A tailored exposure intervention targeting exercise anxiety and avoidance in cardiac rehabilitation

项目概要/摘要 定期锻炼和生活方式体育活动 (PA) 对于成长中的人们的生活质量和长寿至关重要 人口老龄化。衰老会导致心脏的结构和功能发生变化，从而增加 容易患心血管疾病（例如冠心病、心力衰竭和中风）、虚弱和跌倒， 痴呆症和阿尔茨海默病。运动有助于减缓与衰老相关的变化的进展 通过促进心血管和肺系统的适应来改善心脏，但是运动的开始和结束 由于身体失调、疼痛、虚弱和残疾，老年人的维持可能很困难。运动焦虑 是一种与不坚持运动和生活方式 PA 相关的新机制，其特点是认知、 行为和生理基础。患有以下疾病的人的运动焦虑尤其严重 心血管疾病，因为运动时的身体感觉通常与身体感觉相似 经历过或归因于心血管疾病（例如，气短、胸闷、头晕、 疲劳、疼痛）。我们开发了一种基于机械的认知行为干预措施来针对性锻炼 焦虑，称为内感受耐受行为暴露（BE-FIT）。在我们的第一阶段试点研究中，我们 开发并证明了 BE-FIT 对运动焦虑程度低的低活动患者的初步支持 参加门诊心脏康复。干预包括六次会议，作为辅助 心脏康复最初几周的治疗，包括行为暴露于令人恐惧的身体 感觉和锻炼情况，消除错误的安全行为和回避，以及手腕的使用 佩戴活动监视器，用于 PA 反馈和活动目标设定。我们的前期工作确定了可行性， BE-FIT 的可接受性和安全性。我们还发现了目标参与的证据（大幅减少 运动焦虑）以及 BE-FIT 对运动结果影响的初步证据，包括显着的影响 治疗结束时每天增加步数和每天中等强度 PA 分钟。鉴于这些非常 有希望的数据，我们建议采取下一步，进行全功率第二阶段随机控制 试验 (RCT)，旨在测试 BE-FIT 与健康教育控制 (HEC) 干预措施相比对成人的功效 (N=146) 年龄≥40 岁、门诊 CR 明确、活动量低且运动焦虑升高的人， 并测试运动焦虑的变化是否与运动结果的后续变化相关 EOT 和后续行动（第 12、18 和 24 周）。我们将评估对运动焦虑及其影响的干预效果 组成部分，包括认知过程（灾难化、不确定性、不耐受不适）、行为 （回避/安全行为）和生理功能（心脏迷走神经控制）。该项目将贡献 对焦虑和 PA 的科学和临床理解。如果 BE-FIT 的功效能够得到证实，那么这 干预可以作为心脏康复的辅助治疗，并适用于其他患者 人群和治疗环境，以促进 PA 促进成功老龄化。

PROJECT SUMMARY/ABSTRACT Regular exercise and lifestyle physical activity (PA) are critical for quality of life and longevity among a growing aging population. Aging produces changes to the structure and function of the heart, which increases vulnerability to cardiovascular disease (e.g., coronary heart disease, heart failure, and stroke), frailty and falls, dementia, and Alzheimer disease. Exercise helps to slow the progression of aging-associated changes to the heart by promoting adaptations to the cardiovascular and pulmonary system, however exercise initiation and maintenance can be difficult in aging adults due to deconditioning, pain, frailty, and disability. Exercise anxiety is a novel mechanism related to non-adherence to exercise and lifestyle PA, that is characterized by cognitive, behavioral, and physiological underpinnings. Exercise anxiety is particularly elevated in individuals with cardiovascular disease given that the physical sensations of exercise often feel similar to the sensations experienced or attributed to cardiovascular disease (e.g., shortness of breath, chest tightness, dizziness, fatigue, pain). We developed a mechanistically-informed cognitive-behavioral intervention to target exercise anxiety, called Behavioral Exposure For Interoceptive Tolerance (BE-FIT). In our Stage I pilot study, we developed and demonstrated initial support for BE-FIT in low active patients with elevated exercise anxiety enrolled in outpatient cardiac rehabilitation. The intervention was six sessions delivered as an adjunctive treatment during the initial weeks of cardiac rehabilitation, and involved behavioral exposure to feared bodily sensations and exercise situations, elimination of false safety behaviors and avoidance, and use of a wrist- worn activity monitor for PA feedback and activity goal-setting. Our preliminary work established the feasibility, acceptability and safety of BE-FIT. We also found evidence of target engagement (large-sized reductions in exercise anxiety) and initial evidence for the effect of BE-FIT on exercise outcomes, including significant increases in steps/day and moderate-vigorous PA minutes/day at the end of treatment. Given these very promising data, we propose to take the next step by conducting a fully-powered Stage II randomized controlled trial (RCT) to test the efficacy of BE-FIT, compared to a Health Education Control (HEC) intervention, for adults (N=146) who are ≥40 years of age, cleared for outpatient CR, low active and have elevated exercise anxiety, and to test whether changes in exercise anxiety are associated with subsequent changes in exercise outcomes at EOT and follows-ups (Week 12, 18, and 24). We will evaluate intervention effects on exercise anxiety and its components, including cognitive processes (catastrophizing, uncertainty, discomfort intolerance), behavior (avoidance/safety behaviors), and physiological function (cardiac vagal control). This project will contribute scientific and clinical understanding of anxiety and PA. If the efficacy of the BE-FIT can be established, this intervention could serve as an adjunctive treatment to cardiac rehabilitation and be adapted for other patient populations and treatment settings, for PA promotion in support of successful aging.