Caregiver Stress: Interventions to Promote Health and Wellbeing

More and more family members are providing care to their loved ones with prolonged and
progressive illnesses. Chronic intense caregiving represents a situation of chronic stress,
which takes a toll on one's mental and physical health including an increased risk for the
development or worsening of heart disease. Identification of effective self-care
interventions for family caregivers is warranted to improve their emotional wellbeing and
minimize the harmful effects of chronic stress on the heart. This Program Project Grant aims
to promote health and reduce cardiovascular risk in family caregivers (FCG) of persons with
chronic illness. In two studies the investigators will test two interventions,
psycho-education(ED) and physical exercise(EX), individually and in combination. The first
study will target FCG of African American dementia patients; the second will focus on FCG of
heart failure patients. Parallel designs, interventions and measures will create synergy as
will integration of all data management and analyses within a Bio-behavioral Science and
Measures Core. This Core will also provide high level guidance and interpretation of model
testing resulting from analysis of the common data set. The combined de-identified data set
will allow for elucidating the biological mechanisms of stress-induced cardiovascular risk,
further developing the model, and stimulating future research, while the shared core support
will provide substantial efficiency; neither could be achieved outside of a Program Project
approach. These collective efforts will generate important data whereby future care can
significantly enhance the lives of FCG and minimize their risk of cardiovascular disease,
the number one cause of disability and death in the United States.

We hypothesize that FCGs who receive the combined PSYCHED+EX intervention will have better
psychological functioning (lower levels of depressive symptoms, anxiety, and caregiver
burden and higher levels of flourishing), behavioral outcomes (improved sleep quality and
greater physical function), cardiovascular risk measures (improved resting heart rate, blood
pressure, heart rate recovery, oxygen consumption, lipids, glucose, and inflammatory
markers), neuroendocrine function (salivary cortisol) and overall health outcomes (improved
function, muscle strength, and endurance) compared to psycho-education and usual
care-attention control from baseline to six months later mediated by improvements in process
outcomes (lower perceived stress and higher self-efficacy).