Remotely Delivered Cardiac Rehabilitation for Adolescents with Congenital Heart Disease

为患有先天性心脏病的青少年提供远程心脏康复

• 批准号: 10448915
• 负责人: David A White
• 金额: $ 15.44万
• 依托单位: CHILDREN'S MERCY HOSP (KANSAS CITY, MO)
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-15 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10448915
• 关键词: 19 year old; Adolescent; Adult; Aerobic Exercise; Age; Alzheimer' s Disease; American Heart Association; Asthma; Cardiac; Cardiac rehabilitation; Cardiovascular Physiology; Caregivers; Characteristics; Child; Childhood; Clinical Trials; Clinics and Hospitals; Common Ventricle; Conduct Clinical Trials; Control Groups; Data; Demographic Impact; Development; Diabetes Mellitus; Diagnosis; Dissemination and Implementation; Down Syndrome; Dual-Energy X-Ray Absorptiometry; Echocardiography; Effectiveness; Evaluation; Exercise; Family; Financial Hardship; Financial cost; Funding; Goals; Health; Health Technology; Heart Rate; Heart Transplantation; Home; Hospitals; Impairment; Intellectual functioning disability; Intervention; Interview; Knowledge; Life; Mentors; Morbidity - disease rate; Movement; Operative Surgical Procedures; Outcome; Outcomes Research; Parents; Participant; Patients; Pediatric Hospitals; Personal Satisfaction; Physical Exercise; Physical Function; Physical activity; Physiological; Physiology; Population; Preparation; Prevention; Professional Organizations; Quality of life; Randomized; Randomized Controlled Clinical Trials; Research; Research Project Grants; Resistance; Resources; Schedule; Self Efficacy; Self-Direction; Severity of illness; Site; Social support; Structure; Supervision; Surveys; Tablet Computer; Tablets; Technology; Tetralogy of Fallot; Thinness; Time; Training; Transportation; Transposition of Great Vessels; Travel; United States National Institutes of Health; Videoconferencing; Youth; active control; arm; base; biological sex; boys; cardiorespiratory fitness; career; career development; comorbidity; congenital heart disorder; cost; d-transposition of the great arteries; design; disease diagnosis; effective intervention; effectiveness evaluation; exercise intensity; exercise intervention; exercise program; exercise rehabilitation; experience; fitbit; fitness; frailty; girls; heart function; hemodynamics; improved; lean body mass; mHealth; meetings; mortality; multidisciplinary; novel; obesity treatment; pediatric patients; peer; peer support; physiologic stressor; pilot trial; prevent; programs; psychosocial; remote delivery; repaired; resistance exercise; satisfaction; skills; training project

PROJECT SUMMARY/ABSTRACT Adolescents with congenital heart disease [CHD], including repair of tetralogy of Fallot [TOF], dextro-transposi- tion of the great vessels [d-TGA], or functionally univentricular heart physiology [Fontan], have lower cardiorespir- atory fitness [FIT] compared with healthy peers. FIT is a well-established predictor of morbidity, quality of life [QOL], and heart transplantation and is among the strongest predictors of mortality in this population. However, adolescents with CHD have significantly lower FIT when compared to cardio-typical peers, due to abnormal hemodynamics as well as low durations and intensities of physical activity [PA] and exercise. Pediatric cardiac rehabilitation [CR] programs which prescribe aerobic and resistance exercise over 12-wks. have demonstrated improvements in FIT for patients with CHD which persist months after completion of the program. Unfortunately, few hospitals/clinics offer CR programming for children and adolescents due to the financial costs of building and maintaining a CR facility, as well as the travel cost, time requirement, and burden for parents/caregivers to transport their child to/from a hospital for CR exercise sessions multiple times per week. In-home CR reduces barriers related to patient access and the financial burden for hospitals, though data supporting the effectiveness of in-home CR for youth is limited. The use of group video conferencing technology via tablet computer repre- sents a novel and potentially transformational strategy for delivering real-time, live, supervised CR to groups of adolescents with CHD in their homes. The goal of this K23 research plan is to evaluate the effectiveness of video conferencing for the delivery of real-time CR to groups of adolescents with CHD in their homes. We propose a 12-wk. randomized-controlled clinical trial assigning 74 adolescents [12-19 years old] with 1 of 3 CHD diagnoses [Fontan, TOF, or d-TGA] to Remote CR [RCR] [in-home, live, remote group exercise, 3-45-min sessions/week.] or Active control [in-home, self-directed exercise]. Our aims will assess the effectiveness of the RCR approach by comparing between-group changes [0-12 weeks] in: FIT, cardiac function, lean body mass, and frailty. Ex- ploratory aims will assess between group differences [0-12 weeks] in physical function, QOL, PA self-efficacy, and will evaluate the impact of demographic characteristics on program participation and satisfaction, and daily PA. We hypothesize the RCR intervention will elicit greater improvements in each outcome compared to the control group. The PI’s short term career development goal of enhancing knowledge, skills, and experiences in clinical trials research, CHD physiology, and implementation and dissemination [I&D] outcomes research in youth with CHD will be accomplished through a multidisciplinary team of mentors, formal programming/coursework, independent study, and scientific meetings. Career development training and experiences and data from the research plan will prepare the PI to accomplish his long-term career goals to 1] establish an independently funded research program conducting clinical trials to evaluate the impact of exercise, FIT on physical and psy- chosocial function in youth with CHD; and 2] I&D of CR programs across multiple sites.

项目总结/摘要 患有先天性心脏病[CHD]的青少年，包括法洛四联症[TOF]修复术， 大血管的收缩[d-TGA]，或功能性单心室心脏生理学[Fontan]，具有较低的心脏呼吸。 与健康同龄人相比，FIT是一个公认的预测发病率，生活质量 [QOL]和心脏移植，并且是该人群死亡率的最强预测因素之一。然而，在这方面， 与心脏病典型同龄人相比，患有CHD的青少年具有显著较低的FIT， 血液动力学以及体力活动[PA]和锻炼的持续时间和强度较低。小儿心脏 康复[CR]计划规定有氧运动和阻力运动超过12周。 CHD患者的FIT改善，在计划完成后持续数月。不幸的是， 少数医院/诊所为儿童和青少年提供CR编程，因为建筑的财务成本 和维持CR设施，以及旅行成本、时间要求和父母/护理人员的负担 每周多次将他们的孩子运送到医院/从医院运送到CR锻炼课程。家庭CR减少 与患者获取和医院财政负担有关的障碍，尽管数据支持有效性 对于年轻人来说，家庭CR是有限的。通过平板电脑使用群组视频会议技术代表了 发送了一个新的和潜在的转型战略，提供实时，现场，监督CR的群体， 家中患有CHD的青少年。K23研究计划的目标是评估视频的有效性 会议，以便向家中患有CHD的青少年群体提供实时CR。我们提出了一个 12周。一项随机对照临床试验，分配了74名患有3种CHD诊断之一的青少年[12-19岁] [Fontan、TOF或d-TGA]到远程CR [RCR] [在家、现场、远程小组练习，每周3-45分钟。] 或主动控制[在家里，自我指导的锻炼]。我们的目标是评估RCR方法的有效性 通过比较FIT、心功能、瘦体重和虚弱的组间变化[0-12周]。前- 探索性目的将评估组间[0-12周]身体功能、QOL、PA自我效能， 并将评估人口特征对计划参与和满意度的影响， 宾夕法尼亚州我们假设RCR干预将在每个结果中引起更大的改善， 对照组PI的短期职业发展目标是提高知识，技能和经验， 临床试验研究、CHD生理学、青年实施和传播[I&D]结果研究 CHD将通过多学科导师团队、正式编程/课程作业， 独立研究和科学会议。职业发展培训和经验以及来自 研究计划将使PI为实现其长期职业目标做好准备，以1]独立建立 资助的研究计划进行临床试验，以评估运动的影响，健身房对身体和心理， CHD青少年的社会功能;和2]跨多个站点的CR程序的I&D。