Improving Long Term Exercise in Older Cardiac Patients

描述（由申请人提供）：采用三组随机临床试验，我们将对两种不同的基于理论的干预措施SystemCHANGE和CHANGE+进行正面评估，与常规护理相比，以提高老年心脏病患者对运动的接受和维持。SystemCHANGE是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，将与change +（基于当代认知行为策略的干预措施）进行比较。研究问题是：(1)当控制协变量（年龄、种族、功能能力、体脂、共发病、肌肉或关节疼痛、运动经历、家庭和社区环境、抑郁）时，对于接受心脏康复计划（CRP）的个体，SystemCHANGE、CHANGE+和Usual Care在运动采用方面是否存在差异？(2)在控制协变量的情况下，SystemCHANGE、CHANGE+和Usual Care在运动维持方面是否存在差异？(3)制度改变、社会对运动的支持、问题解决能力、动机、健康信念和运动自我效能感是否介导了SystemCHANGE、CHANGE+或Usual Care对运动采用的影响？(4)系统改变、社会对运动的支持、问题解决能力、动机、健康信念和运动自我效能感是否介导了SystemCHANGE、CHANGE+或Usual Care对运动维持的影响？(5)在医疗保健支出、劳动力参与和收入以及家庭生产率方面，SystemCHANGE和CHANGE+干预措施的经济影响是什么？从心脏事件中恢复的老年人（N=420）将被随机分配到三组。在使用心率腕表监测器、运动日记和7天回忆调查完成CRP后的1年内，将采取运动采用和维持的措施（运动小时数、目标心率区运动小时数、运动会话数、代谢当量（METS）消耗数以及受试者是否继续运动）。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干预措施随时间的影响。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.