A Randomized Controlled Trial to Reduce Hopelessness through Enhanced Physical Activity in Adults with Ischemic Heart Disease

摘要 无望与死亡或非致命性心肌梗死的风险增加3.4倍相关 缺血性心脏病(IHD)患者，不受抑郁影响。绝望已经在#年被发现 27-52%的IHD患者在出院后可以持续12个月。无望，一个 对未来的消极展望和无助感，可能是对事件(状态)的暂时反应 或者是一种习惯性的观点(特质)。绝望与身体机能下降和身体机能下降有关 IHD患者的活动度(PA)水平。低水平的PA独立地增加了死亡和 IHD患者的不良事件。IHD患者的PA率继续低到令人无法接受的程度 以医院为基础的心脏康复和家庭环境。绝望往往会使这个问题复杂化。这个 IHD患者的无望感、PA、死亡率和发病率之间的联系尚不清楚。而当 研究已经调查了增加IHD患者PA的策略，我们是唯一一个 设计一种干预措施，特别是在绝望的IHD患者中推广PA。我们的工作，立足于自我 决定论和科恩的压力与应对社会支持理论已经显示出可行性和 结合患者护士和护士的社会支持的激励性干预的初步疗效 和其他促进PA增加的重要因素。这项随机对照试验的目的是建立 我们为期6周的移动健康干预的有效性(心动起来！)在绝望的患者中促进PA增加 和IHD一起。我们将从中西部一家大型社区教学医院招收225名无望的IHD患者。 患者将被随机分为三组之一(每组75人)：1)来自美国的激励性社会支持 护士，2)来自护士的MSS，有额外的重要其他支持(SOS)，或3)注意力控制(AC)。数据 将在基线、8周和24周使用PA加速度计和有效可靠的仪器进行收集 身体和情绪的健康和行为。具体目的是：1)测试6周的有效性 MSS和具有SOS的MSS每天增加中等到剧烈PA的平均分钟数，通过 Actigraph加速计；2)确定每天改变中等到剧烈PA的分钟数对 状态无望感，由状态-特质无望感量表测量；以及3)：决定社会支持是否 (由ENRICHD社会支持量表测量)和动机(由锻炼自我测量 调节问卷)调节心上人的效果！对PA的干预。这项研究的发现 可以通过促进PA重要目标的自我管理来改变对绝望的IHD患者的护理 这可以促进更好的健康结果。这项提议支持NINR在自我管理方面的投资 提高慢性病患者的生活质量。

Abstract Hopelessness is associated with a 3.4 times increased risk of mortality or nonfatal myocardial infarction in patients with ischemic heart disease (IHD), independent of depression. Hopelessness has been identified in 27–52% of patients with IHD and can persist for up to 12 months after hospital discharge. Hopelessness, a negative outlook and sense of helplessness toward the future, can be a temporary response to an event (state) or a habitual outlook (trait). Hopelessness is associated with decreased physical functioning and lower physical activity (PA) levels in individuals with IHD. Low levels of PA independently contribute to increased death and adverse events in patients with IHD. Rates of PA in IHD patients continue to be unacceptably low in both hospital-based cardiac rehabilitation and home settings. Hopelessness frequently compounds this issue. The links among hopelessness, PA, and mortality and morbidity for patients with IHD remain unknown. While research has investigated strategies to increase PA among IHD patients in general, we are the only group to design an intervention to promote PA specifically in hopeless IHD patients. Our work, based on Self Determination Theory and Cohen’s Stress and Coping Social Support Theory, has shown feasibility and preliminary efficacy for a motivational intervention that integrates social support from both the patient’s nurse and significant other to promote increased PA. The purpose of this randomized controlled trial is to establish the effectiveness of our 6-week mHealth intervention (Heart Up!) to promote increased PA in hopeless patients with IHD. We will enroll 225 hopeless IHD patients from a large community teaching hospital in the Midwest. Patients will be randomized (75 per group) to one of three groups: 1) motivational social support (MSS) from a nurse, 2) MSS from a nurse with additional significant other support (SOS), or 3) attention control (AC). Data will be collected at baseline, 8 and 24 weeks using an accelerometer for PA and valid and reliable instruments of physical and emotional health and behaviors. The specific aims are to: 1) test the effectiveness of 6 weeks of MSS and MSS with SOS on increasing mean minutes per day of moderate to vigorous PA, measured by an ActiGraph accelerometer; 2) determine the effects of change in minutes per day of moderate to vigorous PA on state hopelessness, measured by the State-Trait Hopelessness Scale; and 3): determine if social support (measured by the ENRICHD Social Support Inventory) and motivation (measured by the Exercise Self- Regulation Questionnaire) mediate the effects of the Heart Up! intervention on PA. The findings from this study could transform care for IHD patients who are hopeless by promoting self-management of important PA goals that can contribute to better health outcomes. This proposal supports NINR’s investment in self-management to improve the quality of life for individuals with chronic illness.