Mindful Steps: A Web-Based Mind-Body Exercise Intervention to Promote Physical Activity in Chronic Cardiopulmonary Disease

体力活动(PA)是一种重要的可改变的行为，对慢性 心肺健康。慢性阻塞性肺疾病(COPD)和心力衰竭(HF)相似 一种全身性症状，患者经常脱离条件，出现运动不耐受和呼吸困难。 重要的是，这些患者都有极高的久坐行为风险，这预示着不良结局。 虽然PA在疾病管理方面是最重要的(在运动能力、生活质量和 住院)现有的锻炼计划未得到充分利用和难以获得，并且长期坚持 PA是一个普遍存在的问题。迫切需要新的策略来增加这些人群的PA。 近年来，人们对使用互联网/技术中介干预的兴趣迅速增长。 促进慢性病人群健康行为的改变。我们之前的工作调查了一个基于Web的 PA平台，带有激励和教育内容，加上可穿戴的个性化步进跟踪器 显示心肺疾病患者短期内PA升高的STEEP目标。在 与此同时，也有越来越多的关于身心锻炼对健康有益的文献。 行为改变。在心力衰竭和慢性阻塞性肺疾病方面，我们已经显示出生活质量、运动能力和PA的改善， 数据表明，自我效能感可能是促进长期行为改变的一个重要因素。 在之前资助的NIH发展基金(R34AT009354)中，我们利用了我们在网络- 以PA干预为基础，结合我们在心身治疗方面的专业知识，开发一种新的多模式 对慢性阻塞性肺疾病和心力衰竭患者的干预(注意步骤)，以促进PA的长期依从性。我们的 理论模型假设，心身课程的整合增强了关键的行为结构 现有的干预措施还针对新的领域，这些领域将导致自我效能感的增强和增加， 持续的PA。在一项试点研究中，我们论证了研究的可行性(招聘、保留、全远程数据 以及干预的可行性/可接受性(包括在线的同步心身课程)。 在这个R01中，我们建议下一步RCT(N=136)来测试正念步骤的有效性，与 常规护理，促进慢性阻塞性肺疾病和/或心力衰竭患者的PA(客观地通过每日步数测量) (主要目标)。次级目标将在我们的理论模型中检查认知-行为测量(自我 锻炼和疾病管理的有效性、内在动机、正念、内感意识) 和以患者为中心的临床结果(疾病特有的生活质量、运动参与度、呼吸困难、 疲劳)。将技术与传统的身心锻炼原则相结合，专注的步骤强调整体 与NCCIH的战略优先事项非常一致的人员方法。基于一个令人信服的理由和 严格的可行性数据，更大规模的远程疗效试验是评估这一点的下一步 可访问的、基于网络的PA干预，可能会在COPD和HF方面提供更广泛的影响。

Physical activity (PA) is an important modifiable behavior that has enormous impacts on chronic cardiopulmonary health. Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are similar systemic syndromes where patients are often deconditioned and suffer exercise intolerance and dyspnea. Importantly, these patients share a dramatically high risk of sedentary behavior that portend poor outcomes. While PA is paramount in disease management (with improvements in exercise capacity, quality-of-life, and hospitalizations) available exercise programs are underutilized and inaccessible, and long-term adherence to PA is universally problematic. Novel strategies to increase PA in these populations are greatly needed. In recent years, there is rapidly emerging interest in use of internet/technology-mediated interventions to promote health behavior change in chronic disease populations. Our prior work investigated a web-based PA platform with motivational and educational content coupled with a wearable step tracker with individualized step goals that demonstrated increases in PA in patients with cardiopulmonary disease in the short term. At the same time, there is also a growing and robust literature on the benefits of mind-body exercise for health behavior change. In HF and COPD, we have shown improvements in quality-of-life, exercise capacity, and PA, with data suggesting that self-efficacy may be an important factor to facilitate long-term behavior change. In a previously funded NIH developmental grant (R34AT009354) we leveraged our experience in web- based PA interventions together with our expertise in mind-body therapies to develop a novel multi-modal intervention (Mindful Steps) for patients with COPD and HF to foster longer-term PA adherence. Our theoretical model posits that the integration of a mind-body curriculum enhances key behavioral constructs in the existing intervention and also targets new areas that will lead to enhanced self-efficacy and increased, sustained PA. In a pilot study, we have demonstrated study feasibility (recruitment, retention, all-remote data collection), and intervention feasibility/acceptability (including online, synchronous mind-body classes). In this R01, we propose the next step RCT (N=136) to test the efficacy of Mindful Steps, compared to usual care, to promote PA (objectively measured by daily step counts) in patients with COPD and/or HF (primary aim). Secondary aims will examine cognitive-behavioral measures within our theoretical model (self- efficacy for exercise and for disease management, intrinsic motivation, mindfulness, interoceptive awareness) and patient-centered clinical outcomes (disease-specific quality of life, exercise engagement, dyspnea, fatigue). Coupling technology with traditional mind-body exercise principles, Mindful Steps emphasizes a whole person approach that aligns well with NCCIH’s strategic priorities. Based on a compelling rationale and rigorous feasibility data, a larger-scale remotely-delivered efficacy trial is the next step in evaluating this accessible, web-based PA intervention that may provide broader reach in COPD and HF.