Mind-Body Exercise in the Management of Cardiac Disease

简介(申请人提供)：Gloria Yeh博士的长期职业目标是成为一名独立的临床研究员，专注于心血管疾病和心力衰竭患者的循证补充和替代医学(CAM)疗法的关键评估、机制理解和成功整合。她近期的职业目标是：通过课程作业、教育研讨会和开发三项严格的、有指导的研究，提高她在临床试验设计和卫生服务研究方面的方法技能；了解心身锻炼可以改善心脏病患者临床结果的潜在心理社会和生理机制；以及确定心身锻炼和其他CAM模式在当前心血管疾病患者管理中的潜在作用。 该提案包括三个项目，特别关注慢性心力衰竭患者的身心锻炼。第一个将是二级数据库分析，描述全国心脏病患者使用CAM的模式和流行率，并检查与感知到有益于使用太极、气功或瑜伽相关的因素。第二个也是主要项目将是一项试点随机对照试验(n=20)，评估为期12周的太极/气功计划在老年舒张性心力衰竭患者中的可行性和安全性。这项研究将提供有关潜在心理社会影响(例如，自我效能、情绪、生活质量的变化)和生理机制(例如，运动能力、自主神经紧张、神经激素状态的变化)的重要初步数据，为未来R01应用于更大规模的随机临床试验做准备。第三个项目将评估目前心血管疾病和心力衰竭患者可使用的心脏康复计划，以开始探索将身心锻炼纳入这些康复计划，并了解被认为成功的心理社会计划组成部分(例如，可以提高患者自我效能和计划忠诚度的因素)。 完成拟议的研究和职业发展活动将增强叶博士进行以患者为导向的研究的能力，并使她能够实现她的职业目标，即成为一名独立的临床研究员，研究CAM疗法及其在心脏病患者中的应用。

DESCRIPTION (provided by applicant): Dr. Gloria Yeh's long-term career goal is to become an independent clinician investigator focusing on the critical evaluation, mechanistic understanding, and successful integration of evidence-based complementary and alternative medical (CAM) therapies for patients with cardiovascular disease and heart failure. Her immediate career objectives are: to enhance her methodological skills in clinical trial design and health services research through coursework, educational seminars, and the development of three rigorous, mentored studies; to understand the potential psychosocial and physiological mechanisms by which mind-body exercise can improve clinical outcome in cardiac patients; and to define the potential role of mind-body exercise and other CAM modalities in the current management of patients with cardiovascular disease. This proposal includes three projects with a particular focus on mind-body exercise in patients with chronic heart failure. The first will be a secondary database analysis describing the patterns and prevalence of CAM use in a large national sample of patients with cardiac disease and examining the factors associated with perceived beneficial use of tai chi, qigong, or yoga. The second and main project will be a pilot randomized controlled trial (n=20) evaluating study feasibility and safety of a 12-week tai chi/qigong program in older patients with diastolic heart failure. This study will provide important preliminary data regarding potential psychosocial effects (e.g., change in self-efficacy, mood, quality-of-life) and physiological mechanisms (e.g., change in exercise capacity, autonomic tone, neurohormone status) in preparation for a future R01application for a larger randomized clinical trial. The third project will assess current cardiac rehabilitation programs available to patients with cardiovascular disease and heart failure to begin to explore the incorporation of mind-body exercise into these rehabilitation programs and to understand the perceived successful psychosocial program components (e.g., factors that can enhance patient self-efficacy and program adherence). Completion of the proposed research and career development activities will enhance Dr. Yeh's ability to conduct patient-oriented research and allow her to achieve her career goal of becoming an independent clinical researcher investigating CAM therapies and its applications to patients with cardiac disease.