Improving Long Term Exercise in Older Cardiac Patients

描述(申请人提供)：采用随机临床试验的3组，我们将对两种不同的基于理论的干预措施进行面对面的评估，与常规护理相比较，以改善老年心脏病患者对运动的接受和维持。一种专注于环境变化的新型干预措施，使用系统改进策略来增加锻炼，将被比作Change+(一种基于当代认知行为策略的干预措施)。研究问题是：(1)对于接受心脏康复计划(CRP)的个体，在控制协变量(年龄、种族、功能能力、体脂、合并症、肌肉或关节疼痛、锻炼经历、家庭和邻里环境以及抑郁)时，系统改变、改变+和日常护理在运动采用方面是否存在差异？(2)当控制协变量时，系统改变、改变+和日常护理在运动维持方面是否存在差异？(3)系统改变、对锻炼的社会支持、解决问题的技能、动机、健康信念和锻炼自我效能是否调节系统改变、改变+和日常护理的效果？系统改变、锻炼的社会支持、解决问题的技能、动机、健康信念和锻炼自我效能感是否在系统改变、改变+或日常护理对运动维持的影响中起中介作用？(5)系统改变和改变+干预在医疗保健支出、劳动力参与和收入以及家庭生产力方面有什么经济影响？从心脏事件中恢复的老年人(N=420)将被随机分配到三组。在使用心率手表监测器、运动日记和7天回忆调查完成CRP之后，将对运动采用和保持的措施(锻炼小时数、在目标心率区域锻炼的小时数、锻炼时段数、消耗的代谢当量数{METS}，以及受试者是否仍在锻炼)进行为期一年的测量。协变量的影响也将被评估。将确定干预措施实现其效果的机制。多变量分析将检查和比较随着时间的推移干预措施的效果。还将进行成本效益分析。

DESCRIPTION (provided by applicant): Using a randomized clinical trial with 3 groups, we will conduct a head-to-head evaluation of two different theoretically-based interventions, SystemCHANGE and CHANGE+, as compared to Usual Care to improve the adoption and maintenance of exercise in older cardiac patients. SystemCHANGE, a novel intervention that focuses on environmental change uses System Improvement strategies to increase exercise, will be compared to CHANGE+ (an intervention based on contemporary cognitive behavioral strategies). Study questions are: (1) Is there a difference between SystemCHANGE, CHANGE+, and Usual Care in exercise adoption when controlling for covariates (age, race, functional capacity, body fat, co- morbidity, muscle or joint pain, exercise experience, home and neighborhood environment, and depression), for individuals following a cardiac rehabilitation program (CRP)? (2) Is there a difference between SystemCHANGE, CHANGE+, and Usual Care in exercise maintenance when controlling for covariates? (3) Do system changes, social support for exercise, problem-solving skills, motivation, health beliefs, and exercise self-efficacy mediate the effects of SystemCHANGE, CHANGE+, or Usual Care on exercise adoption? (4) Do system changes, social support for exercise, problem-solving skills, motivation, health beliefs, and exercise self-efficacy mediate the effects of SystemCHANGE, CHANGE+, or Usual Care on exercise maintenance? (5) What are the economic impacts of the SystemCHANGE and CHANGE+ interventions in terms of health care spending, labor force participation and earnings, and household productivity? Older persons (N=420) recovering from cardiac events will be randomly assigned to the three groups. Measures of exercise adoption and maintenance (# of hours exercised, # of hours exercised in target heart rate zone, # of exercise sessions, # of metabolic equivalents {METS} expended, and whether or not a subject remains exercising) will be taken for 1 year after completion of a CRP using heart rate wristwatch monitors, exercise diaries, and a 7-Day Recall Survey. The effect of covariates also will be assessed. Mechanisms by which the interventions achieve their effects will be determined. Multivariate analyses will examine and compare the effects of the interventions over time. A cost-effectiveness analysis also will be conducted.