Heart Steps: Adaptive mHealth intervention for physical-activity maintenance

描述（由申请人提供）：心脏病的许多风险因素是行为性的，如缺乏运动、吸烟和富含饱和脂肪和反式脂肪的饮食。心脏康复和其他二级预防计划可以有效地帮助心脏病患者进行降低风险所需的初步生活方式改变，但患者在计划结束后往往无法维持这些改变。在这项研究中，研究人员建议开发一种新的mHealth应用程序，用于支持心脏康复后维持身体活动。通过利用个人与 研究人员将设计和评估一个自适应的个性化应用程序，该应用程序（1）提醒患者注意他们的健康目标，增加他们注意到参与体育活动的机会的可能性;（2）提供患者如何在当前环境下立即活跃的可行性想法;以及（3）帮助患者计划和反思他们的身体活动，以能够建立稳健和可持续的身体活动习惯。此外，该应用程序将随着时间的推移调整其功能，以最大限度地减少用户负担，同时优化其鼓励体力活动和保持参与干预的能力。以用户为中心的设计过程将用于调查长期使用的mHealth技术的设计要求，该系统将在为期一年的研究中对60名完成II期心脏康复的冠状动脉疾病患者进行评估。将对研究数据进行分析，以了解不同组件的使用如何随着时间的推移影响患者的体力活动水平、感知负担和系统参与度。该项目的创新在于将拟议的干预措施建立在自我调节的双过程模型上，开发新的算法以实现应用程序如何随着时间的推移而适应和个性化，并使用微随机化研究设计来实现应用程序使用如何影响患者的因果关系。该项目的成功将为心脏病患者在日常生活中保持身体活动提供持续的支持，并深入了解长期使用的行为改变mHealth技术的技术和设计要求。

DESCRIPTION (provided by applicant): Many of the risk factors for heart disease are behavioral, such as physical inactivity, smoking, and diets high in saturated and trans-fats. Cardiac rehabilitation and other secondary prevention programs are effective at helping cardiac patients make the initial lifestyle changes needed to reduce their risks, but patients often fail t maintain those changes after the program ends. In this grant, the investigators propose to develop a novel mHealth application for supporting maintenance of physical activity after cardiac rehabilitation. By taking advantage of the frequent interactions that individuals have with their mobile phones throughout the day, the investigators will design and evaluate an adaptive, personalized application that (1) keeps patients reminded of their health goals, increasing the likelihood that they will notice opportunities to engage in physical activity; (2) provides actionable ideas for how patients can be active right now, given their current context; and (3) helps patients plan and reflect on their physical activity to enable creation of robust and sustainable physical-activity habits. In addition, the application will adapt its functioning for ech patient over time in order to minimize user burden while optimizing its ability to encourage physical activity and maintain engagement with the intervention. A user-centered design process will be used to investigate design requirements of mHealth technologies for long-term use, and the system will be evaluated in a year-long study with 60 patients with coronary artery disease who completed phase II cardiac rehabilitation. Study data will be analyzed to understand how the use of different components affect, over time, patients' physical activity levels, perceived burden, and engagement with the system. The project's innovations lie in grounding the proposed intervention in dual-process models of self-regulation, developing new algorithms to enable adaptation and personalization of how the application works over time, and using a micro-randomization study design to enable causal accounts of how the application use affects patients' physical activity, user burden, and engagement over the course of a year. The success of the project will provide cardiac patients with continuously available support for staying physically active in the midst of daily life, and deep understanding of technical and design requirements for behavior-change mHealth technologies for long-term use.