BENEFIT OF TAI CHI AS AN ADJUNCT TO STANDARD CARE FOR PATIENTS WITH CHRONIC STA

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。心力衰竭(HF)在美国是一个主要的公共卫生问题，影响着大约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的最常见原因，随着人口老龄化，心力衰竭正在达到流行的比例。需要能够改善功能能力、生活质量以及影响疾病进展的新的、廉价的干预措施。太极是一种流行的身心锻炼形式，是治疗心脏病的潜在辅助手段。太极结合了温和的身体活动和冥想。它可能特别适用于虚弱和虚弱的心力衰竭患者，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)。作为一项由NCCAM资助的研究的一部分，我们现在正在进行一项为期三年的随机对照试验(n=150)，比较12周的太极计划和常规护理(两组都接受HF教育材料)。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病诊所招募。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)以及针对冥想运动的心衰特定的生理/代谢过程(例如，神经激素状态、心率变异性和自主神经张力的标志、心肌结构和功能)。我们建议的研究结果将有助于明确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，并提供对治疗成本和收益的初步分析。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Heart Failure (HF) is a major public health problem in the United States, affecting approximately 5 million adults. Despite recent advances in pharmacological therapy and technological devices, HF 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 affect disease progression, are needed. Tai Chi is a popular mind-body exercise form that is a potential therapeutic adjunct for heart disease. Tai Chi incorporates both gentle physical activity and meditation. It may be particularly suited to frail and de-conditioned patients with HF, but has never been rigorously studied in this population. We conducted a feasibility study of Tai Chi in patients with HF (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. As part of a funded NCCAM study, we are now conducting a randomized controlled trial (n=150) over three years that compares a 12-week Tai Chi program with usual conventional care (both groups receiving HF educational materials). Patients with chronic stable HF (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 HF-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 HF management, further our understanding of the mechanism of action, and provide preliminary analyses of the costs and benefit of treatment.