT), this hypothesis will be tested via three specific aims: 1) To develop a manual-based walking intervention for individuals with SSDs: Physical Activity Can Enhance Life (PACE-Life). The manual will include guidelines for goal setting and translating intentions into behaviors (i.e., “if-then” plans), instructions for the group-based walking activity and home-based walking activity (which includes Fitbits), and increasing exercise intensity in a step-wise manner. 2) To examine the feasibility of implementing PACE-life at a community mental health clinic in an open trial of 14 individuals with SSDs. We will also examine the impact of PACE-life on intermediate targets (autonomous motivation and SDT needs), proximal outcomes (minutes spent walking and steps/day), the primary outcome of CRF, and secondary outcomes. And, 3) To conduct an initial RCT of PACE-life compared to Fitbit Alone (FA) among 56 patients with SSDs receiving treatment in a community mental health center. We hypothesize that, compared to FA, PACE-life will be associated with: a) Improved proximal and primary outcomes including greater minutes/week spent walking and steps/day and increased CRF at mid-treatment (3 months), post-test (6 months), and one-month follow-up; b) Decreases in secondary outcomes including loneliness, SSD symptoms, resting heart rate, and blood pressure at mid- treatment, post-test, and one-month follow-up. And, c) Higher levels of theoretically-relevant, intermediate targets (autonomous motivation and SDT needs) at mid-treatment, post-test, and one-month follow-up.

项目摘要 慢性生理和医学疾病的存在是过早死亡的重要原因 精神分裂症谱系障碍（SSD）的个体。缺乏身体活动是一个可改变的风险因素， 影响全因死亡率，已被确定为改善健康和生活质量的关键目标。 此外，心肺功能（CRF），一个重要的健康指标与降低风险的所有原因 死亡率在患有SSD的个体中降低。尽管众所周知的锻炼的好处和已知的 由于这一人群的久坐生活方式，针对这一人群的既定和可扩展的干预措施有限。 鉴于大多数为SSD患者开发的运动干预措施需要进入健身房， 设备和/或教练的监督，不太可能在研究时采用运动 建成因此，我们的目标是开发和测试一个可访问和可扩展的 整合家庭和团体步行程序、活动跟踪、目标的运动干预 设置和逐步强度进展，以改善CRF和相关的健康指标。 核心假设是，增加身体活动（PA）的干预措施， 每天花在步行上的分钟数（以规定的强度）和步数将改善健康状况并降低风险 对于由上级CRF（主要结局）证明的过早死亡，以及各种次要结局， 结果（例如血压）。以强大的初步数据为指导，以自我决定理论为基础 (SDT)，这一假设将通过三个具体目标进行测试：1）开发一种基于手动的步行 对SSD患者的干预：体育活动可以提高生活质量（PACE-Life）。该手册将 包括目标设定和将意图转化为行为的指导方针（即，“如果-那么”计划）， 基于团体的步行活动和基于家庭的步行活动（包括Fitbits）， 以循序渐进的方式锻炼强度。2)研究在一个 社区心理健康诊所在14名患有SSD的个体中进行开放试验。我们亦会研究 中间目标（自主动机和SDT需求）的PACE-life，近端结局（分钟 步行时间和步数/天）、CRF的主要结局和次要结局。（3）进行 在56名接受治疗的SSD患者中进行的PACE-life与单独Fitbit（FA）相比的初始RCT， 社区精神健康中心我们假设，与FA相比，PACE-life将与以下因素相关：a） 改善近端和主要结局，包括每周步行分钟数和每日步数增加， 治疗中期（3个月）、试验后（6个月）和1个月随访时CRF增加; B） 次要结局包括孤独、SSD症状、静息心率和中期血压。 治疗、后测试和一个月随访。（c）更高水平的理论相关性、中级 目标（自主动机和SDT需要）在治疗中期，测试后，和一个月的随访。