Physical activity is an important modifiable behavior that has enormous impacts on chronic cardiopulmonary health. Chronic obstructive pulmonary disease (COPD) and chronic heart failure (HF) are similar systemic syndromes. Both populations are often are deconditioned, suffer exercise intolerance and dyspnea, and have co-morbidities such as anxiety, depression, and musculoskeletal limitations. Both are notoriously difficult to engage in and sustain physical activity. While exercise improves outcomes, current programs are often underutilized and inaccessible, and long term adherence is problematic. There is a robust literature on the benefits of various mind-body exercises for multiple conditions,. Specifically in our studies of tai chi and mind-body breathing for HF and current investigations in COPD, we have shown improvements in quality of life, exercise capacity, mood, physical activity, with data suggesting that self-efficacy may be an important factor to facilitate long term behavioral change. There is also a growing body of literature examining use of emerging web-based technology to promote healthy habits. While there is interest in intervention delivery modalities that are home-based or use web-based forums, this area of mind- body exercise is much less studied. We have previously developed a conventional web-based physical activity intervention which includes an online interactive platform, providing physical activity feedback from a pedometer, individualized graphs of progress, motivational and educational content, and a community forum for social support. While this intervention increases physical activity in the short term, we have seen that in patients with COPD, this benefit wanes by12 months. Further novel strategies to address long term adherence to physical activity in both COPD and HF are still needed. We plan to address this gap by leveraging our experience in both mind-body therapies and web-based physical activity intervention delivery. In this proposal, we will adapt the existing conventional web-based intervention to incorporate mind- body principles and mind-body exercise, to develop a novel, multimodal physical activity intervention for COPD and HF (?Mindful Steps?). Through the integration of mind-body exercise, this interactive online platform will support mind-body practice and promote the incorporation of mindfulness into daily activities (e.g., mindful walking.) Based on established behavioral theories, we propose that the enhanced intervention may better facilitate overall and exercise-related self-efficacy. Our overarching goal will be test this intervention in a future randomized clinical trial (as compared to the existing conventional intervention and to usual care) to increase self-efficacy and long-term physical activity adherence.
The aims of this R34 grant are 1) to adapt the existing web-based physical activity intervention with an emphasis on mind-body principles and couple this platform with in-person mind-body exercise training and 2) to test delivery of this multimodal intervention (?Mindful Steps?) in a randomized feasibility trial (N=42 total) with usual care control in patients with COPD and HF.
Physical activity is an important modifiable behavior that has enormous impacts on the health of persons with chronic lung and heart disease. An interactive, educational and motivational online platform which emphasizes mindful movement, together with in-person mind-body exercise classes, may be helpful to increase confidence to exercise and promote long-term physical activity.