HEART Camp Connect: Promoting Adherence to Exercise in Adults with Heart Failure with Preserved Ejection Fraction

项目总结/摘要 射血分数保留性心力衰竭（HFpEF）是心力衰竭治疗中最大的挑战之一。 心血管护理今天运动是为数不多的治疗HFpEF成人受益的方法之一。然而，为了实现 并保持锻炼的益处，需要坚持。国家心肺和血液研究所 （NHLBI）HFpEF和心力衰竭运动工作组强调了未来研究的高度优先领域 包括检查策略和干预措施，以促进运动的开始和坚持，测试 干预机制，以改善坚持运动，确定有临床意义的结果，心脏 失败试验超越死亡率，并检查炎症生物标志物的纵向变化，以更好地 了解与临床状态的相关性。我们的团队已经成功地测试了一种干预措施[心力衰竭运动 和阻力训练（心脏）营]，显着提高长期坚持中等强度 在稳定的慢性心力衰竭患者中进行运动（≥120分钟，心率储备为40-80%）。粘附 是由射血分数调节的，对我们的HFpEF亚组的二次分析显示， 长期坚持锻炼。我们现在提出一个有足够把握度的随机对照试验来测试 在HFpEF成人中实现长期运动坚持的2种干预措施。我们的总体目标保持一致 与NHLBI的优先事项，并努力实现我们的长期目标，以促进坚持运动HFpEF： (a)评估基于理论的训练和教练干预对长期坚持锻炼的影响， (b)确定与患者报告的有临床意义的变化相关的中等强度运动的分钟数 结果，（c）评价干预机制和中期临床事件作为依从性的介质 行为，以及（d）检查干预交付的成本。为了实现这些目标，我们提出了一个3组 比较2种干预措施（HEART Camp（面对面）与HEART Camp Connect）的随机对照试验 （虚拟）彼此，并加强HFpEF成人的日常护理。拟议的研究包括几个 创新：1.我们是第一个：测试行为干预的效果，旨在促进长期的 在HFpEF中使用依从性的客观测量进行锻炼依从性，尝试定义 达到有临床意义的变化所需的运动分钟数，并评估运动干预成本; 和2.我们结合了技术创新，包括用于实时捕获运动数据的网络应用程序， 一种创新的分析方法，检查中期临床事件对依从性的影响，HFpEF 算法和大规模炎症测定。这些创新挑战了当前的模式，并有助于 达到HFpEF科学的新视野。我们的方法结合了经过充分研究的理论机制， 通过虚拟辅导和培训与面对面辅导和培训进行测试，将使我们能够更好地 了解HFpEF患者的运动依从性。这项研究将通过减少不依从性产生关键影响， 阻碍HFpEF成人患者通过定期运动训练进行临床护理的进展。

PROJECT SUMMARY/ABSTRACT Heart failure with preserved ejection fraction (HFpEF) is one of the greatest treatment challenges in cardiovascular care today. Exercise is one of few treatments shown to benefit adults with HFpEF. Yet, to achieve and sustain the benefits of exercise, adherence is required. Recent National Heart Lung and Blood Institute (NHLBI) working groups on HFpEF and exercise in heart failure highlighted high priority areas for future study including examining strategies and interventions to promote exercise initiation and adherence, testing interventional mechanisms to improve adherence to exercise, identifying clinically meaningful outcomes for heart failure trials beyond mortality, and examining longitudinal changes in inflammatory biomarkers to better understand correlates to clinical status. Our team has successfully tested an intervention [Heart Failure Exercise and Resistance Training (HEART) Camp] that significantly improves long-term adherence to moderate intensity exercise (≥120 minutes of exercise at a heart rate reserve of 40-80%) in stable, chronic heart failure. Adherence was moderated by ejection fraction and a secondary analysis of our HFpEF subgroup showed promising long- term exercise adherence. We now propose a sufficiently powered randomized controlled trial to test the efficacy of 2 interventions in achieving long-term exercise adherence in adults with HFpEF. Our overall objectives align with NHLBI priorities and work toward achieving our long-term goal to promote adherence to exercise in HFpEF: (a) evaluate the effects of theory-based training and coaching interventions on long-term adherence to exercise, (b) identify minutes of moderate-intensity exercise that relate to clinically meaningful change in patient-reported outcomes, (c) evaluate interventional mechanisms and interim clinical events as mediators of adherence behaviors, and (d) examine the cost of intervention delivery. To meet these objectives, we propose a 3-group randomized controlled trial to compare 2 interventions, HEART Camp (in-person) to HEART Camp Connect (virtual) to each other and to enhanced usual care in adults with HFpEF. The proposed study incorporates several innovations: 1. We are the first to: test the effects of behavioral interventions designed to promote long-term exercise adherence in HFpEF using an objective measure of adherence, attempt to define a benchmark of minutes of exercise needed to achieve a clinically meaningful change, and assess exercise intervention cost; and 2. We incorporate technical innovations including a web application for real-time capture of exercise data, an innovative analytic approach that examines the influence of interim clinical events on adherence, a HFpEF algorithm and large-scale inflammatory assays. These innovations challenge the current paradigm and help to reach new horizons in HFpEF science. Our approach, which combines well-studied theoretical mechanisms delivered with virtual coaching and training tested against in-person coaching and training, will allow us to better understand exercise adherence in HFpEF. This study will have a critical impact by lessening non-adherence as a barrier to progress in the clinical care of adults with HFpEF through regular exercise training.