Tai Chi Mind-Body Therapy for Chronic Heart Failure

描述(由申请者提供)：心力衰竭是美国的一个主要公共卫生问题，影响到大约500万成年人。尽管最近在药物治疗和技术设备方面取得了进展，但心力衰竭是医疗保险患者住院治疗的最常见原因，随着人口老龄化，心力衰竭正在达到流行的程度。需要能够提高功能能力、生活质量以及延缓疾病进展的新的、廉价的干预措施。 太极是一种流行的身心运动，是治疗心脏病的一种潜在的辅助疗法。太极结合了温和的身体活动和冥想。它可能特别适合虚弱和患有心力衰竭的患者，但从未在这一人群中进行过严格的研究。我们在心力衰竭患者(n=30)中进行了太极的可行性研究，发现与没有参加太极计划的患者相比，随机参加太极计划的患者显著改善了他们的运动能力(6分钟步行距离)、生活质量(明尼苏达州心力衰竭评分)和神经激素状态(血清B型钠尿肽水平)。 在这项申请中，我们提出了一项为期四年的随机对照试验(n=150)，将12周的太极拳计划与教育注意力控制进行比较。慢性稳定型心力衰竭(收缩功能障碍，左心室射血分数<40%，纽约心脏协会I-IV级)的患者将从门诊初级保健和心脏科诊所招募。我们的主要目标将是研究太极对机能能力和生活质量的影响。第二个目标旨在进一步阐明太极影响的机制，包括检查认知行为或心理社会影响(例如，情绪、心理社会功能、自我效能、对心身医学的信念和期望)以及针对心力衰竭的特定生理/代谢过程(例如，神经激素状态、心率变异性和自主神经张力标记物、心肌结构和功能)。我们建议的研究结果将有助于确定太极在当前心力衰竭治疗中的作用，加深我们对其作用机制的理解，并对治疗的成本和收益提供初步分析。

DESCRIPTION (provided by applicant): Heart failure is a major public health problem in the United States, affecting approximately 5 million adults. Despite recent advances in pharmacological therapy and technological devices, heart failure is the most common reason for hospitalization among Medicare patients and is reaching epidemic proportions as the population ages. New and inexpensive interventions that can improve functional capacity, quality of life, as well as delay disease progression, are needed. Tai Chi is a popular mind-body exercise that is a potential adjunctive treatment for heart disease. Tai Chi incorporates both gentle physical activity and meditation. It may be particularly suited to frail and deconditioned patients with heart failure, but has never been rigorously studied in this population. We conducted a feasibility study of Tai Chi in patients with heart failure (n=30) and found that those randomized to a Tai Chi program significantly improved their exercise capacity (six-minute walk distance), quality-of-life (Minnesota Living with Heart Failure score), and neurohormonal status (serum B-type natriuretic peptide levels) compared to patients who did not participate in Tai Chi. In this application, we propose a randomized controlled trial (n=150) over four years that compares a 12-week Tai Chi program with an education attention control. Patients with chronic stable heart failure (systolic dysfunction, left ventricular ejection fraction <40%, New York Heart Association Class I-IV) will be recruited from outpatient primary care and cardiology clinics. Our primary aim will be to examine Tai Chi's effects on functional capacity and quality-of-life. Secondary aims are designed to further elucidate the mechanism of Tai Chi's effects, including examination of cognitive-behavioral or psychosocial influences (e.g., mood, psychosocial functioning, self-efficacy, beliefs and expectations of mind-body medicine) and Heart Failure-specific physiologic/metabolic processes in response to meditative exercise (e.g., neurohormonal status, heart rate variability and markers of autonomic tone, myocardial structure and function). The results of our proposed research will help define the role of Tai Chi in current heart failure management, further our understanding of the mechanism of action, and provide preliminary analyses of the costs and benefits of treatment.