Practical Barriers May Affect Exercise Adherence, Subsequent Outcomes in HF Patients

Deborah Brauser

November 24, 2015

DURHAM, NC — Practical, day-to-day obstacles, such as the weather, problems with transportation, or finances, can play a major part in decreasing participation in an exercise program for patients with heart failure (HF), which may subsequently result in worsening cardiac outcomes, suggests new research[1].

A cohort of 2279 participants in the HF-ACTION trial showed that those with the highest Perceived Social Support Scale (PSS) scores had significantly higher average exercise times at the 12-month follow-up (118 minutes per week) than those with the lowest PSS scores (92 minutes/week). Higher exercise times were also found for those with the lowest vs highest barrier-to-exercise scores (169 minutes/week vs 86 minutes/week, respectively; all, P<0.05).

In addition, those who had the lowest barrier scores had fewer CV deaths or hospitalizations (P=0.035). PSS scores, however, did not significantly affect any association between exercise and outcomes.

"Although HF patients may have physical and cardiopulmonary limitations to exercise, it is important to recognize that psychosocial factors may also limit a patient's ability or perceived ability to exercise," write the investigators, led by Dr Lauren B Cooper (Duke Clinical Research Institute, Durham, NC).

Therefore, assessment of these factors "may facilitate individualized approaches to implement and sustain exercise training therapy in clinical practice," they add.

The findings were published online November 17, 2015 in Circulation: Heart Failure.

Adherence Remains Low

"In February 2014, Medicare announced the decision to cover cardiac rehabilitation for patients with chronic heart failure," write the investigators. Even so, they note that adherence among these patients has remained low.

As reported by heartwire from Medscape, the original HF-ACTION trial was created to evaluate the safety and efficacy of aerobic exercise in patients with stable chronic HF. It randomized about half the 2331 participants to usual care and the other half to usual care plus supervised thrice-weekly exercise sessions for 3 months. Results showed reduced incidence of all-cause mortality or all-cause hospitalization for the exercise group—even though only one-third of this group fully adhered to all exercise sessions.

In the current analysis, the investigators assessed the participants who filled out at baseline the PSS and the barrier scale, which was developed for the trial and asked questions about 10 potential exercise program obstacles.

At both the 3- and 12-month follow-ups, the participants in the highest PSS score quintile vs the lowest quintile (and in the lowest barrier score quintile vs the highest quintile) had the highest amounts of exercise minutes per week.

"An Important Goal"

The findings also showed "a trend toward an association between [barrier scores] and all-cause death or hospitalization events, with higher quintiles associated with more events than lower quintiles (P=0.05)," report the investigators.

In addition, there was a significant association between increasing barrier scores and increased CV death or HF hospitalization in the group randomized to the exercise treatment (HR 1.25, 95% CI 0.99–1.59) but not to usual care.

There were no significant associations between PSS and any of these outcomes, including in unadjusted and adjusted Cox regression models.

Although exercise adherence did not affect all-cause death or hospitalization, there was a higher risk of CV death or HF hospitalization in those who had poor adherence vs those who had full adherence (HR 1.47, 95% CI 1.02–2.11, P=0.04).

"Because exercise training has been shown to improve outcomes in this population, increasing exercise adherence is an important goal in the care of patients with HF," write the investigators, reiterating their recommendation that clinicians assess social support and perceived exercise barriers in this patient population.

HF-ACTION was funded by the National Institutes of Health. The study authors report no relevant financial relationships.

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