Development of a Tai Chi Program to Overcome Barriers to Cardiac Rehabilitation

描述（由申请人提供）：心脏康复计划（CRP）降低急性冠状动脉事件或血运重建术恢复患者的总体死亡率和心血管死亡率。可改变的冠状动脉危险因素，如缺乏运动、超重和高血脂水平也在crp后得到改善。然而，目前只有30%的患者参加了CRPs，损耗率可能达到60%。障碍包括年龄较大、女性、害怕或不喜欢CRP中提出的运动训练类型、缺乏社会支持、抑郁和远离CRP中心。显然，有必要根据那些目前没有参加现有课程的人的特点和需求制定专门的课程。太极拳是一种以轻度/中度有氧运动为基础的身心干预，伴随着冥想的成分，它可以改善久坐不动的老年人的有氧能力，也可以改善心力衰竭患者的运动自我效能、生活质量和情绪。老年人和身体状况不佳的人可以安全地练习太极拳；它不需要任何特殊的设备，可以在任何时间和地点进行。由于太极拳通常是团体教学，即使对高危患者也是安全的，因此它已成功地在社区中心提供，从而克服了交通障碍并限制了成本。所有这些特征表明，太极拳可以克服传统CRP的多重障碍，可以作为不愿参加传统CRP的患者的替代干预措施。我们的长期目标

DESCRIPTION (provided by applicant): Cardiac rehabilitation programs (CRP) reduce overall and cardiovascular mortality in patients recovering from acute coronary events or revascularization procedures. Modifiable coronary risk factors such as physical inactivity, overweight and high serum lipid levels also improve after CRPs. However, only 30% of patients currently enroll in CRPs and attrition may reach 60%. Barriers include older age, female gender, fear or dislike for the type of exercise training proposed in CRPs, lack of social support, depression and distance from CRP center. Clearly, there is a need to develop programs tailored to the characteristics and needs of those who do not attend presently available programs. Tai Chi, a mind-body intervention based on light/moderate aerobic exercise accompanied by meditative components, has improved aerobic capacity in older sedentary adults as well as exercise self-efficacy, quality of life and mood in patients with heart failure. Tai Chi can be practiced safely by elderly and deconditioned individuals; it does not require any particular equipment and it may be performed at any time and place. Since Tai Chi is usually taught in groups, and is safe even in high-risk patients, it has been successfully offered in community centers thus overcoming transportation barriers and limiting costs. All these characteristics indicate that Tai Chi may overcome multiple barriers to traditional CRP and could be proposed as an alternative intervention for patient unwilling to attend traditional CRPs. Our long-term goal is conduct a phase III randomized clinical trial (RCT) to determine the efficacy of Tai Chi in improving overall physical activity in patients with recent coronary events or procedures that are unable or unwilling to attend traditional CRPs. The objectives of this treatment development study are to define the content, optimal dose, feasibility and safety of a Tai Chi intervention in this new population and to optimize the design of the future RCT. Specifically, (aim 1) we will use a modified Delphi technique to develop a Tai Chi intervention tailored to the specific rehabilitative needs of patients with recent coronary events or procedures that are unable or unwilling to attend traditional CRPs. Next, (aim 2) we will define the appropriate dose of the intervention by comparing the feasibility, acceptability and safety of two doses of the Tai Chi intervention. 60 patients (30 per dose arm) will be randomized to a "low dose" of Tai Chi (the dose used in our previous studies with heart failure patients) or to a "high dose" matching current recommendations for the frequency and duration of exercise classes in current CRPs. We will obtain estimates of the effect of each dose on physical activity and on the proportion of patients achieving current recommendation for physical activity. Additional outcomes will be body weight, fitness, quality of life, exercise self-efficacy, mindfulness, perceived social suppor, depression and sleep. Measurements will be conducted at baseline, 3-, 6-, and 9- months after enrollment. Lastly, (aim 3) the investigative team will make the final adjustments to the Tai Chi intervention protocol based on findings from the dosing study and will finalize the design of the future RCT.