Developing a Mindfulness Movement Intervention Program for Post-MI Patients

描述（由申请人提供）：每年约有78.5万美国人患有首次心肌梗死（MI）， 47万美国人会复发。美国心脏协会（AHA）推荐以运动为基础的心脏康复（CR）来减少随后的心脏事件。尽管CR有好处，但只有14-35%的符合条件的心肌梗死患者参加了CR。有合并症的患者、女性、老年人和少数民族患者最不可能利用CR服务。许多医疗中心没有CR项目，患者必须到很远的地方进行CR。反过来，许多太极拳干预，已经在老年人群体中进行了研究，不需要昂贵的设备，可以在家里练习，并且在健康水平和合共疾病中都能很好地耐受。太极拳可以增加心率（最大心率的56%到65%）、耗氧量和乳酸积累，这表明太极拳是一种低到中等强度的有氧运动。然而，没有针对心肌梗死后患者的太极研究采用最先进的心功能和运动能力测量，因此，在心肌恢复期间，太极拳是否具有与CR相似的益处尚不清楚。拟议的研究将采用超声心动图、心率恢复和自行车几何测量等工具，这些工具已在许多CR研究中用于评估治疗的有效性。这项研究的创新之处在于，它专门针对首次心肌梗死后30天内没有选择参加正式CR计划的患者，并强调招募年龄较大、身体功能能力强、女性和少数民族的患者。共有75名首次MI的男性和女性将被随机分配到4个月的太极训练，包括20个冥想动作或标准护理（SOC）。临床评估将在6个月的时间内进行，在治疗前、治疗中和治疗后4个月进行测试，并在8周的随访中进行测试。我们目前的目标是收集研究可行性、可接受性的初步数据，并找到改善身体、心脏和心理/行为因素的迹象。如果这项探索性/发展性研究的目标得到满足，未来将进行一项大规模的研究来证实太极拳对心肌梗死后患者的疗效。迫切需要这样的研究，以便为不同的心肌梗死患者制定适当的康复干预措施。

DESCRIPTION (provided by applicant): Each year around 785,000 Americans endure a first myocardial infarction (MI) and 470,000 will have a recurrent event. The American Heart Association (AHA) recommends exercise-based cardiac rehabilitation (CR) for reductions in subsequent cardiac events. Despite the benefits of CR, only 14-35% of eligible MI patients participate in CR. Patients with co-morbidities, women, older adults, and ethnic minorities are least likely to utilize CR services. Many medical centers do not have CR programs and patients have to travel to distant locations to undergo CR. In turn, many Tai Chi interventions, have been studied in elderly cohorts, require no expensive equipment, can be practiced at home, and is well tolerated across fitness levels, and co-morbidities. Tai Chi increases heart rate (56% to 65% of maximum), oxygen consumption and lactate accumulation, signifying that Tai Chi serves as an aerobic exercise of low to moderate intensity. However, no Tai Chi studies in post-MI patients have employed state-of-the-art measures of cardiac function and exercise capacity and therefore it is unclear whether Tai Chi has similar benefits as CR during a period of myocardial recovery. The proposed study would employ tools including echocardiograms, heart rate recovery, and bicycle ergometry, which have been used in many CR studies to assess the effectiveness of treatment. This study is also innovative in that it specifically targets patients who have not opted to participate in a formal CR program within 30 days of a first-time MI and emphasizes recruitment of patients spanning an older age range, physical function ability, women and minorities. A total of 75 men and women with a first time MI will be randomly assigned to 4 months of Tai Chi training composed of 20 meditative movements or to standard of care (SOC). Clinical assessments will be performed over a six-month period, with testing occurring before, mid-way, and after 4 months of treatments, and at an 8 week follow-up. Our current goal is to gather preliminary data on study feasibility, acceptability and to find indicatins of improvements in physical, cardiac and psychological/behavioral factors. If the aims are met from this exploratory/development study, a future large scale study will be undertaken to confirm Tai Chi's efficacy in post-MI patients. Such research is critically needed so adequate rehabilitative interventions can be developed for diverse MI patients.