What strategies are effective for exercise adherence in heart failure? A systematic review of controlled studies
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Physical activity is recommended for people with stable heart failure (HF), because it is known to improve quality of life and health outcomes. However, adherence to this recommendation has been poor in many studies. A systematic review was conducted to examine the effectiveness of strategies used to promote exercise adherence in those with HF. The following databases were searched for relevant literature published between January 1980 and December 2010: British Nursing Index; CINAHL; Cochrane Library; Embase; Medline and PsycINFO. Papers with a control group focused on adults with HF that measured exercise or physical activity adherence were included. Nine randomised controlled trials were identified, involving a total of 3,231 patients (range 16–2,331). Six of these studies were informed by specific psychological theories. Positive outcomes occurred in the short-term from interventions using approaches such as exercise prescriptions, goal setting, feedback and problem-solving. However, longer-term maintenance of exercise was less successful. There was some support for interventions underpinned by theoretical frameworks, but more research is required to make clearer recommendations. Addressing self-efficacy in relation to exercise may be a particularly useful area to consider in this respect.
KeywordsControlled trials Exercise adherence Heart failure Physical activity Self-management Systematic review
This project was funded by the Greater Manchester Collaborative Leadership in Applied Health Research and Care (CLAHRC) flexibility and sustainability funding. The work was supported by the Manchester Academic Health Sciences Centre and the NIHR Manchester Biomedical Research Centre.
Conflict of interest
None of the authors have any conflict of interest or financial ties to disclose.
- 2.Davies EJ, Moxham T, Rees K, Singh S, Coats AJS, Ebrahim S, Lough F, Taylor RS (2010) Exercise based rehabilitation for heart failure. Cochrane Database of Systematic Reviews. Issue 4. Art. No.: CD003331. doi: 10.1002/14651858.CD003331.pub3
- 6.Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG et al (2009) 2009 Focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 119:e391–e479PubMedCrossRefGoogle Scholar
- 8.National Clinical Guideline Centre (2010) Chronic heart failure: the management of chronic heart failure in adults in primary and secondary care. National Clinical Guideline Centre, London (retrieved on 21/03/11 from: http://guidance.nice.org.uk/CG108/Guidance/pdf/English)
- 12.Tierney S, Mamas M, Skelton D, Woods S, Rutter MK, Gibson M, Neyses L, Deaton C (in press) What can we learn from patients with heart failure about exercise adherence? A systematic review of qualitative papers. Health PsycholGoogle Scholar
- 13.Joanna Briggs Institute (JBI) (2008) Reviewers’ manual. Joanna Briggs Institute, AdelaideGoogle Scholar
- 14.Barnason S, Zimmerman L, Nieveen J, Schmaderer M, Carranza B, Reilly S (2003) Impact of a home communication intervention for coronary artery bypass graft patients with ischemic heart failure on self-efficacy, coronary disease risk factor modification, and functioning. Heart Lung 32:147–158PubMedCrossRefGoogle Scholar
- 19.Jolly K, Taylor RS, Lip GY, Davies M, Davis R, Mant J, Singh S, Greenfield S, Ingram J, Stubley J, Bryan S, Stevens A (2009) A randomized trial of the addition of home-based exercise to specialist heart failure nurse care: the Birmingham Rehabilitation Uptake Maximisation study for patients with Congestive Heart Failure (BRUM-CHF) study. Eur J Heart Fail 11:205–213PubMedCrossRefGoogle Scholar
- 20.O’Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, Leifer ES, Kraus WE, Kitzman DW, Blumenthal JA, Rendall DS, Miller NH, Fleg JL, Schulman KA, McKelvie RS, Zannad F, Piña IL, HF-ACTION Investigators (2009) Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA 301:1439–1450PubMedCrossRefGoogle Scholar
- 21.Piotrowicz E, Baranowski R, Bilinska M, Stepnowska M, Piotrowska M, Wójcik A, Korewicki J, Chojnowska L, Malek LA, Klopotowski M, Piotrowski W, Piotrowicz R (2010) A new model of home-based telemonitored cardiac rehabilitation in patients with heart failure: effectiveness, quality of life, and adherence. Eur J Heart Fail 12:164–171PubMedCrossRefGoogle Scholar
- 24.Tomita MR, Tsai BM, Fisher NM, Kumar NA, Wilding G, Stanton K, Naughton BJ (2009) Effects of multidisciplinary Internet-based program on management of heart failure. J Multidiscip Healthc 2:13–21Google Scholar
- 25.Bandura A (1997) Self-efficacy: the exercise of control. Freeman, New YorkGoogle Scholar
- 27.Whellan DJ, O’Connor CM, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, Leifer ES, Kraus WE, Kitzman DW, Blumenthal JA, Rendall DS, Houston-Miller N, Fleg JL, Schulman KA, Ileana L, Pina IL on behalf of the HF-ACTION (2007) Heart failure and a controlled trial investigating outcomes of exercise TraiNing (HF-ACTION): design and rationale. Am Heart J 153:201–211PubMedCrossRefGoogle Scholar
- 28.Prochaska JO, DiClemente CC (1982) States and processes of self-change in smoking towards an integrative model of change. J Consult Clin Psychol 51:390–395Google Scholar
- 29.Prochaska JO, DiClemente CC (1986) Towards a comprehensive model of change. In: Miller WR N, Heather N (eds) Treating addictive behaviours: processes of change. Plenum Press, New YorkGoogle Scholar
- 40.US Department of Health and Human Services (2008) 2008 physical activity guidelines for Americans (retrieved on 18/04/11 from: http://www.health.gov/paguidelines/pdf/paguide.pdf)