Tuesday, November 29, 2022
11/29/2022
Project Summary/Abstract Background: Cardiovascular disease (CVD) remains the number one cause of death in the U.S. Physical inactivity is a modifiable CVD risk factor, but the majority of adults are not assessed and receive no counseling on engaging in physical activity (PA) by their healthcare provider (HCP). This leaves physical inactivity as the only major CVD risk factor not routinely addressed. Promotion of PA by HCPs is endorsed by the American Heart Association. Therefore, the purpose of this feasibility study is to implement the standardized assessment promotion and monitoring of PA in the clinic setting. Specifically, the two aims of this study are to: test the preliminary clinical efficacy of a PA promotion intervention on patients' cardiovascular risk profile (PA, cardiorespiratory fitness, BMI, waist circumference, blood pressure, lipids, and Framingham Heart Study Risk Score); and to evaluate the implementation of the PA promotion intervention. Methods: Participants will be adult patients (>18 years) being seen in a preventive cardiology clinic. PA will be assessed using the 3- question validated Physical Activity Vital Sign: “1) “On average, how many days per week do you engage in PA or exercise?”; 2) “On average, how many total minutes of PA or exercise do you perform on those days?”; and 3) “Describe the intensity of your PA or exercise (light=casual walk, moderate=brisk walk, or vigorous=jogging)”. An automated decision support will alert the HCPs to patients achieving less than 50% of current recommended levels of PA, and generate an automated PA recommendation. Recommendation options will include a referral for cardiac rehabilitation for eligible patients, or recommendations to increase duration and/or intensity of PA. Patients will receive a written summary of their PA vital sign with recommendations. Participants in the study will receive an activity tracker to monitor their PA for three months which will be electronically integrated into their electronic health record for ongoing monitoring. Data analysis will include assessing the preliminary efficacy of the intervention on CVD risk factors (comparing baseline to follow-up) and performing a detailed process evaluation of the implementation based on the RE-AIM framework (assessing the intervention's reach, efficacy, adoption, implementation, and maintenance). Findings from this study may be used to establish routine assessment, promotion and monitoring of PA using existing technology. The study significance is its potential to standardize “assess, promote, and monitor PA” in diverse clinical settings. Future implications are widespread use of this standard protocol, which may positively impact this prevalent risk factor for CVD. Career Development Plans: The long-term goal of the training plan is to prepare the candidate for a research career based in informatics, implementation science, clinical trials, and behavior change interventions aimed at reducing CVD risk through improved levels of PA. The immediate goals of this training plan are to provide the candidate with hands-on experiential learning in developing, implementing and assessing a technology-based PA decision support tool.
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