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

针对心脏康复中运动焦虑和回避的量身定制的暴露干预措施

• 批准号: 10298686
• 负责人: Samantha Gwen Farris
• 金额: $ 58.33万
• 依托单位: RUTGERS, THE STATE UNIV OF N.J.
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10298686
• 关键词: Accelerometer; Acute; Adherence; Adult; Adverse event; Age; Age-Years; Aging; Alzheimer' s Disease; Anxiety; Awareness; Behavior; Behavioral; Belief; Blood Pressure; Cardiac; Cardiac rehabilitation; Cardiovascular Diseases; Cardiovascular system; Chest; Clinical; Cognition; Cognitive; Cognitive Therapy; Coronary heart disease; Data; Dementia; Disease; Dizziness; Electrocardiogram; Enrollment; Ensure; Esthesia; Event; Exercise; Exertion; Exposure to; Fatigue; Feedback; Female; Fright; Future; Goals; Grant; Health; Health education; Heart; Heart Rate; Heart failure; Individual; Informal Social Control; Intervention; Knowledge; Lead; Life Style; Link; Longevity; Lung; Maintenance; Measures; Mediating; Monitor; Operative Surgical Procedures; Outcome; Outpatients; Pain; Patients; Physical Exercise; Physical activity; Physiological; Physiological Processes; Pilot Projects; Population; Prevention; Procedures; Psychologist; Public Health; Quality of life; Race; Randomized; Randomized Controlled Trials; Research; Risk; Safety; Science; Seeds; Shortness of Breath; Specific qualifier value; Strenuous Exercise; Stroke; Structure; Supervision; Sweating; System; Testing; Time; Treatment Efficacy; Uncertainty; United States National Institutes of Health; Work; Wrist; age related; aging population; anxious; base; behavior change; bodily sensation; cognitive process; deconditioning; design; disability; efficacy testing; exercise intensity; exercise physiologist; exercise prescription; exercise rehabilitation; experience; falls; fitbit; frailty; health related quality of life; heart function; improved; intervention effect; novel; patient population; preservation; programs; psychological distress; theories; uptake

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.

项目摘要/摘要 有规律的锻炼和生活方式体育活动(PA)对于成长中的人的生活质量和长寿至关重要 人口老龄化。衰老会使心脏的结构和功能发生变化，从而增加 易患心血管疾病(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，然而，运动的启动和 由于解除条件、疼痛、虚弱和残疾，老年人的维护可能很困难。运动焦虑 是一种与不坚持锻炼和生活方式有关的新机制，其特征是认知、 行为和生理基础。运动焦虑在患有以下疾病的人中尤其高 心血管疾病，因为运动的身体感觉通常与感觉相似 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)。我们开发了一种机械知晓的认知-行为干预来针对运动 焦虑，称为行为暴露以获得感觉间耐受(BE-FIT)。在我们的第一阶段试点研究中，我们 开发并展示了对运动焦虑升高的低活动度患者的Be-Fit的初步支持 参加门诊心脏康复。干预是六个疗程，作为一个辅助项目进行 在心脏康复的最初几周进行治疗，并涉及行为暴露于令人恐惧的身体 感觉和锻炼情况，消除虚假的安全行为和回避，以及使用手腕- 佩戴活动监视器，用于PA反馈和活动目标设定。我们的初步工作确立了可行性， BE-FIT的可接受性和安全性。我们还发现了目标参与的证据(大规模削减 运动焦虑)和匹配对运动结果的影响的初步证据，包括显著的 在治疗结束时增加步数/天和中等强度的PA分钟/天。考虑到这些非常 有希望的数据，我们建议采取下一步，通过进行完全有效的第二阶段随机对照 试验(RCT)，以测试BE-FIT的有效性，与健康教育控制(HEC)干预相比较 (n=146)≥，40岁，无门诊CR，低活跃度和运动焦虑升高， 并测试运动焦虑的变化是否与随后运动结果的变化相关 在EOT和后续(12、18和24周)。我们将评估对运动焦虑的干预效果及其 组成部分，包括认知过程(灾害化、不确定性、不适耐受性)、行为 (回避/安全行为)和生理功能(心脏迷走神经控制)。这个项目将有助于 对焦虑症和PA的科学和临床认识。如果可以确定BE-FIT的疗效，这 干预可以作为心脏康复的辅助治疗，并适用于其他患者 人口和治疗环境，以促进PA以支持成功老龄化。