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

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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.