HL-132: Increasing Adherence to Guideline-Based Exercise Therapy For Chronic Heart Failure

项目摘要/摘要 这项建议是对NHLBI感兴趣的主题的回应：HL-132推进运动疗法的研究 慢性心力衰竭(R01)。这项建议旨在优化心力衰竭患者对运动疗法的依从性。 (HF)，改善身体功能和生活质量，减少发病率。心力衰竭是一种主要的公共卫生 令人担忧的是，虽然几十年来存活率有所改善，但心力衰竭的绝对死亡率仍然高达 约50%在首次诊断后5年内。许多研究表明，有规律的体力活动 运动显著改善运动耐量和心力衰竭的临床结果。把锻炼作为一种可靠的 然而，由于短期和长期依从性较差，辅助干预仍然有限。这 拟议的研究将检验心脏锻炼和阻力训练的有效性-同行领导 心动干预显著维持心力衰竭患者运动依从性的对比研究 更标准的运动干预。心动干预将改编自之前的 NHLBI资助的R01研究表明，对老年人的适度体力活动有持续的影响。这 拟议的研究将使干预措施对心力衰竭患者来说是安全的，提供心脏病方面的干预措施 诊所，并在18个月内测试对该计划的遵守情况。合适的诊所工作人员和心力衰竭患者 将对榜样进行培训，以便与训练有素的健康教育人员一起教授干预活动。到那时，他们将成为 负责维持心脏病诊所的计划。玩心的程序和行为 变革将是可持续的，因为同行和员工领导层的存在，以及因为它雇佣了 来自社会认知理论和生态模型的成熟策略，包括自我监控、社会支持、 以身作则，预防复发。相比之下，锻炼课程有固定的时间表和有限的时间 坚持的证据，心脏游戏教会患者如何积累有意义的身体活动 并提供支持性的社会基础设施来维持动力。在严格的随机聚类中 加州大学圣地亚哥分校(UCSD)医院和退伍军人事务部心脏病诊所的对照试验 圣地亚哥医疗系统(VASDHS)，我们将开发和评估心脏发挥干预计划 在264名社会经济和种族不同的女性和男性中，60岁以上的心力衰竭患者中的任何一种都有保留的 射血分数(HFpEF)或射血分数降低的心衰(HFrEF)。心花路放的参与者 在标准的锻炼计划中，将接受有氧加阻力训练的自我监测工具 以及团体教育和材料。心动游戏的参与者将额外获得同伴和工作人员 领导力。我们将演示以临床环境为基础的同行主导的心脏发挥计划将 显著提高坚持每周150分钟中等体力活动的主要研究终点 在18个月的随访中每周活动一次。我们预计这项研究的结果将为我们提供一个成功的 可输出到临床环境的干预模式。

PROJECT SUMMARY/ABSTRACT This proposal is in response to NHLBI Topics of Interest: HL-132 Advancing Research in Exercise Therapy for Chronic Heart Failure (R01). This proposal aims to optimize adherence to exercise regimens in heart failure (HF), improve physical functioning and quality of life, and reduce morbidity. HF is a major public health concern, and while survival has improved over the decades the absolute mortality rate for HF remains high at approximately 50% within 5 years of initial diagnosis. Numerous studies show that regular physical activity / exercise significantly improves exercise tolerance as well as clinical outcomes in HF. Exercise as a reliable adjunctive intervention, however, remains limited due to poor short- as well as long-term adherence. This proposed study will examine the effectiveness of the Heart Exercise And Resistance Training – Peer Lead ActivitY (HEART–PLAY) intervention to significantly sustain exercise adherence in HF patients, as compared to a more standard exercise intervention. The HEART–PLAY intervention will be adapted from previous NHLBI-funded R01 work shown to have a sustained impact on moderate physical activity in the elderly. This proposed study will adapt the intervention to be safe for HF patients, deliver the intervention in cardiology clinics, and test adherence to the program over 18 months. Clinic staff and HF patients who are appropriate role models will be trained to teach the intervention activities with trained health educators. They will then be responsible for maintaining the program in the cardiology clinics. The HEART–PLAY program and behavior change will be sustainable because of the presence of peer and staff leadership and because it employs proven strategies from social cognitive theory and ecological models including self monitoring, social support, role modeling, and relapse prevention. In contrast to exercise classes that have a fixed schedule and limited evidence for adherence, HEART-PLAY teaches patients how to accumulate meaningful physical activity across the day and provides a supportive social infrastructure to maintain motivation. In a rigorous cluster randomized controlled trial at cardiology clinics at the University of California, San Diego (UCSD) hospitals and at the VA San Diego Healthcare System (VASDHS), we will develop and assess the HEART–PLAY intervention program in 264 socioeconomically and ethnically diverse women and men 60+ years old with either HF with preserved Ejection Fraction (HFpEF) or HF with reduced Ejection Fraction (HFrEF). Participants in the HEART–PLAY and in the STANDARD exercise programs will receive self-monitoring tools for aerobic plus resistance training as well as group education and materials. Participants in HEART–PLAY will additionally receive peer and staff leadership. We will demonstrate that the peer-led HEART–PLAY program based in the clinic setting will significantly enhance the primary study endpoint of adherence to 150 min/week of moderate physical activity/week over an 18-month follow up. We envision the study’s findings will provide a successful intervention model that will be exportable to the clinic environment.!