HL-132: Increasing Adherence to Guideline-Based Exercise Therapy For Chronic Heart Failure

项目概要/摘要 该提案是对NHLBI感兴趣的主题：HL-132运动疗法的先进研究的回应。 慢性心力衰竭（R 01）。该提案旨在优化心力衰竭患者运动方案的依从性 (HF)，改善身体机能和生活质量，降低发病率。HF是一种主要的公共卫生 虽然存活率在过去几十年中有所改善，但HF的绝对死亡率仍然很高， 约50%在首次诊断的5年内。许多研究表明，有规律的身体活动/ 运动显著改善运动耐量以及HF的临床结果。作为一个可靠的运动 然而，由于短期和长期依从性差，预防性干预仍然有限。这 拟议的研究将检查心脏运动和阻力训练的有效性-同行领导 ActivitY（HEART-1）干预可显著维持HF患者的运动依从性， 更标准的运动干预。心脏病干预将根据之前的 NHLBI资助的R 01研究表明，对老年人的适度体力活动有持续的影响。这 拟议的研究将调整干预措施，使其对HF患者安全， 诊所，并在18个月内测试该计划的依从性。适合的诊所工作人员和HF患者 将对榜样进行培训，以便与训练有素的卫生教育工作者一起教授干预活动。于其后向业主悉数 负责维护心脏病诊所的计划。HEART-EQUIPMENT程序和行为 变革将是可持续的，因为同行和工作人员领导的存在，因为它雇用 从社会认知理论和生态模型，包括自我监控，社会支持， 角色塑造和预防复发与有固定时间表和有限时间限制的运动课程相比， 坚持的证据，HEART教患者如何积累有意义的身体活动， 这一天，并提供了一个支持性的社会基础设施，以保持动力。在一个严格的随机分组中 在加州大学圣地亚哥分校（UCSD）医院和VA的心脏病诊所进行的对照试验 圣地亚哥医疗保健系统（VASDHS），我们将制定和评估心脏病干预计划 在264名60岁以上的社会经济和种族多样的女性和男性中， 射血分数（HFpEF）或射血分数降低的HF（HFrEF）。参与者的心脏- 在标准锻炼计划中，将获得有氧加阻力训练的自我监测工具 以及团体教育和材料。参加HEART-EQUIPMENT的人还将获得同行和工作人员 领导我们将证明，基于诊所环境的同行领导的HEART-EQUIPMENT计划将 显著提高了主要研究终点，即坚持每周150分钟的中度体力活动， 在18个月的随访中，每周的活动量。我们设想这项研究的结果将提供一个成功的 将可导出到临床环境的干预模型。

PROJECT SUMMARY/ABSTRACT This proposal is in response to NHLBI Topics of Interest: HL-132 Advancing Research in Exercise Therapy for Chronic Heart Failure (R01). This proposal aims to optimize adherence to exercise regimens in heart failure (HF), improve physical functioning and quality of life, and reduce morbidity. HF is a major public health concern, and while survival has improved over the decades the absolute mortality rate for HF remains high at approximately 50% within 5 years of initial diagnosis. Numerous studies show that regular physical activity / exercise significantly improves exercise tolerance as well as clinical outcomes in HF. Exercise as a reliable adjunctive intervention, however, remains limited due to poor short- as well as long-term adherence. This proposed study will examine the effectiveness of the Heart Exercise And Resistance Training – Peer Lead ActivitY (HEART–PLAY) intervention to significantly sustain exercise adherence in HF patients, as compared to a more standard exercise intervention. The HEART–PLAY intervention will be adapted from previous NHLBI-funded R01 work shown to have a sustained impact on moderate physical activity in the elderly. This proposed study will adapt the intervention to be safe for HF patients, deliver the intervention in cardiology clinics, and test adherence to the program over 18 months. Clinic staff and HF patients who are appropriate role models will be trained to teach the intervention activities with trained health educators. They will then be responsible for maintaining the program in the cardiology clinics. The HEART–PLAY program and behavior change will be sustainable because of the presence of peer and staff leadership and because it employs proven strategies from social cognitive theory and ecological models including self monitoring, social support, role modeling, and relapse prevention. In contrast to exercise classes that have a fixed schedule and limited evidence for adherence, HEART-PLAY teaches patients how to accumulate meaningful physical activity across the day and provides a supportive social infrastructure to maintain motivation. In a rigorous cluster randomized controlled trial at cardiology clinics at the University of California, San Diego (UCSD) hospitals and at the VA San Diego Healthcare System (VASDHS), we will develop and assess the HEART–PLAY intervention program in 264 socioeconomically and ethnically diverse women and men 60+ years old with either HF with preserved Ejection Fraction (HFpEF) or HF with reduced Ejection Fraction (HFrEF). Participants in the HEART–PLAY and in the STANDARD exercise programs will receive self-monitoring tools for aerobic plus resistance training as well as group education and materials. Participants in HEART–PLAY will additionally receive peer and staff leadership. We will demonstrate that the peer-led HEART–PLAY program based in the clinic setting will significantly enhance the primary study endpoint of adherence to 150 min/week of moderate physical activity/week over an 18-month follow up. We envision the study’s findings will provide a successful intervention model that will be exportable to the clinic environment.!