Cardiovascular Behavioral Medicine

Wii ♥ Fitness: Study One

The primary goal of this pilot study is to examine the feasibility, acceptability and preliminary efficacy of a supervised program of exergames on markers of physical fitness and cardiovascular disease risk. Sedentary, prehypertensive adults will participate in a 12-week exergame program using Nintendo's Wii gaming platform. A trained research assistant will supervise all exercise sessions in which heart rate will be monitored throughout each session. Assessments will include measures of feasibility (e.g., attendance, study completion), acceptability (e.g., enjoyment, satisfaction), physical fitness, and cardiovascular disease risk (blood pressure, resting heart rate). Our primary outcomes are the feasibility and acceptability of using the Wii to meet the national recommendations for physical activity. Secondary outcomes include changes in fitness and cardiovascular risk indices. We will use descriptive techniques and repeated measures analyses to examine the within-group changes from pre- to post-intervention. If study hypotheses are supported, additional funding will be sought to rigorously test whether exergames are a viable physical activity program that provides enjoyment and variety to individuals at risk for hypertension and/or CVD.

Principal Investigators:Beth Bock, PhD and Eva Serber, PhD

Co-Investigators: Joe Ciccolo, PhD and Peter Tilkemeier, MD

Funding Agency: The Centers for Behavioral and Preventive Medicine and the Rhode Island Foundation

Dates: 2009-2011

Hemodynamic and Cognitive Function in Cardiovascular Disease

The goal of this project is to use functional magnetic resonance imaging (fMRI) and arterial spin labeling (ASL) to examine how cardiovascular disease (CVD) affects cognitive function and the measurement of brain function. CVD is associated with cognitive deficits; however, it is not understood how abnormal cardiac output associated with severe CVD leads to impaired cognitive function. A potential decoupling of neural demands and observed blood oxygenation level-dependent (BOLD) response needs to be examined to address validity and reliability of fMRI among this population. We will directly examine these possibilities by assessing systemic cardiovascular function, cerebrovascular hemodynamic functions, and cognitive performance among elderly patients with severe CVD and a cohort of age-matched controls. We predict that BOLD response will be diminished during all conditions among the CVD group, and that a significant portion of this reduction will be attributed to vascular hypoperfusion.

Principal Investigators: Ronald Cohen, PhD (Subcontract) and Lawrence Sweet, PhD (Project PI)

Funding Agency: National Heart, Lung, and Blood Institute

Dates: 2007 - 2011

Cognitive Benefits of Cardiac Rehabilitation in Heart Failure

The main goal of this project is to study CVD and its effects on the brain, and particularly how cardiac rehabilitation and the effects of vascular conditioning are influenced by the vascular CVD and systemic vascular disease factors.

Principal Investigators: Ron Cohen, PhD (Subcontract) and John Gunstad (Project PI)

Funding Agency: National Heart, Lung, and Blood Institute

Dates: 2008 - 2012


Biobehavioral Studies of Cardiovascular Disease

This study is designed to examine the biobehavioral predictors of cardiovascular risk factors and disease.

Principal Investigators:Jeanne McCaffery, PhD (Subcontract) and Stephen B. Manuck, PhD (Project PI)

Funding Agency: National Heart, Lung, and Blood Institute

Dates: 2007 - 2012

Maintaining Exercise after Cardiac Rehabilitation

Maintaining exercise participation among patients who have completed cardiac rehabilitation is integral to secondary prevention of coronary events and cardiac re-hospitalization. To promote exercise maintenance after completion of a 12 week Phase II rehabilitation program, we propose to offer a theoretically-based intervention that we have used successfully to promote exercise among older, primary-care patients. This program (maintenance counseling) includes brief advice from the cardiac rehabilitation case manager at Phase II program discharge followed by telephone-counseling based on the Transtheoretical Model of Behavior Change and Social Cognitive Theory. Using a randomized controlled design, 180 patients will be assigned to maintenance counseling or brief advice plus contact control. Outcome assessments will include an exercise tolerance test (baseline/post-rehabilitation and 6 months), self-reported exercise participation, motivational readiness for exercise, and objective activity monitoring at baseline, 6 and 12 months. These data will help to identify whether telephone-based exercise counseling is an effective strategy for sustaining regular exercise and fitness among cardiac rehabilitation patients, thereby contributing to secondary prevention of coronary heart disease.

Principal Investigator:Bernardine Pinto, PhD

Co-Investigators: Michael Goldstein, MD; George Papandonatos, PhD; Bess Marcus, PhD; John Todaro, PhD; Peter Tilkemeier, MD

Funding Agency: National Heart, Lung, and Blood Institute

Dates: 2004 - 2010

Cardiac Autonomic Regulation Enhancement through Exercise (CARE-E) Trial

This project examines the feasibility, acceptability, and short-term efficacy of a randomized clinical trial examining a 3-month supervised exercise intervention compared to a heart healthy education intervention, designed specifically for patients with implantable cardioverter defibrillators (ICD) with the primary aim of estimating an effect size for change in parasympathetic activity. Other aims of this study are examining: (1) intervention effects on the frequencies of arrhythmias and ICD therapies, and (2) parasympathetic function in relation to changes in exercise tolerance. The study will also examine changes in psychological well-being and quality of life from pre- to post- intervention (3-months), and short-term follow-up (6-months).

Principal Investigator: Eva R. Serber, PhD

Co-Investigators: Alfred Buxton, MD; Bess Marcus, PhD; Ray Niaura, PhD; Peter Tilkemeier, MD; John Todaro, PhD

Funding Agency: National Heart, Lung, and Blood Institute

Dates: 2008 - 2011

Training in Behavioral and Preventive Medicine (T32 HL076134)

The primary goal of the T32 Training Program is to train postdoctoral fellows to conduct research related to changing behavior to reduce the burden of cardiovascular disease (CVD). The Brown University Centers for Behavioral and Preventive Medicine (CBPM) provides a wealth of research training experiences to address the most prominent lifestyle risk factors for CVD: cigarette smoking, adverse diet, obesity, and physical inactivity. Specifically, there are opportunities to learn to use multidisciplinary approaches to treat healthy and medically ill populations (e.g. individuals with diabetes; participants in cardiovascular rehabilitation programs), deliver services in unique settings (e.g., emergency departments, neonatal intensive care units, after cardiovascular procedures) and use innovative channels of delivery (Internet, telephone, print) to more efficiently disseminate interventions. There are ongoing collaborations between behavioral researchers at the CBPM and faculty in the Brown department of medicine and department of community health. Currently funded clinical trials evaluate the effect of behavior change on cardiovascular endpoints, studies of genetic and environmental contributions to health behaviors and CVD, and projects assessing the role of psychosocial factors in cardiovascular disease and adherence to behavior change recommendations.

The strength and competitiveness of the research and training programs in the CBPM attract outstanding candidates for research fellowships. Program faculty have an outstanding history of successful mentoring. Our aim will be to recruit three fellows each year, with two MD fellows recruited over the project. Training will be highly individualized with all fellows developing excellent core competencies in areas such as CVD epidemiology, clinical trials related to behavioral risk factors and research skills. Fellows will also develop a complementary set of specialized competencies specific to their area of research (i.e., tobacco use, obesity, or physical activity). A formal curriculum includes both formal didactics (i.e., coursework and seminars) and mentored research experiences. The mentoring team will be headed by a senior behavioral scientist; with a physician or population scientist and a junior faculty member as secondary mentors.Individual training plans, constructed with the fellow's unique training needs in mind, outline the competencies, mentoring arrangement, training activities, and objectives for each fellow.

Principal Investigator and Director:Rena Wing, PhD

Co-Investigators and Co-Directors: Justin Nash, PhD and Bess Marcus, PhD

Co-Investigator: Jeanne McCaffery, PhD

Funding Agency: National Heart, Lung, and Blood Institute

Dates: 2006 - 2011