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

项目摘要/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 心血管疾病患者在活动结束后仍会久坐不动。参与心脏康复计划是 糟糕的，长期遵守PA仍然是一个问题。迫切需要发展…… 新的锻炼计划，以改善这一高危患者群体的PA。 太极拳(TC)是一种多维干预，将中、低强度体育锻炼与 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，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也培养了社会支持。初步证据表明，TC可能 对PA和选定的心血管危险因素有积极影响。对于ACS来说，TC是一个有吸引力的锻炼选项 幸存者，他们通常是久坐不动或条件不佳的。也有越来越多的证据支持使用 可穿戴技术(例如，Fitbit)作为推广PA的有效行为策略。可穿戴设备可以 利用基于证据的技术，如个性化的目标设定和反馈来增加动力 和锻炼的自我效能感。在心脏代谢性疾病患者中，将可穿戴技术添加到 有组织的锻炼有望增加中等强度的PA，并改善心血管风险。 此应用程序利用我们之前与TC的合作，在久坐的ACS幸存者中推广PA，Experience 通过远程交付基于团队的TC，以及将身心锻炼与可穿戴设备相结合的体验(Fitbit)。 我们建议进行一项多地点可行性研究，作为未来全面试验的必要步骤。 研究结合虚拟、团体TC课程的多模式干预(TC+可穿戴设备)的有效性 使用单独的可穿戴设备来支持整体PA，从而影响下游的心脏代谢风险。 具体目的是：1)评估TC+Wearable Plus多地点随机对照试验的可行性 强化常规护理(使用心血管危险因素教育材料)与单独强化常规护理相比 在不活跃的急性冠脉综合征幸存者中。可行性措施将包括招聘和留住；干预 可接受性、坚持性和保真度；以及多站点数据收集的协调/管理。病人- 中心结果将包括加速度法评估的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(运动量、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，为未来的研究工作提供信息。我们将让患者、提供者和TC指导员参与 关于TC+可穿戴设备的可接受性(内容、促进者/障碍、TC和 设备)；远程交付的技术方面；以及对未来提供商和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.