Advancement of Clinical Referral to Physical Activity for Cardiometabolic Disease Prevention

临床转介体力活动预防心血管代谢疾病的进展

• 批准号: 10414033
• 负责人: Bonny Rockette-Wagner
• 金额: $ 13.47万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10414033
• 关键词: Accelerometer; Address; Adoption; Adult; Advisory Committees; Aerobic; Affect; American; American Heart Association; Attitude; Behavior; Behavior Therapy; Belief; Blood Pressure; Body Weight; Cardiometabolic Disease; Cardiovascular Diseases; Characteristics; Cholesterol; Clinical; Cognitive; Consensus; Control Groups; Data; Development; Diabetes Mellitus; Dyslipidemias; Electronic Health Record; Elements; Enrollment; Epidemiologic Methods; Exercise; Funding; Future; Glucose; Goals; Guidelines; Health; Health Professional; Health system; Healthcare Systems; Hypertension; Individual; Informatics; Insulin; Intervention; Interview; Knowledge; Lead; Learning; Life Style; Maintenance; Measures; Mentors; Methods; Monitor; National Heart, Lung, and Blood Institute; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Outcomes Research; Overweight; Paper; Participant; Patient Care; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Persons; Physical activity; Population; Prevention; Preventive service; Primary Health Care; Primary Prevention; Procedures; Process; Program Acceptability; Program Evaluation; Qualitative Research; Quality of life; Questionnaires; Randomized; Randomized Controlled Trials; Recommendation; Reporting; Research; Research Methodology; Research Personnel; Resources; Risk; Risk Factors; SECTM1 gene; Self Efficacy; Small Business Innovation Research Grant; Sports Medicine; Structure; Supervision; System; Technology; Telephone; Testing; Training; Triglycerides; Update; Walking; Wrist; active control; aged; base; behavior change; burden of illness; cardiometabolic risk; cardiometabolism; cardiovascular disorder prevention; cardiovascular risk factor; clinical care; clinical outcome measures; clinical practice; college; cost; design; disorder prevention; document outlines; evidence base; experience; fasting glucose; follow-up; glycemic control; improved; interdisciplinary approach; intervention program; lifestyle intervention; meetings; modifiable risk; novel strategies; online intervention; pragmatic trial; primary outcome; programs; recruit; routine care; satisfaction; secondary outcome; skills; social; social cognitive theory; standard care; statistics; success; tool; usability; vigorous intensity; waist circumference

Inadequate physical activity (PA) is considered a major risk factor for cardiometabolic disease. Clinical recommendations endorse achieving healthy PA levels in the primary prevention of cardiovascular disease and type 2 diabetes. The need for wider reaching primary prevention efforts with increasing PA levels as a “central element” has been suggested by previous studies. PA improvement programs integrated with clinical practice have the potential to reach a large number of at-risk individuals. Although a framework for clinician identification and treatment of people with low PA levels has been developed by the American College of Sports Medicine (ACSM), and clinical PA referral is now endorsed by the American Heart Association (AHA), the practice of identifying and addressing inadequate PA is not common in clinical practice. This proposal aims to improve important aspects of clinical PA referral for primary care patients with low PA and additional cardiometabolic risk factors. Aim 1 of the proposal will determine the efficacy of an inexpensive, convenient, evidence-based online intervention for improving PA levels that is appropriate for adult patients not meeting the US aerobic PA goal of 150 minutes/ week of moderate-vigorous intensity (e.g., brisk walking) PA who also have at least one other common cardiometabolic risk factor (high blood pressure, elevated glucose levels, and/or overweight/obesity). Adult primary care patients (n=54; aged 40-70) meeting the criteria for low PA and additional cardiometabolic risk who can safely increase activity without supervision will be recruited. Participants will be randomized to an active control (to receive a commercial wrist-worn physical activity tracker; PAT) or an online social-cognitive theory-based intervention (3 months of weekly sessions and 9 months maintenance) plus PAT. Primary outcomes will include the change in average step counts/day and percentage meeting the 150 minutes/week activity goal; they will be assessed at 6 and 12 months of follow-up. Secondary outcomes will include body weight, waist circumference, blood pressure, fasting glucose, insulin, cholesterol, triglycerides, and patient-reported outcomes including self-efficacy, quality of life, cost, and experience/satisfaction. Statistics on participant usage of the online platform and tracking tools, participant attitudes/beliefs, and opinions regarding maintenance strategies, will also be collected. We will leverage real world evidence by examining associations between changes in PA levels and important cardiometabolic outcomes that are measured clinically and by identifying EHR measures of patient characteristics that predict changes in PA levels. Methods for dealing with missing data will be considered. The goal of Aim 2 is to develop procedural recommendations for adding PAT data to an Epic-based electronic health record (EHR). Communicating patient PA levels with clinical teams through the EHR, using existing PATs holds value, but there is no consensus on how to accomplish this. We will engage key stakeholders in developing an interdisciplinary set of procedures that considers the needs of health professionals, health systems, researchers, and patients. Completion of these aims will provide pilot data to inform future efforts to develop feasible, effective PA referral programs that can be coordinated with clinical care and will build important collaborative relationships and skills relevant to pragmatic trials.

体育活动不足（PA）被认为是心脏代谢疾病的主要危险因素。临床 建议在主要预防心血管疾病和 2型糖尿病。随着“中心 先前的研究提出了元素”。与临床实践相结合的PA改进计划 有可能达到大量高危个人。尽管是临床的框架 美国学院已经开发了PA水平低的人的识别和治疗 运动医学（ACSM）和临床PA转诊现在得到美国心脏协会（AHA）的认可， 在临床实践中，识别和解决PA不足的实践并不常见。该提议的目的 为了改善PA低的初级保健患者的临床PA转诊的重要方面 心脏代谢危险因素。该提案的目标1将决定廉价，方便， 基于证据 美国有氧PA的目标是150分钟/周现代刺激的强度（例如，轻快的步行）PA 至少有一个常见的心脏代谢危险因素（高血压，葡萄糖水平升高， 和/或超重/肥胖）。成人初级保健患者（n = 54; 40-70岁）符合低PA和PA的标准 可以招募可以安全增加活动的其他心脏代谢风险。 参与者将被随机进行主动控制（接受商业腕上的体育锻炼 跟踪器； PAT）或基于在线社会认知理论的干预措施（每周3个月和9个 几个月维护）加上PAT。主要结果将包括平均步骤计数/天的变化 达到150分钟/周活动目标的百分比；他们将在6个月和12个月的随访中进行评估。 次要结果将包括体重，腰围，血压，空腹葡萄糖，胰岛素， 胆固醇，甘油三酸酯和患者报告的结果，包括自我效能感，生活质量，成本和 经验/满意度。关于在线平台和跟踪工具的参与使用的统计数据，参与 还将收集态度/信念以及对维护策略的意见。我们将利用真实的 通过检查PA级别变化与重要心脏代谢之间的关联，通过研究世界证据 通过临床测量并通过识别EHR测量的患者特征来预测的结果 PA级别的变化。将考虑处理丢失数据的方法。目标2的目标是发展 将PAT数据添加到基于史诗般的电子健康记录（EHR）的程序建议。 使用现有PATS具有价值，通过EHR将患者PA水平与临床团队传达 如何实现这一目标尚无共识。我们将吸引主要利益相关者开发 考虑卫生专业人员，卫生系统的需求，跨学科的程序集 研究人员和患者。这些目标的完成将提供试点数据，以告知未来的努力以开发 可行，有效的PA推荐计划，可以与临床护理协调，并将建立重要 与务实试验相关的协作关系和技能。