Advancement of Clinical Referral to Physical Activity for Cardiometabolic Disease Prevention

体力活动不足（PA）被认为是心脏代谢疾病的主要危险因素。临床 建议支持在心血管疾病的一级预防中达到健康的PA水平， 2型糖尿病需要更广泛地开展初级预防工作，提高预防保健水平， “要素”已被先前的研究所提出。与临床实践相结合的PA改进计划 有可能接触到大量的高危人群。虽然临床医生的框架 识别和治疗PA水平低的人已经由美国大学开发， 运动医学（ACSM）和临床PA转诊现在由美国心脏协会（AHA）认可， 在临床实践中，识别和解决PA不足的实践并不常见。这项建议旨在 改善低PA和额外PA的初级保健患者的临床PA转诊的重要方面， 心脏代谢危险因素。该提案的目标1将确定一种廉价、方便、 用于改善PA水平的循证在线干预，适用于不符合 美国有氧PA目标为150分钟/周，中等强度（例如，快步走）PA谁也 具有至少一种其他常见的心脏代谢风险因素（高血压，葡萄糖水平升高， 和/或超重/肥胖）。符合低PA标准的成人初级保健患者（n=54;年龄40-70岁）， 将招募能够在没有监督的情况下安全地增加活动的额外的心脏代谢风险。 参与者将被随机分配到一个积极的控制（接受商业手腕佩戴的身体活动， 跟踪器; PAT）或基于社会认知理论的在线干预（3个月的每周会议和9个月的每周会议）。 月维护）加PAT。主要结局将包括平均步数/天的变化， 达到150分钟/周活动目标的百分比;将在6个月和12个月随访时对其进行评估。 次要结果将包括体重、腰围、血压、空腹血糖、胰岛素， 胆固醇、甘油三酯和患者报告的结局，包括自我效能、生活质量、成本和 体验/满意度参与者使用在线平台和跟踪工具的统计数据，参与者 态度/信念，以及对保养策略的意见。我们将利用真实的 通过检查PA水平变化与重要心脏代谢指标之间的关联， 临床测量的结果，并通过识别预测患者特征的EHR指标 PA水平的变化。将考虑处理缺失数据的方法。目标2的目标是发展 将PAT数据添加到基于Epic的电子健康记录（EHR）的程序建议。 通过EHR与临床团队沟通患者PA水平，使用现有的PAT具有价值，但 在如何实现这一点上没有达成共识。我们将与主要利益相关者合作， 考虑到卫生专业人员、卫生系统 研究人员和患者。这些目标的完成将提供试点数据，为今后的发展努力提供信息， 可行的，有效的PA转诊计划，可以与临床护理协调，并将建立重要的 合作关系和相关的务实审判技能。

Inadequate physical activity (PA) is considered a major risk factor for cardiometabolic disease. Clinical recommendations endorse achieving healthy PA levels in the primary prevention of cardiovascular disease and type 2 diabetes. The need for wider reaching primary prevention efforts with increasing PA levels as a “central element” has been suggested by previous studies. PA improvement programs integrated with clinical practice have the potential to reach a large number of at-risk individuals. Although a framework for clinician identification and treatment of people with low PA levels has been developed by the American College of Sports Medicine (ACSM), and clinical PA referral is now endorsed by the American Heart Association (AHA), the practice of identifying and addressing inadequate PA is not common in clinical practice. This proposal aims to improve important aspects of clinical PA referral for primary care patients with low PA and additional cardiometabolic risk factors. Aim 1 of the proposal will determine the efficacy of an inexpensive, convenient, evidence-based online intervention for improving PA levels that is appropriate for adult patients not meeting the US aerobic PA goal of 150 minutes/ week of moderate-vigorous intensity (e.g., brisk walking) PA who also have at least one other common cardiometabolic risk factor (high blood pressure, elevated glucose levels, and/or overweight/obesity). Adult primary care patients (n=54; aged 40-70) meeting the criteria for low PA and additional cardiometabolic risk who can safely increase activity without supervision will be recruited. Participants will be randomized to an active control (to receive a commercial wrist-worn physical activity tracker; PAT) or an online social-cognitive theory-based intervention (3 months of weekly sessions and 9 months maintenance) plus PAT. Primary outcomes will include the change in average step counts/day and percentage meeting the 150 minutes/week activity goal; they will be assessed at 6 and 12 months of follow-up. Secondary outcomes will include body weight, waist circumference, blood pressure, fasting glucose, insulin, cholesterol, triglycerides, and patient-reported outcomes including self-efficacy, quality of life, cost, and experience/satisfaction. Statistics on participant usage of the online platform and tracking tools, participant attitudes/beliefs, and opinions regarding maintenance strategies, will also be collected. We will leverage real world evidence by examining associations between changes in PA levels and important cardiometabolic outcomes that are measured clinically and by identifying EHR measures of patient characteristics that predict changes in PA levels. Methods for dealing with missing data will be considered. The goal of Aim 2 is to develop procedural recommendations for adding PAT data to an Epic-based electronic health record (EHR). Communicating patient PA levels with clinical teams through the EHR, using existing PATs holds value, but there is no consensus on how to accomplish this. We will engage key stakeholders in developing an interdisciplinary set of procedures that considers the needs of health professionals, health systems, researchers, and patients. Completion of these aims will provide pilot data to inform future efforts to develop feasible, effective PA referral programs that can be coordinated with clinical care and will build important collaborative relationships and skills relevant to pragmatic trials.