Adherence of Heart Failure Patients to Exercise
Despite the known problem of poor adherence to exercise in patients with HF, there is unfortunately little evidence for interventions to improve adherence. In a systematic review of controlled studies evaluating interventions to increase initiation and maintenance of exercise, nine studies in 11 papers were reviewed. Only four studies included >100 patients, and five followed patients for ≥ 6 months. Exercise was measured in multiple ways, primarily self-reported (either through recall or by a concurrent diary) frequency of attendance at supervised exercise sessions, frequency of reported exercise, calculated energy expenditure in kcal/kg/day, and minutes spent walking or in exercise sessions. Only one study used an objective measure of distance walked (pedometer), and none of the published papers reported MET h.
In the short term (≤ 6 months), cognitive behavioural strategies such as those used in motivational interviewing, and strategies that enhanced patient self-efficacy for exercise have been successful in increasing exercise in intervention groups by 25–30% compared with controls. These strategies included goal setting, exercise prescriptions, problem-solving, feedback, positive reinforcement, and group interaction, and were primarily part of studies with a clear theoretical framework. Education alone was not effective. No studies showed a significant long-term effect, and adherence declined between 6 and 12 months. From this, it would seem logical that a second dose of the intervention to increase adherence is needed at ~6 months.
Studies are increasingly targeting self-efficacy in undertaking exercise, as it has been shown to predict physical activity in HF and other long-term conditions, and to have positive short-term effects on adherence to exercise in HF. Self-efficacy can be developed through supervised exercise training, peer support and seeing peers undertake exercise, realistic goal setting, and support from family and friends.
Table 4 presents recommendations for clinicians to help patients overcome barriers to exercise.
Overcoming Barriers: What Strategies Work?
Despite the known problem of poor adherence to exercise in patients with HF, there is unfortunately little evidence for interventions to improve adherence. In a systematic review of controlled studies evaluating interventions to increase initiation and maintenance of exercise, nine studies in 11 papers were reviewed. Only four studies included >100 patients, and five followed patients for ≥ 6 months. Exercise was measured in multiple ways, primarily self-reported (either through recall or by a concurrent diary) frequency of attendance at supervised exercise sessions, frequency of reported exercise, calculated energy expenditure in kcal/kg/day, and minutes spent walking or in exercise sessions. Only one study used an objective measure of distance walked (pedometer), and none of the published papers reported MET h.
In the short term (≤ 6 months), cognitive behavioural strategies such as those used in motivational interviewing, and strategies that enhanced patient self-efficacy for exercise have been successful in increasing exercise in intervention groups by 25–30% compared with controls. These strategies included goal setting, exercise prescriptions, problem-solving, feedback, positive reinforcement, and group interaction, and were primarily part of studies with a clear theoretical framework. Education alone was not effective. No studies showed a significant long-term effect, and adherence declined between 6 and 12 months. From this, it would seem logical that a second dose of the intervention to increase adherence is needed at ~6 months.
Studies are increasingly targeting self-efficacy in undertaking exercise, as it has been shown to predict physical activity in HF and other long-term conditions, and to have positive short-term effects on adherence to exercise in HF. Self-efficacy can be developed through supervised exercise training, peer support and seeing peers undertake exercise, realistic goal setting, and support from family and friends.
Table 4 presents recommendations for clinicians to help patients overcome barriers to exercise.
SHARE
