Heart Camp: Promoting Adherence to Exercise in Patients with Heart Failure

描述(申请人提供)：对于580万心力衰竭(HF)患者来说，遵守美国心力衰竭协会(HFSA)2010年的指南是困难的，该指南建议每周五天进行30分钟的有监督的中等强度运动 在日常日常活动中呼吸急促和疲劳。大多数心力衰竭患者没有进行任何有规律的运动，他们报告说，坚持运动比任何其他心力衰竭所需的行为改变都更困难。患者认为缺乏技能和动力是 不遵守的原因。因此，需要创新的计划来帮助心力衰竭患者获得启动和坚持长期锻炼的知识、技能和动力。本前瞻性随机两组重复试验设计的目的是确定心力衰竭(心力衰竭运动和阻力训练)营行为运动训练干预对心力衰竭患者18个月时长期坚持运动的疗效。246名心力衰竭受试者的样本规模将在3年内招募。所有受试者将在随机化前的3周磨合期内接受心肺运动测试和9次有监督的运动训练。完成9次训练中的6次的受试者将被随机分为心脏训练营干预组(HC)或标准护理(SC)运动组。HC干预组将接受认知-行为策略，这些策略涉及知识、态度、自我效能、行为自我管理技能和社会支持等干预组成部分。在18个月的学习期间，SC小组可以使用锻炼设施和常规设施工作人员。我们的中心假设S认为，在18个月时，HC组对锻炼的坚持程度将显著提高。我们将通过以下具体目标来验证我们的假设：目的1.评估心营对坚持锻炼的影响(通过加速度量仪和自我报告来测量)；目的2.评估心营干预的哪些组成部分调节干预对坚持的影响；目的3.评估心营对特定健康结果的影响；目的4.探索选定的人口统计学变量(种族、性别、年龄)作为心营干预对坚持的影响的潜在调节因素；以及目标5.探索影响锻炼坚持的感知和经验。心脏训练营的干预是创新的，因为它是第一次测试一种旨在改善心力衰竭患者长期坚持锻炼行为的多组分干预。它使用了一种创造性的夏令营氛围，其座右铭是：“选择行动，改善心脏”。互动小组会议(六个夏令营主题)和一名教练用于提供干预组件。这项研究将通过调查坚持锻炼的挑战性问题来影响心力衰竭的管理。提高对运动的长期坚持是确保必要的运动量的合乎逻辑的第一步，这是实现有益的健康结果和降低这种负担沉重的慢性病的成本所必需的。

DESCRIPTION (provided by applicant): Adherence to the Heart Failure Society of America (HFSA) 2010 guidelines that recommend 30 minutes of supervised moderate intensity exercise five days per week is difficult for the 5.8 million patients with heart failure (HF) who experience shortness of breath and fatigue in regular daily activities. A majority of patients with HF do not engage in any regular exercise and they report adherence to exercise is more difficult than any of the other required behavioral changes for HF. Patients identify lack of skills and motivation as reasons for non-adherence. Therefore, innovative programs are needed to assist HF patients to gain the knowledge, skills and motivation to initiate and adhere to long-term exercise. The objective of this prospective randomized two-group repeated measures experimental design is to determine the efficacy of the HEART (Heart Failure Exercise and Resistance Training) Camp behavioral exercise training intervention on long-term adherence to exercise at 18 months in patients with HF. A sample size of 246 subjects with heart failure will be recruited over a 3 year period. All subjects will receive a cardiopulmonary exercise test and 9 supervised exercise training sessions during a 3 week run-in period prior to randomization. Subjects completing 6 of 9 training sessions will be randomized to the HEART Camp Intervention group (HC) or to a standard care (SC) exercise group. The HC intervention group will receive cognitive-behavioral strategies that address the intervention components of knowledge, attitudes, self-efficacy, behavioral self-management skills and social support. The SC group is provided access to the exercise facility and regular facility staff for the 18 month study period. Our central hypothesis s that the HC group will have significantly better adherence to exercise at 18 months. We will test our hypothesis with the following Specific Aims: Aim 1. To evaluate the effect of HEART Camp on adherence to exercise (measured by accelerometry and self-report); Aim 2. To evaluate which components of the HEART Camp intervention mediate the effects of the intervention on adherence; Aim 3. To evaluate the effect of HEART Camp on specific health outcomes; Aim 4. To explore selected demographic variables (race, gender, age) as potential moderators of the effect of the HEART Camp intervention on adherence; and Aim 5. To explore the perceptions and experiences that contextualize exercise adherence. The HEART Camp intervention is innovative because it is the first to test a multi-component intervention designed to improve long-term adherence to exercise behavior in patients with HF. It uses a creative, camp atmosphere with the motto: "Choose to Move for Heart Improvement". Interactive group sessions (six camp topics) and a coach are used to deliver intervention components. This study will impact the management of heart failure by investigating the challenging problem of adherence to exercise. Improving long-term adherence to exercise is the logical first step to ensure the required dose of exercise that is necessary to realize beneficial health outcomes and reduce costs in this burdensome chronic illness.