Improving Long Term Exercise in Older Cardiac Patients

描述（由申请人提供）：使用3组随机临床试验，我们将对两种不同的基于理论的干预措施（SystemCHANGE和CHANGE+）进行头对头评价，并与老年护理进行比较，以改善老年心脏病患者对运动的采用和维持。SystemCHANGE是一种关注环境变化的新型干预措施，使用系统改进策略来增加运动，将与CHANGE+（基于当代认知行为策略的干预措施）进行比较。研究问题包括：（1）对于心脏康复计划（CRP）后的个体，在控制协变量（年龄、种族、功能能力、体脂、合并症、肌肉或关节疼痛、运动经验、家庭和社区环境以及抑郁症）时，SystemCHANGE、CHANGE+和患者护理在运动采用方面是否存在差异？(2)在控制协变量时，SystemCHANGE、CHANGE+和运动护理之间在运动维持方面是否存在差异？(3)系统变化，社会支持运动，解决问题的技能，动机，健康信念和运动自我效能介导的影响SystemCHANGE，CHANGE+，或医疗保健运动采用？(4)系统变化、社会支持运动、解决问题的技能、动机、健康信念和运动自我效能感是否介导了SystemCHANGE、CHANGE+或医疗保健对运动维持的影响？(5)SystemCHANGE和CHANGE+干预措施在医疗保健支出、劳动力参与和收入以及家庭生产力方面有哪些经济影响？从心脏事件中恢复的老年人（N=420）将被随机分配到三组。在完成CRP后1年，使用心率手表监测器、运动日记和7天回忆调查，测量运动采用和维持（运动小时数、在目标心率区运动小时数、运动次数、消耗的代谢当量（METS）数以及受试者是否仍在运动）。还将评估协变量的影响。将确定干预措施发挥作用的机制。多变量分析将检查和比较干预措施随时间的影响。还将进行成本效益分析。

DESCRIPTION (provided by applicant): Using a randomized clinical trial with 3 groups, we will conduct a head-to-head evaluation of two different theoretically-based interventions, SystemCHANGE and CHANGE+, as compared to Usual Care to improve the adoption and maintenance of exercise in older cardiac patients. SystemCHANGE, a novel intervention that focuses on environmental change uses System Improvement strategies to increase exercise, will be compared to CHANGE+ (an intervention based on contemporary cognitive behavioral strategies). Study questions are: (1) Is there a difference between SystemCHANGE, CHANGE+, and Usual Care in exercise adoption when controlling for covariates (age, race, functional capacity, body fat, co- morbidity, muscle or joint pain, exercise experience, home and neighborhood environment, and depression), for individuals following a cardiac rehabilitation program (CRP)? (2) Is there a difference between SystemCHANGE, CHANGE+, and Usual Care in exercise maintenance when controlling for covariates? (3) Do system changes, social support for exercise, problem-solving skills, motivation, health beliefs, and exercise self-efficacy mediate the effects of SystemCHANGE, CHANGE+, or Usual Care on exercise adoption? (4) Do system changes, social support for exercise, problem-solving skills, motivation, health beliefs, and exercise self-efficacy mediate the effects of SystemCHANGE, CHANGE+, or Usual Care on exercise maintenance? (5) What are the economic impacts of the SystemCHANGE and CHANGE+ interventions in terms of health care spending, labor force participation and earnings, and household productivity? Older persons (N=420) recovering from cardiac events will be randomly assigned to the three groups. Measures of exercise adoption and maintenance (# of hours exercised, # of hours exercised in target heart rate zone, # of exercise sessions, # of metabolic equivalents {METS} expended, and whether or not a subject remains exercising) will be taken for 1 year after completion of a CRP using heart rate wristwatch monitors, exercise diaries, and a 7-Day Recall Survey. The effect of covariates also will be assessed. Mechanisms by which the interventions achieve their effects will be determined. Multivariate analyses will examine and compare the effects of the interventions over time. A cost-effectiveness analysis also will be conducted.