Sitting Interruption and Whole-body Cardiovascular Health: Linking Physiological Responses to Risk Behaviors

久坐中断与全身心血管健康：将生理反应与危险行为联系起来

• 批准号: 10362147
• 负责人: Lee Stoner
• 金额: $ 67.87万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-03 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10362147
• 关键词: Acute; Address; Adherence; Adoption; Adult; Advisory Committees; Behavior; Behavior Therapy; Behavioral; Behavioral Model; Benchmarking; Biological; Blood; Brain; Cardiovascular Diseases; Cardiovascular system; Chronic; Clinical Trials; Communities; Coronary heart disease; Cross-Over Trials; Data; Development; Dose; Environment; Exposure to; Focus Groups; Frequencies; Future; Goals; Guidelines; Heart; Hormonal; Hour; Individual; International Agencies; Interruption; Intervention; Intervention Studies; Laboratory Study; Level of Evidence; Link; Literature; Lower Extremity; Measures; Metabolic; Modeling; National Heart, Lung, and Blood Institute; Organ; Outcome; Participant; Persons; Physical activity; Physical environment; Physiologic pulse; Physiological; Policies; Policy Developments; Posture; Questionnaires; Randomized; Randomized Clinical Trials; Recommendation; Research; Risk Behaviors; Risk Factors; Social Environment; Stroke; Stroke Volume; Supination; Testing; Time; Translations; Walking; Work; arm; arterial stiffness; base; behavior change; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular health; design; efficacy testing; endothelial dysfunction; feasibility testing; feasibility trial; hemodynamics; middle age; mortality; novel strategies; predictive marker; predictive test; prevent; response; sedentary lifestyle; shear stress; social culture; therapy design

ABSTRACT Sedentary behaviors (SB) are biologically distinct but understudied cardiovascular disease (CVD) risk factors. National and international agencies have surmised that the level of evidence for an overall and dose-response association between SB and CVD mortality is moderate-strong. These agencies do not provide specific recommendations for breaking-up SB, though do call on the research community to facilitate policy development by establishing biological plausibility, identifying the optimal dose for SB substitution strategies, and conducting randomized clinical trials to test the efficacy of these strategies. Our goal is to identify mechanism-informed, socioecological-based SB substitution recommendations to mitigate CVD risk. Aim 1A will identify a feasible SB substitution strategy to prevent the adverse cardiovascular responses to prolonged SB. Adverse cardiovascular responses will be measured using aortic arterial stiffness (AS), a noninvasive test that predicts future CVD. To accomplish this aim, in 56 middle-aged (36-55 years) participants, we will measure aortic AS and associated mechanistic responses to the following over 4 hours: (i) SB with once/hour 5 min walk break; (ii) SB with once/hour 15 min stand break; (iii) SB with twice/hour breaks (alternating 5 min walk and 15 min stand); and (iv) SB with no breaks (control). These strategies were selected based on extensive prior work by our group, and because they are feasible, which is a key component of this proposal. SB reduction strategies will only decrease CVD risk if people are willing to adhere to future SB substitution recommendations. To increase the likelihood of feasibility and long-term adherence, Aim 1B will evaluate the determinants of SB using a socioecological model. This recognizes that behavior change is likely to be limited if the physical and sociocultural environments do not support the behavior change. To accomplish Aim 1B, a combined inductive-deductive qualitative approach will be used. Participants who complete Aim 1A will be participate in one of 6 focus groups (6-8 participants/group). Aim 2A will then test the feasibility of implementing the strategy in the real-world via an individualized single-arm 12-week intervention (n=40, 36-64 years). The mechanistic (Aim 1A) and qualitative (Aim 1B) data from Aim 1 will guide the intervention design. We will test the following feasibility domains: demand, acceptability, implementation, practicality, integration, and limited-efficacy. Lastly, Aim 2B will investigate which components of the intervention worked and which components did not work. All participants who complete Aim 2A will be asked to complete questionnaires pertaining to our behavioral model as well as participate in a focus group. The focus groups will be used to add context to the quantitative feasibility data. Specifically, we will address acceptability, adoption, appropriateness, sustainability, and the perceived socioecological determinants. Crucially, the outcomes from this proposal will be instrumental in facilitating the design of a subsequent clinical trial to test a mechanism-informed yet feasible SB reduction intervention, and in doing so directly support the development of SB policy.

抽象的 久坐的行为（SB）是生物学上不同但正在研究的心血管疾病（CVD）危险因素。 国家和国际机构推测，总体和剂量反应的证据水平 SB和CVD死亡率之间的关联是中等的。这些机构不提供特定的 分手SB的建议，尽管请呼吁研究社区促进政策 通过建立生物学合理性来开发，确定SB替代策略的最佳剂量， 并进行随机临床试验以测试这些策略的功效。我们的目标是确定 具有机制的基于社会生态的SB替代建议，以减轻CVD风险。 AIM 1A将确定可行的SB替代策略，以防止心血管对 长时间的SB。不良心血管反应将使用主动脉动脉刚度（AS）测量 预测未来CVD的非侵入性测试。为了实现这一目标，在56个中年（36 - 55年）中 参与者，我们将测量主动脉AS的主动脉和相关的机械响应以下4小时：（i） SB，一次/小时5分钟步行休息； （ii）一次/小时15分钟的SB休息； （iii）SB，每小时两次休息 （交替步行5分钟和15分钟的支架）； （iv）没有断裂的SB（对照）。选择了这些策略 基于我们小组的大量先前工作，并且因为它们是可行的，这是其中的关键组成部分 提议。 SB减少策略只有在人们愿意遵守未来SB的情况下才会降低CVD风险 替代建议。为了增加可行性和长期依从性的可能性，AIM 1B将 使用社会生态模型评估SB的决定因素。这认识到行为改变可能是 如果物理和社会文化环境不支持行为改变，则受到限制。完成 AIM 1B，将使用一种组合的电感左右定性方法。完成AIM 1A的参与者 将参加6个焦点小组之一（6-8名参与者/组）。 AIM 2A然后测试 通过个性化的单臂12周干预（n = 40，36-64）在现实世界中实施策略 年）。 AIM 1的机械（AIM 1A）和定性（AIM 1B）数据将指导干预设计。 我们将测试以下可行性域：需求，可接受性，实施，实用性，整合， 和效率有限。最后，AIM 2B将调查干预措施的哪些组成部分以及哪些组成部分 组件不起作用。所有完成AIM 2A的参与者都将被要求完成问卷调查 与我们的行为模型以及参与焦点小组有关。焦点组将用于添加 定量可行性数据的上下文。具体来说，我们将解决可接受性，采用，适当性， 可持续性和感知的社会生态决定因素。至关重要的是，该提议的结果将 有助于促进随后的临床试验的设计，以测试一种信息，但可行的机制 SB减少干预，并这样做直接支持SB政策的制定。