Using a randomized clinical trial with 3 groups, we will conduct a head-to-head evaluation of two different theoretically-based interventions, SystemCHANGE and CHANGE+, as compared to Usual Care to improve the adoption and maintenance of exercise in older cardiac patients. SystemCHANGE, a novel intervention that focuses on environmental change uses System Improvement strategies to increase exercise, will be compared to CHANGE+ (an intervention based on contemporary cognitive behavioral strategies). Study questions are: (1) Is there a difference between SystemCHANGE, CHANGE+, and Usual Care in exercise adoption when controlling for covariates (age, race, functional capacity, body fat, co- morbidity, muscle or joint pain, exercise experience, home and neighborhood environment, and depression), for individuals following a cardiac rehabilitation program (CRP)? (2) Is there a difference between SystemCHANGE, CHANGE+, and Usual Care in exercise maintenance when controlling for covariates? (3) Do system changes, social support for exercise, problem-solving skills, motivation, health beliefs, and exercise self-efficacy mediate the effects of SystemCHANGE, CHANGE+, or Usual Care on exercise adoption? (4) Do system changes, social support for exercise, problem-solving skills, motivation, health beliefs, and exercise self-efficacy mediate the effects of SystemCHANGE, CHANGE+, or Usual Care on exercise maintenance? (5) What are the economic impacts of the SystemCHANGE and CHANGE+ interventions in terms of health care spending, labor force participation and earnings, and household productivity? Older persons (N=420) recovering from cardiac events will be randomly assigned to the three groups. Measures of exercise adoption and maintenance (# of hours exercised, # of hours exercised in target heart rate zone, # of exercise sessions, # of metabolic equivalents {METS} expended, and whether or not a subject remains exercising) will be taken for 1 year after completion of a CRP using heart rate wristwatch monitors, exercise diaries, and a 7-Day Recall Survey. The effect of covariates also will be assessed. Mechanisms by which the interventions achieve their effects will be determined. Multivariate analyses will examine and compare the effects of the interventions over time. A cost-effectiveness analysis also will be conducted. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL084767-02
Application #
7258413
Study Section
Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
Program Officer
Cooper, Lawton S
Project Start
2006-07-10
Project End
2010-03-31
Budget Start
2007-04-01
Budget End
2008-03-31
Support Year
2
Fiscal Year
2007
Total Cost
$683,033
Indirect Cost
Name
Case Western Reserve University
Department
Type
Schools of Nursing
DUNS #
077758407
City
Cleveland
State
OH
Country
United States
Zip Code
44106
Wright, Kathy D; Moore-Schiltz, Laura; Sattar, Abdus et al. (2018) Does Lifestyle Exercise After a Cardiac Event Improve Metabolic Syndrome Profile in Older Adults? J Cardiovasc Nurs 33:E1-E9
Moore, Shirley M; Jones, Lenette; Alemi, Farrokh (2016) Family self-tailoring: Applying a systems approach to improving family healthy living behaviors. Nurs Outlook 64:306-311
Alemi, Farrokh; Zargoush, Manaf; Erdman, Harold et al. (2011) Genetic markers anticipate response to citalopram in a majority of patients. Psychiatr Genet 21:287-93
Alemi, Farrokh; Erdman, Harold; Griva, Igor et al. (2009) Improved Statistical Methods are Needed to Advance Personalized Medicine. Open Transl Med J 1:16-20
Alemi, Farrokh; Moore, Shirley; Baghi, Heibatollah (2008) Self-experiments and analytical relapse prevention. Qual Manag Health Care 17:53-65