Heart Camp: Promoting Adherence to Exercise in Patients with Heart Failure

描述（由申请人提供）：遵守美国心力衰竭协会（HFSA）2010年指南，该指南建议每周5天进行30分钟有监督的中等强度运动，这对于580万患有心力衰竭（HF）的患者来说是困难的， 呼吸急促和日常活动疲劳。大多数HF患者不进行任何常规运动，他们报告坚持运动比HF所需的任何其他行为改变更困难。患者认为缺乏技能和动力， 不遵守的原因。因此，需要创新的计划来帮助HF患者获得知识，技能和动机，以开始并坚持长期运动。本前瞻性随机两组重复测量实验设计的目的是确定HEART（心力衰竭运动和阻力训练）营地行为运动训练干预对HF患者18个月时长期坚持运动的疗效。将在3年内招募246例心力衰竭受试者的样本量。所有受试者将在随机化前的3周导入期内接受心肺运动试验和9次有监督的运动训练。完成9次训练中的6次的受试者将被随机分配至HEART Camp干预组（HC）或标准护理（SC）运动组。HC干预组将接受认知行为策略，解决知识，态度，自我效能，行为自我管理技能和社会支持的干预组成部分。在18个月的研究期间，SC组可以使用运动设施和常规设施工作人员。我们的中心假设是，HC组在18个月时对运动的坚持性明显更好。我们将通过以下具体目标来检验我们的假设：目标1。评估心脏训练营对坚持锻炼的影响（通过加速度计和自我报告测量）;目的2。评估HEART Camp干预措施的哪些组成部分介导了干预措施对依从性的影响;目的3。评估心脏营对特定健康结果的影响;目的4。探索选定的人口统计学变量（种族，性别，年龄）作为HEART Camp干预对依从性影响的潜在调节因素;目标5。探索情境化锻炼坚持性的感知和经验。HEART Camp干预是创新的，因为它是第一个测试多成分干预的项目，旨在改善HF患者对运动行为的长期坚持。它采用了一种创造性的营地氛围，其座右铭是：“选择为心脏改善而运动”。互动小组会议（六个营地主题）和教练被用来提供干预组件。这项研究将通过调查坚持锻炼的挑战性问题来影响心力衰竭的管理。改善长期坚持锻炼是确保所需运动剂量的合理第一步，这对于实现有益的健康结果和降低这种负担沉重的慢性疾病的成本是必要的。

DESCRIPTION (provided by applicant): Adherence to the Heart Failure Society of America (HFSA) 2010 guidelines that recommend 30 minutes of supervised moderate intensity exercise five days per week is difficult for the 5.8 million patients with heart failure (HF) who experience shortness of breath and fatigue in regular daily activities. A majority of patients with HF do not engage in any regular exercise and they report adherence to exercise is more difficult than any of the other required behavioral changes for HF. Patients identify lack of skills and motivation as reasons for non-adherence. Therefore, innovative programs are needed to assist HF patients to gain the knowledge, skills and motivation to initiate and adhere to long-term exercise. The objective of this prospective randomized two-group repeated measures experimental design is to determine the efficacy of the HEART (Heart Failure Exercise and Resistance Training) Camp behavioral exercise training intervention on long-term adherence to exercise at 18 months in patients with HF. A sample size of 246 subjects with heart failure will be recruited over a 3 year period. All subjects will receive a cardiopulmonary exercise test and 9 supervised exercise training sessions during a 3 week run-in period prior to randomization. Subjects completing 6 of 9 training sessions will be randomized to the HEART Camp Intervention group (HC) or to a standard care (SC) exercise group. The HC intervention group will receive cognitive-behavioral strategies that address the intervention components of knowledge, attitudes, self-efficacy, behavioral self-management skills and social support. The SC group is provided access to the exercise facility and regular facility staff for the 18 month study period. Our central hypothesis s that the HC group will have significantly better adherence to exercise at 18 months. We will test our hypothesis with the following Specific Aims: Aim 1. To evaluate the effect of HEART Camp on adherence to exercise (measured by accelerometry and self-report); Aim 2. To evaluate which components of the HEART Camp intervention mediate the effects of the intervention on adherence; Aim 3. To evaluate the effect of HEART Camp on specific health outcomes; Aim 4. To explore selected demographic variables (race, gender, age) as potential moderators of the effect of the HEART Camp intervention on adherence; and Aim 5. To explore the perceptions and experiences that contextualize exercise adherence. The HEART Camp intervention is innovative because it is the first to test a multi-component intervention designed to improve long-term adherence to exercise behavior in patients with HF. It uses a creative, camp atmosphere with the motto: "Choose to Move for Heart Improvement". Interactive group sessions (six camp topics) and a coach are used to deliver intervention components. This study will impact the management of heart failure by investigating the challenging problem of adherence to exercise. Improving long-term adherence to exercise is the logical first step to ensure the required dose of exercise that is necessary to realize beneficial health outcomes and reduce costs in this burdensome chronic illness.