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

项目总结/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，超过80%的 心血管患者在事件之后保持久坐不动。参与心脏康复计划是 对PA的不良和长期坚持仍然是个问题。迫切需要发展 新的运动计划，以改善PA在这个高风险的患者群体。 太极拳（TC）是一种多维度的干预，将低强度的体育锻炼与 冥想的组成部分，已被证明可以提高重要的自我调节技能和认知- 行为改变的行为决定因素，如自我效能、动机和情绪健康。因为 它是以班级形式提供的，TC还促进社会支持。初步证据表明，TC可能 积极影响PA和选定的心血管危险因素。TC是ACS的一个有吸引力的锻炼选项 幸存者，他们经常久坐不动或缺乏营养。也有越来越多的证据支持使用 可穿戴技术（例如，Fitbit）作为一种有效的行为策略来推广PA。可穿戴设备可以 利用以证据为基础的技术，如个性化的目标设定和反馈，以增加动力 和锻炼的自我效能感。在患有心脏代谢疾病的患者中， 有组织的运动有希望增加中度-剧烈的PA并改善心血管风险。 该应用程序利用我们先前与TC的合作，在久坐的ACS幸存者中推广PA，经验 通过远程提供基于小组的TC，以及将身心锻炼与可穿戴设备（Fitbit）相结合的经验。 我们建议进行多中心可行性研究，作为未来全面试验准备的必要步骤 调查结合虚拟团体TC课程的多模式干预（TC+可穿戴设备）的有效性 与单个可穿戴设备一起支持整体PA，从而影响下游心脏代谢风险。 具体目的是：1）评估TC+Wearable plus多中心随机对照试验的可行性 强化常规护理（使用心血管风险因素教育材料）vs.单独强化常规护理 非活跃的ACS幸存者中。可行性措施将包括征聘和留用;干预 可接受性、依从性和忠实性;以及多中心数据收集的协调/管理。病人- 集中的结果将包括加速度计评估的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)从以下方面获得定性反馈： 多个利益相关者为未来的研究提供信息。我们将让患者，提供者和TC讲师参与， 关于TC+Wearable可接受性的访谈/焦点小组（内容、促进者/障碍、TC和 设备）;远程交付的技术方面;以及对未来提供者和TC讲师参与的开放性。

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.