Tai Chi Mind-Body Therapy for Chronic Heart Failure

描述（由申请人提供）：心力衰竭是美国的一个主要公共卫生问题，影响约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，并且随着人口老龄化而达到流行病的比例。需要新的和廉价的干预措施，可以改善功能能力，生活质量，以及延迟疾病进展。 太极是一种流行的身心锻炼，是一种潜在的心脏病预防治疗。太极拳结合了温和的身体活动和冥想。它可能特别适合于虚弱和去适应的心力衰竭患者，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）中进行了太极拳的可行性研究，发现与未参加太极拳的患者相比，那些随机参加太极拳计划的患者显着改善了他们的运动能力（6分钟步行距离），生活质量（明尼苏达心力衰竭生活评分）和神经激素状态（血清B型利钠肽水平）。 在本申请中，我们提出了一项为期四年的随机对照试验（n=150），比较了12周的太极计划与教育注意力控制。慢性稳定性心力衰竭患者（收缩功能障碍，左心室射血分数<40%，纽约心脏协会I-IV级）将从门诊初级保健和心脏病诊所招募。我们的主要目的是研究太极对功能能力和生活质量的影响。次要目的旨在进一步阐明太极拳效果的机制，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、身心医学的信念和期望）和响应于冥想练习的心力衰竭特异性生理/代谢过程（例如，神经激素状态、心率变异性和自主神经张力、心肌结构和功能的标志物）。我们提出的研究结果将有助于确定太极拳在当前心力衰竭管理中的作用，进一步了解其作用机制，并提供治疗成本和效益的初步分析。

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.