The proposed research seeks to determine whether virtual coaching and social supportfocusing on key social cognitive factors will be an effective strategy for maintainingphysical activity (PA) after completing cardiac rehabilitation (CR). Despite thewell-documented benefits of CR, only 15-50% of individuals continue to exercise 6 monthsafter completing CR.4-6 Thus, after 36 sessions (typically 12 weeks), many patients areleft without the support necessary to sustain physical activity (PA) and prevent adversesecondary cardiac events. Though previous research has explored interventions to sustainPA after CR, many studies have been lacking in a theoretical basis, objective measurementof PA, measurement, and analysis of psychosocial and social cognitive factors, andlong-term impact on clinical outcomes. Low-cost, pragmatic approaches to maintaining PAafter CR is urgently needed for older adults, and virtual technologies offer promisingsolutions to promote adherence to PA. The three specific aims of the project are to: 1)determine the effect of virtual coaching and social support on adherence to PA (measuredby objective step counts) in the intervention vs. control groups; secondary measures willbe amount of sedentary time, functional fitness, and self-reported exercise; 2) determinethe effect of virtual coaching and social support on psychosocial and social cognitivefactors in the intervention vs. control groups; 2a) evaluate the extent to whichpsychosocial and social cognitive factors mediate the effect of the intervention on PAadherence; 3) examine differences in cardiovascular (CVD) risk factors (blood pressure,lipids, HbA1c, BMI) between groups.
The investigators propose a randomized clinical trial in which the "STRIVE" control group
will receive the Trainerize mobile app for (1) daily self monitoring of exercise, blood
pressure, and weight; (2) education via weekly text messages; and (3) assigned monthly
videos on various health topics. The "STRIVE +" intervention group will receive the same
app for self-monitoring and education via text messages as the control group PLUS
individually-tailored virtual coaching with goal-setting and social support/networking.
Our specific aims are to:
Aim 1: Determine the effect of virtual coaching and social support on adherence to
physical activity (PA; measured by objective step counts) in the intervention vs. control
groups; secondary measures will be amount of sedentary time, functional fitness, and
self-reported exercise.
Hypothesis 1: The intervention group will have more PA steps and self-reported exercise,
less sedentary time, and higher functional fitness compared to the control group.
Aim 2: Determine the effect of virtual coaching and social support on psychosocial and
social cognitive factors in the intervention vs. control groups.
Hypothesis 2: The intervention group will have lower depression/loneliness and higher
self-efficacy/perceived social support compared to the control group.
Aim 2a: Evaluate the extent to which psychosocial and social cognitive factors mediate
the effect of the intervention on PA adherence. Hypothesis 3: Lower depression/loneliness
and higher perceived social support will mediate the effect of the intervention on PA
adherence.
Aim 3: Examine differences in CVD risk factors (blood pressure, lipids, HbA1c, BMI)
between groups. H: The intervention group will have better control of risk factors at 6,
12, and 18 months compared to control.
Behavioral: Virtual Coaching and social support
The investigators propose a randomized clinical trial (RCT) of a virtual coaching and
social support intervention that integrates evidence- and theory-based approaches to
build self-efficacy, self-regulation, and perceived social support after cardiac
rehabilitation (CR) to improve physical activity, psychosocial, social cognitive, and
clinical outcomes, delivered via a social networking platform (Trainerize). Our
intervention will also include goal setting for exercise and tailored feedback by our
qualified intervention team.
Study population: We will recruit 286 older adults who are 55 years and older with
qualifying diagnoses for cardiac rehabilitation (CR).
Inclusion Criteria:
1. ≥ 55 years of age
2. History of CVD that qualified patient for CR (myocardial infarction, percutaneous
coronary intervention, coronary artery bypass grafting, heart failure, valve
replacement, etc.)
3. Adherence (>50% of sessions for ≥1 month) to outpatient Phase II CR and pending
completion
Exclusion Criteria:
1. Participation in Phase III CR (optional extended CR after outpatient Phase II CR for
those who pay out-of-pocket)
2. Cognitive impairment (per Mini-Cog assessment tool with score 0-2)
3. Lack of English or Spanish proficiency/literacy
4. Clinical conditions including:
1. Unstable arrhythmias, aortic stenosis, thrombophlebitis, dissecting aneurysm or
symptomatic anemia
2. Active infection
3. Uncontrolled hypertension: resting systolic >180 mmHg, diastolic >100 mmHg
4. Decompensated heart failure, NYHA Class III-IV
5. Current unstable angina
6. 2nd or 3rd degree heart block or exercise induced arrhythmias
University of California, San Francisco
San Francisco, California, United States
Investigator: Julia von Oppenfeld
Contact: 415-676-1153
julia.vonoppenfeld@ucsf.edu
Julia von Oppenfeld
415-676-1153
julia.vonoppenfeld@ucsf.edu
Linda Park, PhD, NP, Principal Investigator
University of California, San Francisco