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

项目摘要 心脏病及其治疗，包括住院治疗，手术和程序，可导致毁灭性的后果。 功能丧失，特别是在不活跃的老年人中，他们往往面临长期的恢复。最大化健身 和促进足够的体力活动（PA）是健康老龄化和心脏病后恢复的关键目标。 活动心脏康复（CR）提供多达36个监督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PA， 优化心脏健康，并支持这些患者更成功的衰老。然而，许多CR方案 未能达到改善患者健康的既定基准。这种失败可能是由于 CR项目中运动强度处方实践的显著差异，最近 被识别。 具体来说，在CR中规定运动强度的最常见方法是使用 感知用力（RPE）结合“经验法则”方法来实现运动训练心率 (HR)比静息心率高20-30 bpm。虽然易于实施，但这些常规护理（UC）技术 经常导致自我选择的和次优的锻炼强度。这反过来又会导致健身的收益降低， 未能达到既定基准。相反，社会指南建议患者接受分级的 运动测试（GXT），以测量峰值运动HR，并使用计算的 目标心率范围（THRR）。这种方法（GXT-THRR）允许根据运动量定制运动。 个体患者对急性运动的反应。然而，迄今为止还没有研究测试GXT的功效- THRR与UC相比，这一关键的知识差距可能是造成 运动强度处方技术跨程序。我们的初步数据表明GXT-THRR将导致 在CR中获得更大的健身收益，提高自我效能，减少对运动的恐惧，并改善结果。 为了解决这个基本问题，我们将进行一项320人的随机试验，比较GXT- 在接受CR治疗的心脏病老年人中，THR与UC的关系。在目标1中，我们将衡量 CR期间的健身。在目标2中，我们将评估GXT-THRR对与以下相关的心理因素的影响： 锻炼坚持性（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、健身和临床结局。 我们的多学科团队在此提案的各个方面都有广泛的经验，包括运动 生理学、CR、心脏病学、老年病学和心理学。我们的方法是由一个成功的试点试验告知 这证明了GXT-THRR的明确可行性和潜在有效性。最终，我们预计 我们的研究结果将促进CR项目中基于证据的运动强度实践， 健身，PA和运动自我效能的改善，以及更成功的衰老。

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.