Mobile Intervention to Enhance Physical Activity in the Chronically Ill

项目摘要 该项目旨在满足对促进身体活动的安全和参与干预的迫切需求 在患有慢性疾病的患者群体中（例如，糖尿病、哮喘、骨关节炎和慢性心脏病 失败）。令人信服的证据表明，体力活动是一种有效的治疗干预， 许多慢性疾病。然而，尽管人们普遍认为体育活动应该是一种 作为许多慢性病的综合治疗组成部分，大多数患者由于各种原因而保持不活动1， 他们经常遇到的障碍和障碍。 因此，我们建议创新性地采用有效的运动促进干预措施， 2向因慢性病而有特殊需要和限制的人群提供久坐不动的机会， 将此干预作为可通过智能手机、平板电脑或计算机访问的移动的应用程序提供。 我们提出了一个程序设计，遵循来自最近NIH资助的元， 对促进慢性病患者身体活动的干预措施进行分析性审查， 强调行为激活的重要性，而不是认知行为干预功能。 因此，我们全面的移动的应用程序包括：（a）初始筛选;（B）基线物理检查 通过无线加速计设备记录的活动（PA）水平;（c）评估， （d）设定目标;（e）每天通过电子邮件或短信说明目标 （f）一个简短的登记， 确定用户当前是否遇到障碍（疼痛、疲劳等）量身定制的补救措施， 通过社交媒体功能和专家咨询消除障碍;（g）提示进行日常锻炼;（h） 无线加速度计设备的集成（例如，Fitbit（R））来补充自我报告的运动数据， 以驱动定制的反馈和目标设定;（i）关于活动完成的签到（例如，”“是吗 完成练习了吗？““你喜欢这个练习吗？“”锻炼后感觉好点了吗？“）;（j） 关于所执行的身体活动如何有助于目标进展的即时、个性化反馈;以及（k） 为初级保健医生提供反馈报告。这些设计功能将共同促进和支持 在这一弱势群体中养成定期PA的可持续习惯。 在一项为期30天的前后研究中，我们将测试这种原型干预的初步疗效和可行性， 38例慢性骨关节炎成人患者。第一阶段原型计划将限于 证明骨关节炎患者控制I期总体范围的可行性 项目我们假设这种干预将使这一人群参与进来，并将受试者的PA水平从 评估前到评估后。如果这项先导性疗效试验取得令人满意的结果， 该计划的范围包括所有患有其他慢性疾病的患者（例如，骨关节炎， 高血压、糖尿病、肺病）。

PROJECT SUMMARY This project aims to fill the urgent need for a safe and engaging intervention that promotes physical activity in a population of patients with chronic diseases (e.g., diabetes, asthma, osteoarthritis, and chronic heart failure). Compelling evidence suggests that physical activity is an effective therapeutic intervention for numerous chronic diseases. However, in spite of the wide consensus that physical activity should be an integral treatment component for many chronic diseases, most patients remain inactive1 due to a variety of barriers and obstacles they regularly encounter. We therefore propose to innovatively adapt an efficacious exercise-promoting intervention that targets sedentary employees2 to a population with specific needs and constraints that result from chronic disease and deliver this intervention as a mobile application that can be accessed via smartphone, tablet, or computer. We propose a program design that follows recommendations derived from a recent NIH-funded meta- analytic review of interventions to promote physical activity in patients with chronic diseases, which emphasizes the importance of behavioral activation as opposed to cognitive-behavioral intervention features.3 Our comprehensive mobile application is therefore composed of (a) an initial screening; (b) baseline physical activity (PA) levels recorded via wireless accelerometer device; (c) an assessment that elicits information regarding preferences for and barriers to PA; (d) goal setting; (e) daily e-mail or text messages stating the goal for the day, the type of exercise, and a link to a video demonstrating the exercise; (f) a brief check-in to determine whether the user is currently encountering a barrier (pain, fatigue, etc.) and tailored remediation for the barrier through social media functionality and expert advice; (g) prompts to execute the daily exercise; (h) integration of a wireless accelerometer device (e.g., Fitbit(R)) to supplement self-reported exercise data and to drive tailored feedback and goal setting; (i) check-in regarding activity completion (e.g., "have you completed the exercise?," "did you enjoy this exercise?," "do you feel better after this exercise?"); (j) immediate, personalized feedback on how executed physical activities contribute to goal progress; and (k) feedback reports for the primary care physician. Together these design features will promote and support a sustainable habit of regular PA in this vulnerable population. In a 30-day pre-post study, we will test preliminary efficacy and feasibility of this prototype intervention in a population of 38 adult patients with chronic osteoarthritis. The Phase I prototype program will be limited to demonstrating feasibility with individuals with osteoarthritis to control the overall scope of the Phase I project. We hypothesize that this intervention will engage this population and increase subjects' PA level from pre- to post-assessment. If this pilot efficacy trial yields satisfactory results, the Phase 2 project will expand the scope of the program to include all patients with additional chronic diseases (e.g., osteoarthritis, hypertension, diabetes, pulmonary disease).