Project Summary/Abstract Physical activity (PA) is a cornerstone of secondary prevention after an acute coronary syndrome (ACS) with associated improvements in cardiovascular risk, morbidity, and mortality. Unfortunately, over 80% of these cardiovascular patients remain sedentary after an event. Participation in cardiac rehabilitation programs is poor, and long-term adherence to PA remains problematic. There is a critical need for the development of novel exercise programs to improve PA in this high-risk patient population. Tai Chi (TC) is a multi-dimensional intervention that integrates low-moderate intensity physical exercise with meditative components that have been shown to improve important self-regulatory skills and cognitive- behavioral determinants of behavior change, such as self-efficacy, motivation, and emotional health. Because it is delivered in a class format, TC also fosters social support. Preliminary evidence suggests that TC may positively impact PA and selected cardiovascular risk factors. TC is an attractive exercise option for ACS survivors, who are often sedentary or deconditioned. There is also growing evidence supporting the use of wearable technology (e.g., Fitbit) as an effective behavioral strategy to promote PA. Wearable devices can utilize evidence-based techniques such as individualized goal setting and feedback in increasing motivation and self-efficacy for exercise. In patients with cardiometabolic disease, the addition of wearable technology to structured exercise has been promising to increase moderate-vigorous PA and improve cardiovascular risk. This application leverages our prior work with TC to promote PA among sedentary ACS survivors, experience with remote delivery of group-based TC, and experience combining mind-body exercise with wearables (Fitbit). We propose a multi-site feasibility study as a necessary step in preparation for a future, fully-powered trial investigating the efficacy of a multi-modal intervention (TC+Wearable) that combines virtual, group TC classes with an individual wearable device to support overall PA, and thus impact downstream cardiometabolic risk. The specific aims are: 1) To assess feasibility of a multi-site randomized controlled trial of TC+Wearable plus enhanced usual care (with cardiovascular risk factor education materials) vs. enhanced usual care alone among inactive ACS survivors. Feasibility measures will include recruitment and retention; intervention acceptability, adherence, and fidelity; and coordination/management of multi-site data collection. Patient- centered outcomes will include accelerometry-assessed PA and sedentary time, cognitive-behavioral constructs (self-efficacy, intrinsic motivation, awareness, anxiety/depression, stress), and cardiometabolic measures (exercise capacity, weight, lipids, blood pressure, glucose). 2) To obtain qualitative feedback from multiple stakeholders to inform future study conduct. We will engage patients, providers, and TC instructors in interviews/focus groups on acceptability of TC+Wearable (content, facilitators/barriers, integration of TC and device); technical aspects of remote delivery; and openness for future provider and TC instructor engagement.

Project Narrative Physical activity is an important component in the secondary prevention of cardiovascular morbidity in individuals after an acute coronary syndrome. Two promising approaches to promoting physical activity include 1) Tai Chi exercise that is suitable for sedentary individuals, and 2) wearable technology that tracks and provides feedback of activity. This application investigates an intervention that combines remote Tai Chi exercise classes with a Fitbit to promote an increase in overall physical activity that has the potential to significantly impact cardiovascular risk and morbidity in high-risk individuals.