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的身体活动（PA）是生活质量和长寿的关键， 人口老龄化衰老使心脏的结构和功能发生变化， 易患心血管疾病（例如，冠心病、心力衰竭和中风），虚弱和福尔斯， 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， 通过促进对心血管和肺系统的适应， 由于失调、疼痛、虚弱和残疾，老年人的维持可能是困难的。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，其特征在于认知， 行为和生理基础。运动焦虑在患有以下疾病的人中尤其升高： 心血管疾病，因为运动的身体感觉往往与运动的感觉相似， 经历或归因于心血管疾病（例如，呼吸急促，胸闷，头晕， 疲劳、疼痛）。我们开发了一种针对运动的机械认知行为干预措施 行为暴露内感受性耐受（Behavioral Exposure For Interoceptive Tolerance，BE-FIT）在我们的第一阶段试点研究中，我们 在运动焦虑升高的低活动患者中开发并证明了对BE-FIT的初步支持 参加了门诊心脏康复。干预是六次会议，作为一个连续性的 在心脏康复的最初几周进行治疗，并涉及行为暴露于恐惧的身体 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- 佩戴活动监测器，用于PA反馈和活动目标设定。我们的前期工作确立了可行性， BE-FIT的可接受性和安全性。我们还发现了目标参与的证据（ 运动焦虑）和BE-FIT对运动结果影响的初步证据，包括显著的 治疗结束时，步数/天增加，PA分钟数/天中等-剧烈。鉴于这些非常 有希望的数据，我们建议采取下一步行动，进行充分的第二阶段随机对照 一项旨在测试BE-FIT与健康教育对照（HEC）干预相比在成人中的疗效的随机对照试验（RCT） （N=146）年龄≥40岁、门诊CR、低活动和运动焦虑升高的患者， 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和随访时（第12、18和24周）。我们将评估运动焦虑的干预效果， 成分，包括认知过程（灾难化，不确定性，不适耐受），行为 （回避/安全行为）和生理功能（心脏迷走神经控制）。该项目将有助于 对焦虑和PA的科学和临床理解。如果能够确定BE-FIT的疗效， 介入可作为心脏康复后续治疗，并适用于其他患者 人口和治疗环境，为PA促进支持成功的老龄化。

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.