Mindful Steps: A Web-Based Mind-Body Exercise Intervention to Promote Physical Activity in Chronic Cardiopulmonary Disease

身体活动（PA）是一种重要的可改变行为，对慢性病有巨大的影响。 心肺健康慢性阻塞性肺疾病（COPD）和心力衰竭（HF）相似 全身性综合征，患者经常失调并遭受运动不耐受和呼吸困难。 重要的是，这些患者都有极高的久坐行为风险，这预示着不良的结果。 虽然PA在疾病管理中至关重要（运动能力、生活质量和 现有的锻炼计划未得到充分利用，无法获得，长期坚持 PA是普遍存在的问题。非常需要在这些人群中增加PA的新策略。 近年来，人们对使用互联网/技术介导的干预措施的兴趣迅速兴起 促进慢性病人群的健康行为改变。我们之前的工作调查了一个基于网络的 PA平台具有激励和教育内容，并配有个性化的可穿戴脚步追踪器 步骤目标，证明在心肺疾病患者的PA在短期内增加。在 与此同时，关于身心锻炼对健康的好处的文献也越来越多 行为改变在HF和COPD患者中，我们已经显示出生活质量、运动能力和PA的改善， 有数据表明，自我效能可能是促进长期行为改变的重要因素。 在先前资助的NIH发展赠款（R34 AT 009354）中，我们利用了我们在网络方面的经验， 基于PA干预与我们在身心疗法的专业知识，以开发一种新的多模式 针对COPD和HF患者的干预（正念步骤），以促进长期PA依从性。我们 理论模型假定，身心课程的整合增强了关键的行为结构， 现有的干预措施，也针对新的领域，这将导致提高自我效能和增加， 持续PA在试点研究中，我们已经证明了研究的可行性（招募、保留、所有远程数据 收集），和干预的可行性/可接受性（包括在线，同步身心类）。 在本R 01中，我们提出了下一步RCT（N=136）来测试正念步骤的有效性，与 常规护理，以促进COPD和/或HF患者的PA（通过每日步数客观测量） （主要目标）。次要目标将在我们的理论模型（自我）中检查认知行为措施。 锻炼和疾病管理的功效，内在动机，正念，内感受意识） 和以患者为中心的临床结局（疾病特异性生活质量，运动参与，呼吸困难， 疲劳）。结合技术与传统的身心锻炼原则，正念步骤强调整体 人的方法，符合NCCIH的战略重点。基于令人信服的理由， 严格的可行性数据，一个更大规模的远程交付的有效性试验是下一步评估这一点 可访问的、基于网络的PA干预，可在COPD和HF中提供更广泛的覆盖范围。

Physical activity (PA) is an important modifiable behavior that has enormous impacts on chronic cardiopulmonary health. Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are similar systemic syndromes where patients are often deconditioned and suffer exercise intolerance and dyspnea. Importantly, these patients share a dramatically high risk of sedentary behavior that portend poor outcomes. While PA is paramount in disease management (with improvements in exercise capacity, quality-of-life, and hospitalizations) available exercise programs are underutilized and inaccessible, and long-term adherence to PA is universally problematic. Novel strategies to increase PA in these populations are greatly needed. In recent years, there is rapidly emerging interest in use of internet/technology-mediated interventions to promote health behavior change in chronic disease populations. Our prior work investigated a web-based PA platform with motivational and educational content coupled with a wearable step tracker with individualized step goals that demonstrated increases in PA in patients with cardiopulmonary disease in the short term. At the same time, there is also a growing and robust literature on the benefits of mind-body exercise for health behavior change. In HF and COPD, we have shown improvements in quality-of-life, exercise capacity, and PA, with data suggesting that self-efficacy may be an important factor to facilitate long-term behavior change. In a previously funded NIH developmental grant (R34AT009354) we leveraged our experience in web- based PA interventions together with our expertise in mind-body therapies to develop a novel multi-modal intervention (Mindful Steps) for patients with COPD and HF to foster longer-term PA adherence. Our theoretical model posits that the integration of a mind-body curriculum enhances key behavioral constructs in the existing intervention and also targets new areas that will lead to enhanced self-efficacy and increased, sustained PA. In a pilot study, we have demonstrated study feasibility (recruitment, retention, all-remote data collection), and intervention feasibility/acceptability (including online, synchronous mind-body classes). In this R01, we propose the next step RCT (N=136) to test the efficacy of Mindful Steps, compared to usual care, to promote PA (objectively measured by daily step counts) in patients with COPD and/or HF (primary aim). Secondary aims will examine cognitive-behavioral measures within our theoretical model (self- efficacy for exercise and for disease management, intrinsic motivation, mindfulness, interoceptive awareness) and patient-centered clinical outcomes (disease-specific quality of life, exercise engagement, dyspnea, fatigue). Coupling technology with traditional mind-body exercise principles, Mindful Steps emphasizes a whole person approach that aligns well with NCCIH’s strategic priorities. Based on a compelling rationale and rigorous feasibility data, a larger-scale remotely-delivered efficacy trial is the next step in evaluating this accessible, web-based PA intervention that may provide broader reach in COPD and HF.