Improving outcomes from cardiac rehabilitation among older adults through exercise testing and individualized exercise intensity prescriptions

通过运动测试和个性化运动强度处方改善老年人心脏康复的结果

• 批准号: 10672281
• 负责人: Quinn Russell Pack
• 金额: $ 59.07万
• 依托单位: BAYSTATE MEDICAL CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10672281
• 关键词: Accelerometer; Acute; Address; Age; Aging; Anxiety; Benchmarking; Cardiac; Cardiac health; Cardiac rehabilitation; Cardiology; Cessation of life; Clinical; Counseling; Coupled; Data; Effectiveness; Elderly; Event; Exercise; Exercise Physiology; Exercise Test; Exertion; Expert Opinion; Face; Failure; Female; Fright; Geriatrics; Goals; Guidelines; Heart; Heart Diseases; Heart Rate; Hospitalization; Ischemia; Knowledge; Life; Life Style; Measures; Mediating; Metabolic; Methods; Myocardial Infarction; Operative Surgical Procedures; Outcome; Outpatients; Patients; Perception; Persons; Pharmaceutical Preparations; Physical Function; Physical Performance; Physical activity; Physicians; Positioning Attribute; Prevention program; Procedures; Prognosis; Psychological Factors; Psychology; Quality of life; Randomized, Controlled Trials; Recommendation; Recovery; Rehabilitation Centers; Rest; Role; SF-36; Scientist; Secondary Prevention; Self Efficacy; Strenuous Exercise; Stress Tests; Stroke; Techniques; Testing; Time; Training; United States; Walking; Workload; acceptability and feasibility; economic outcome; effectiveness outcome; efficacy evaluation; efficacy testing; evidence base; exercise adherence; exercise intensity; exercise prescription; exercise training; experience; fitness; healthy aging; implementation outcomes; improved; improved outcome; indexing; individual patient; individual response; loss of function; mortality; multidisciplinary; patient response; pilot trial; programs; psychologic; psychological outcomes; randomized trial; recruit; response; secondary outcome; sex; treatment as usual; trial comparing

PROJECT SUMMARY Heart disease and its treatments, including hospitalization, surgery, and procedures, can result in devastating loss of function, particularly in inactive older adults, who often face a prolonged recovery. Maximizing fitness and promoting adequate physical activity (PA) are critical targets for healthy aging and recovery after a cardiac event. Cardiac rehabilitation (CR) provides up to 36 supervised exercise training sessions and lifestyle counseling to these patients and is thus ideally positioned to promote full recovery, encourage regular PA, optimize cardiac health, and support more successful aging for these patients. However, many CR programs fail to meet established benchmarks for improving fitness among their patients. This failure is likely attributable to marked differences in exercise intensity prescription practices across CR programs, which have recently been identified. Specifically, the most common method for prescribing exercise intensity in CR is the use of ratings of perceived exertion (RPE) coupled with a “rule of thumb” approach to achieve an exercise training heart rate (HR) that is 20-30 bpm higher than resting HR. While easy to implement, these usual care (UC) techniques often result in a self-selected and suboptimal exercise intensity. This, in turn, leads to lower gains in fitness and failure to reach established benchmarks. Instead, societal guidelines recommend patients undergo a graded exercise test (GXT) to measure a peak exercise HR and be prescribed exercise intensity using a computed target heart rate range (THRR). This approach (GXT-THRR) allows tailoring of exercise based on the individual patient’s response to acute exercise. However, no studies to date have tested the efficacy of GXT- THRR compared to UC, and this critical knowledge gap is likely responsible for the marked differences in exercise intensity prescription techniques across programs. Our preliminary data suggest GXT-THRR will lead to greater gains in fitness in CR, boost self-efficacy, reduce fear of exercise, and improve outcomes. To address this fundamental question, we will perform a 320-person randomized trial comparing GXT- THRR to UC among older adults with heart disease attending CR. In Aim 1, we will measure improvements in fitness during CR. In Aim 2, we will assess the impact of GXT-THRR on psychological factors associated with exercise adherence (self-efficacy and fear). In Aim 3, we will evaluate how the use of GXT-THRR impacts long-term PA, quality of life, fitness, and clinical outcomes. Our multi-disciplinary team has broad experience in all aspects of this proposal, including exercise physiology, CR, cardiology, geriatrics, and psychology. Our approach is informed by a successful pilot trial which demonstrated the clear feasibility and potential effectiveness of GXT-THRR. Ultimately, we anticipate our results will promote evidence-based exercise intensity practices in CR programs, leading to greater improvements in fitness, PA, and exercise self-efficacy, and more successful aging.

项目总结 心脏病及其治疗，包括住院、手术和手术，可能会导致毁灭性的后果 功能丧失，特别是不活跃的老年人，他们经常面临长期的康复。最大化健康 促进足够的体力活动(PA)是心脏手术后健康衰老和恢复的关键目标 事件。心脏康复(CR)提供多达36次有监督的运动训练课程和生活方式 为这些患者提供咨询，因此非常适合促进完全康复，鼓励定期进行PA， 优化心脏健康，为这些患者提供更成功的老龄化支持。然而，许多CR节目 未能达到改善患者健康状况的既定基准。这一失败很可能是由于 到不同CR项目在运动强度处方实践上的显著差异，这些项目最近 已被确认身份。 具体地说，在CR中规定运动强度的最常见方法是使用 感知劳力(RPE)与“经验法则”相结合以达到运动训练的心率 (HR)比静息HR高20-30次/分钟。虽然易于实施，但这些常规护理(UC)技术 通常会导致自我选择和不理想的运动强度。这反过来又会导致较低的健身收益和 未能达到既定的基准。相反，社会指南建议患者接受分级 运动试验(GXT)测量峰值运动心率，并使用计算机指定运动强度 目标心率范围(THRR)。这种方法(GXT-THRR)允许根据 个体患者对急性运动的反应。然而，到目前为止，还没有研究测试GXT的疗效。 THRR与UC相比，这一关键的知识差距可能是导致 跨项目的运动强度处方技术。我们的初步数据显示，GXT-THRR将领先 在CR中获得更大的健康收益，提高自我效能，减少对运动的恐惧，并改善结果。 为了解决这个根本问题，我们将进行一项320人的随机试验，比较GXT- 在接受CR治疗的老年心脏病患者中，THRR到UC。在目标1中，我们将衡量以下方面的改进 CR期间的体能。在目标2，我们将评估GXT-THRR对与以下相关的心理因素的影响 坚持锻炼(自我效能和恐惧)。在目标3中，我们将评估GXT-THRR的使用如何影响 长期PA、生活质量、健康状况和临床结果。 我们的多学科团队在这项提案的所有方面都有丰富的经验，包括练习 生理学、CR、心脏病学、老年病学和心理学。我们的方法是从一次成功的试飞中获得灵感的 这证明了GXT-THRR的明显可行性和潜在有效性。最终，我们预计 我们的结果将在CR项目中促进基于证据的运动强度实践，导致更多 在健身、PA和锻炼自我效能感方面的改善，以及更成功的衰老。