Tai Chi Exercise and Wearable Feedback Technology to Promote Physical Activity in ACS Survivors

太极拳运动和可穿戴反馈技术促进 ACS 幸存者的身体活动

• 批准号: 10696084
• 负责人: Elena Salmoirago-Blotcher
• 金额: $ 56.83万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-05 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10696084
• 关键词: Accelerometer; Adherence; Aerobic Exercise; Affect; American Heart Association; Anxiety; Awareness; Behavioral; Blood Pressure; Body Weight; Cardiac rehabilitation; Cardiometabolic Disease; Cardiovascular system; Chronic; Chronic Disease; Cognition; Cognitive; Communities; Coronary heart disease; Data; Development; Devices; Dimensions; Educational Materials; Emotional; Energy Metabolism; Enrollment; Equilibrium; Event; Exercise; Feasibility Studies; Feedback; Focus Groups; Fostering; Future; Glucose; Goals; Guidelines; Health; Home; Individual; Intervention; Interview; Light; Lipids; Measures; Mental Depression; Meta-Analysis; Morbidity - disease rate; Motivation; Musculoskeletal Pain; Patient-Focused Outcomes; Patients; Physical Exercise; Physical activity; Physical assessment; Population; Preparation; Prognosis; Provider; Pulmonary Heart Disease; Qualitative Methods; Quality of life; Randomized; Randomized, Controlled Trials; Recommendation; Rehabilitation therapy; Risk Factors; Safety; Secondary Prevention; Self Efficacy; Site; Social support; Strenuous Exercise; Stress; Structure; Survivors; System; Tai Ji; Techniques; Technology; Time; Training; Weight; Work; acceptability and feasibility; acute coronary syndrome; behavior change; behavioral construct; cardiometabolic risk; cardiometabolism; cardiovascular health; cardiovascular risk factor; data collection site; evidence base; exercise capacity; exercise intervention; exercise program; exercise training; experience; fasting plasma glucose; fitbit; heart disease risk; high risk; high risk population; improved; instructor; interest; intrinsic motivation; mind/body; mindfulness; moderate-to-vigorous physical activity; monitoring device; mortality; multi-component intervention; novel; participant retention; patient engagement; patient population; peer support; physical inactivity; pragmatic trial; programs; public health priorities; recruit; remote delivery; remote group; sedentary; skills; stress management; treatment as usual; uptake; virtual; wearable device

Project Summary/Abstract Physical activity (PA) is a cornerstone of secondary prevention after an acute coronary syndrome (ACS) with associated improvements in cardiovascular risk, morbidity, and mortality. Unfortunately, over 80% of these cardiovascular patients remain sedentary after an event. Participation in cardiac rehabilitation programs is poor, and long-term adherence to PA remains problematic. There is a critical need for the development of novel exercise programs to improve PA in this high-risk patient population. Tai Chi (TC) is a multi-dimensional intervention that integrates low-moderate intensity physical exercise with meditative components that have been shown to improve important self-regulatory skills and cognitive- behavioral determinants of behavior change, such as self-efficacy, motivation, and emotional health. Because it is delivered in a class format, TC also fosters social support. Preliminary evidence suggests that TC may positively impact PA and selected cardiovascular risk factors. TC is an attractive exercise option for ACS survivors, who are often sedentary or deconditioned. There is also growing evidence supporting the use of wearable technology (e.g., Fitbit) as an effective behavioral strategy to promote PA. Wearable devices can utilize evidence-based techniques such as individualized goal setting and feedback in increasing motivation and self-efficacy for exercise. In patients with cardiometabolic disease, the addition of wearable technology to structured exercise has been promising to increase moderate-vigorous PA and improve cardiovascular risk. This application leverages our prior work with TC to promote PA among sedentary ACS survivors, experience with remote delivery of group-based TC, and experience combining mind-body exercise with wearables (Fitbit). We propose a multi-site feasibility study as a necessary step in preparation for a future, fully-powered trial investigating the efficacy of a multi-modal intervention (TC+Wearable) that combines virtual, group TC classes with an individual wearable device to support overall PA, and thus impact downstream cardiometabolic risk. The specific aims are: 1) To assess feasibility of a multi-site randomized controlled trial of TC+Wearable plus enhanced usual care (with cardiovascular risk factor education materials) vs. enhanced usual care alone among inactive ACS survivors. Feasibility measures will include recruitment and retention; intervention acceptability, adherence, and fidelity; and coordination/management of multi-site data collection. Patient- centered outcomes will include accelerometry-assessed PA and sedentary time, cognitive-behavioral constructs (self-efficacy, intrinsic motivation, awareness, anxiety/depression, stress), and cardiometabolic measures (exercise capacity, weight, lipids, blood pressure, glucose). 2) To obtain qualitative feedback from multiple stakeholders to inform future study conduct. We will engage patients, providers, and TC instructors in interviews/focus groups on acceptability of TC+Wearable (content, facilitators/barriers, integration of TC and device); technical aspects of remote delivery; and openness for future provider and TC instructor engagement.

项目概要/摘要 体力活动 (PA) 是急性冠脉综合征 (ACS) 后二级预防的基石 心血管风险、发病率和死亡率的相关改善。不幸的是，其中80%以上 心血管疾病患者在事件发生后保持久坐不动。参与心脏康复计划是 不良且长期坚持 PA 仍然存在问题。迫切需要发展 新颖的锻炼计划可改善这一高危患者群体的 PA。 太极拳（TC）是一种将低中等强度的体育锻炼与 冥想成分已被证明可以提高重要的自我调节技能和认知能力 行为改变的行为决定因素，例如自我效能、动机和情绪健康。因为 它以课堂形式提供，TC 还促进社会支持。初步证据表明 TC 可能 对 PA 和选定的心血管危险因素产生积极影响。 TC 对 ACS 来说是一个有吸引力的锻炼选择 幸存者，他们经常久坐或身体状况不佳。也有越来越多的证据支持使用 可穿戴技术（例如 Fitbit）作为促进 PA 的有效行为策略。可穿戴设备可以 利用基于证据的技术，例如个性化目标设定和反馈来提高动力 以及锻炼的自我效能感。对于患有心脏代谢疾病的患者，添加可穿戴技术可以 结构化运动有望增加中等强度的 PA 并降低心血管风险。 该应用程序利用了我们之前与 TC 的合作，在久坐的 ACS 幸存者中推广 PA，经验 具有远程提供团体 TC 的能力，并且拥有将身心锻炼与可穿戴设备 (Fitbit) 相结合的经验。 我们建议进行多地点可行性研究，作为为未来全功率试验做准备的必要步骤 研究结合虚拟团体 TC 课程的多模式干预（TC+可穿戴）的功效 使用个人可穿戴设备来支持整体 PA，从而影响下游心脏代谢风险。 具体目标是： 1）评估TC+Wearable plus多中心随机对照试验的可行性 加强常规护理（使用心血管危险因素教育材料）与单独加强常规护理 不活动的 ACS 幸存者中。可行性措施将包括招聘和保留；干涉 可接受性、遵守性和忠诚度；以及多站点数据收集的协调/管理。病人- 以加速度计评估的 PA 和久坐时间、认知行为 结构（自我效能、内在动机、意识、焦虑/抑郁、压力）和心脏代谢 测量（运动能力、体重、血脂、血压、血糖）。 2) 获得定性反馈 多个利益相关者为未来的研究行为提供信息。我们将让患者、提供者和 TC 讲师参与 关于 TC+可穿戴设备可接受性的访谈/焦点小组（内容、促进因素/障碍、TC 和可穿戴设备的整合） 设备）;远程交付的技术方面；并对未来提供者和 TC 讲师的参与持开放态度。