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The practical management of heart failure remains a challenge. Not only are heart failure patients expected to adhere to a complicated pharmacological regimen, they are also asked to follow salt and fluid restriction, and to cope with various procedures and devices. Furthermore, physical training, whose benefits have been demonstrated, is highly re...
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Context 1
... regarding patients' barriers for non-adherence and reasons for drop-out from cardiac rehabilitation programmes may provide guidance to design successful strategies to increase participation. The main factors are discussed below ( Table 3). The ability of patients to follow exercise recommendations is frequently compromised by more than one barrier, usually related to different aspects of the problem. ...
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Citations
... Adherence to a physiotherapy treatment program describes the extent to which an individual can implement the advised and agreed interval, treatment dose, and dosing regimen of their prescribed intervention (Conraads et al, 2012). Treatment adherence is an important factor, which can influence the outcome of a treatment as those who are able to adhere are shown to have better treatment outcomes (Hayden, Van Tulder, Malmivaara, and Koes, 2005). ...
Background:
There has been a recent rise in the use of technology for health promotional practices, which have begun to gain popularity among physiotherapists but not much research has been conducted to explore its many opportunities and challenges among older adults in developing countries.
Objectives:
To explore Nigerian-based Physiotherapists' perspectives on how digital health technologies (DHT) can be utilized to promote physiotherapy home treatment programs among Nigerian older people.
Methods:
This is a one-on-one semi-structured interview of 12 geriatric physiotherapists (7 Male, 5 female) virtually in the Teams Meeting platform. Data generated were analyzed thematically using the latest version of NVivo software.
Results:
Three overarching themes were conceptualized including the usage of DHT in Nigeria, challenges to DHT application, and strategies to improve DHT usage. These described a low awareness and usage of DHT despite its recognized need and advantages for promoting home program. The forms of DHT commonly being used are mostly mobile-based through calls or texts, which could be due to barriers to the use of DHT including older people's declining cognition, poverty, and low interest in technology. Some external problems included the physiotherapists' attachment to hands-on practice and low commitment from the informal caregivers.
Conclusions:
These findings suggested ways to utilize the DHT in promoting physiotherapy home treatment programs among older people by encouraging technological innovations and raising awareness among physiotherapists, while the physiotherapists need to patiently educate both the older people and involve their informal caregivers.
... People with HF are advised to be physically active [3], but in spite of physical activity being associated with improved prognosis [4], a majority of people with HF display low levels of physical activity [5]. Barriers to adherence to physical activity for this population, like low motivation, fear of worsening symptoms and lack of influence over what activities to perform [6], could potentially be addressed by a homebased mHealth-tool. We sought to develop a tool to support physical activity, based on the Medical Research Council (MRC) guidelines on developing and evaluating complex interventions [7]. ...
Background
Physical inactivity and a sedentary lifestyle are common among people with heart failure (HF), which may lead to worse prognosis. On an already existing mHealth platform, we developed a novel tool called the Activity coach, aimed at increasing physical activity. The aim of this study was to evaluate the usability of the Activity coach and assess feasibility of outcome measures for a future efficacy trial.
Methods
A mixed-methods design was used to collect data. People with a HF diagnosis were recruited to use the Activity coach for four weeks. The Activity coach educates the user about physical activity, provides means of registering daily physical activity and helps the user to set goals for the next week. The usability was assessed by analysing system user logs for adherence, reported technical issues and by interviews about user experiences. Outcome measures assessed for feasibility were objective physical activity as measured by an accelerometer, and subjective goal attainment. Progression criteria for the usability assessment and for the proposed outcomes, were described prospectively.
Results
Ten people with HF were recruited, aged 56 to 78 with median age 72. Data from nine of the ten study participants were included in the analyses. Usability: The Activity coach was used 61% of the time and during the first week two study participants called to seek technical support. The Activity coach was found to be intuitive and easy to use by all study participants. An increased motivation to be more physically active was reported by six of the nine study participants. However, in spite of feeling motivated, four reported that their habits or behaviours had not been affected by the Activity coach. Feasibility: Data was successfully stored in the deployed hardware as intended and the accelerometers were used enough, for the data to be analysable. One finding was that the subjective outcome goal attainment, was challenging to collect. A proposed mitigator for this is to use pre-defined goals in future studies, as opposed to having the study participants be completely free to formulate the goals themselves.
Conclusions
It was confirmed that the Activity coach was easy to use. Furthermore, it might stimulate increased physical activity in a population of people with HF, who are physically inactive. The outcomes investigated seem feasible to include in a future efficacy trial.
Trial registration
ClinicalTrials.gov identifier: NCT05235763. Date of first registration: 11/02/2022.
... Engagement in regular physical activity is a class I recommended non-pharmacologic therapy for all stable HF patients 40 . More importantly, there is substantial evidence indicating that regular physical activity is beneficial for stable HF patients 41,42 . Despite the importance of exercise as a crucial component of HF therapy, our study revealed that 76.1% of patients were not regularly engaged in exercise. ...
Despite the indispensable role of self-care behavior in managing heart failure, the practice of self-care behavior remains poor, especially in developing countries. There is a scarcity of research focusing on poor self-care behavior and its determinants within our specific context. Therefore, the objective of this study was to investigate the prevalence and predictors of poor self-care behavior among ambulatory heart failure patients. A facility-based cross-sectional study was conducted at a tertiary care hospital in Ethiopia, involving patients with heart failure. We utilized the European Heart Failure Self-Care Behavior Scale (EHFScBS-9) to evaluate adherence to self-care behaviors. Data were gathered through patient interviews and a review of medical records. A binary logistic regression analysis was performed to identify predictors of poor self-care behavior in heart failure patients. We included a total of 343 participants in the final analysis of this study. The findings revealed that a majority of the patients (73.8%) demonstrated poor overall self-care behavior. Specifically, the majority of patients did not engage in regular exercise (76.1%), failed to consult doctors in case of rapid weight gain (75.6%), did not monitor weight daily (71.5%), did not restrict fluid intake (69.9%), and did not contact doctors in case of experiencing fatigue (68.6%). Additionally, 32.4% of patients did not reach out to doctors when experiencing shortness of breath, 30% did not restrict salt intake, 29% did not adhere to prescribed medication, and only 7% did not consult doctors if edema occurred. Our findings indicated that rural residence (AOR: 5.76, 95% CI: 2.47–13.43), illiteracy (AOR: 2.64, 95% CI: 1.52–6.31), prior hospitalization (AOR: 2.09, 95% CI: 1.21–3.61), and taking five or more medications (AOR: 1.83, 1.01–3.33) were significant predictors of poor self-care behavior. In conclusion, a majority of the participants in our study demonstrated poor self-care behavior. Risk factors for this behavior included rural residence, illiteracy, prior hospitalization, and taking five or more medications. Therefore, it is crucial to prioritize these high-risk patients and implement interventional programs aimed at improving self-care behaviors and overall treatment outcomes in heart failure patients.
... In consequence, evidence is lacking when it comes to the choice of optimal training programs for the individual [20,92]. Furthermore, patients' adherence to exercise-based therapies is often undermined by the high efforts regular exercise requires [93,94]. Individuals with the poorest functional capacity who carry the highest risk of early frailty and disability, especially, do not seem reachable in many multifactorial risk-based studies [95]. ...
Accelerated biological vascular ageing is still a major driver of the increasing burden of cardiovascular disease and mortality. Exercise training delays this process, known as early vascular ageing, but often lacks effectiveness due to a lack of understanding of molecular and clinical adaptations to specific stimuli. This narrative review summarizes the current knowledge about the molecular and clinical vascular adaptations to acute and chronic exercise. It further addresses how training characteristics (frequency, intensity, volume, and type) may influence these processes. Finally, practical recommendations are given for exercise training to maintain and improve vascular health. Exercise increases shear stress on the vascular wall and stimulates the endothelial release of circulating growth factors and of exerkines from the skeletal muscle and other organs. As a result, remodeling within the vascular walls leads to a better vasodilator and -constrictor responsiveness, reduced arterial stiffness, arterio- and angiogenesis, higher antioxidative capacities, and reduced oxidative stress. Although current evidence about specific aspects of exercise training, such as F-I-T-T, is limited, and exact training recommendations cannot be given, some practical implications can be extracted. As such, repeated stimuli 5–7 days per week might be necessary to use the full potential of these favorable physiological alterations, and the cumulative volume of mechanical shear stress seems more important than peak shear stress. Because of distinct short- and long-term effects of resistance and aerobic exercise, including higher and moderate intensities, both types of exercise should be implemented in a comprehensive training regimen. As vascular adaptability towards exercise remains high at any age in both healthy individuals and patients with cardiovascular diseases, individualized exercise-based vascular health prevention should be implemented in any age group from children to centenarians.
... Despite the existence of volumes of evidence supporting the cardiovascular benefits of exercise therapy in patients with heart failure, 40%-91% of patients do not participate in regular exercise, with the percentage dropout ranging from 33%-56% during the actual program [25,26]. Various factors that contribute to poor adherence include age, low level of education, being socio-economically disadvantaged, lack of motivation for exercise, lack of time, laziness, inadequate social support, poor health status with greater severity of symptoms, rate of progression and coexisting co-morbidities, and poor access to health care [26]. ...
... Despite the existence of volumes of evidence supporting the cardiovascular benefits of exercise therapy in patients with heart failure, 40%-91% of patients do not participate in regular exercise, with the percentage dropout ranging from 33%-56% during the actual program [25,26]. Various factors that contribute to poor adherence include age, low level of education, being socio-economically disadvantaged, lack of motivation for exercise, lack of time, laziness, inadequate social support, poor health status with greater severity of symptoms, rate of progression and coexisting co-morbidities, and poor access to health care [26]. On the other hand, factors like scheduling exercise, motivation, knowledge about exercise, social support, and improvement in health status reinforced long-term adherence [25]. ...
Cardiovascular diseases pose a serious problem for health globally. Among these, congestive heart failure is the leading cause of mortality and morbidity worldwide. According to the recent census, heart failure contributes to a huge financial burden annually. Exercise therapy is an integral part of the non-pharmacological management of heart failure. Due to the availability of various types of exercise therapies and rapid advancements in the existing evidence, it is often challenging to prescribe an appropriate exercise program. Although there is unequivocal evidence supporting the cardiovascular benefits of aerobic therapy, the incorporation of resistance training into exercise regimens should also be encouraged due to its effects on muscular endurance and ameliorating skeletal myopathy in heart failure.
In this study, we used a systematic literature review (SLR) approach to give an overview of the current literature and highlight the cardiovascular benefits of resistance training, alone or in combination with aerobic training. We reviewed articles from well-recognized journals published between 2013 and 2023, finally narrowing down to nine selected papers for a thorough analysis. The inclusion criteria comprise studies dealing with heart failure with reduced ejection fraction (HFrEF), resistance training alone or in combination with aerobic therapy, and studies available for free in either the PubMed or Google Scholar databases. The systematic review revealed that resistance training in combination with aerobic therapy has greater cardiovascular benefits than either resistance or aerobic therapy alone. A few unique approaches, like periodic intermittent muscular exercise (PRIME) and super circuit training (SCT), have demonstrated an improvement in cardiac and non-cardiac clinical outcomes compared to conventional exercise therapies. Moreover, various factors, like lack of motivation and lack of time, contribute to poor adherence to exercise therapy. Approaches like telerehabilitation and designing exercise regimens with activities that patients enjoy have led to improvements in long-term adherence rates. Nevertheless, further exploration and research by conducting randomized controlled trials on a larger scale is essential to explore the potential of resistance training in the rehabilitation of patients with heart failure with reduced ejection fraction and to develop the most effective exercise therapy.
... [720][721][722][723][724][725] Despite proven benefits, the rates of referral to, participation in, and implementation of CR programmes are low. [726][727][728][729][730] Another identified issue is that many patients adopt healthier lifestyles during CR but relapse to pre-morbid habits when returning to everyday life. 731 Therefore, there is an unmet need for complementary pathways to the classical centrebased CR model. ...
... This can be explained from previous observations that patients with HF can lack self-efficacy or motivation for exercise and may require personalized oneon-one attention when starting an exercise program. 31,32 Indeed, self-efficacy, the confidence in one's ability to continue performing a task in challenging circumstances, 33 has shown to mediate the relationship between motivation and physical activity in patients with HF. 34 Previous inexposure and anxiety associated with using newer technology may keep older HF patients from participating in technology-driven exercise programs. However, with adequate training and exposure, even older HF patients have reported liking the use of wrist-worn physical activity monitors such as the Fitbit for their ability to provide feedback on heart rate and step count. ...
... 11 Achieving adherence to exercise guidelines has remained the "Achilles heel" for most exercise intervention programs in HF patients. 31 Motivation for exercise is a challenge and a barrier that HF patients find hard to overcome. 31 Educating patients on the known benefits of exercise on health outcomes can serve as an extrinsic motivator for patients with HF or HT to exercise. ...
... 31 Motivation for exercise is a challenge and a barrier that HF patients find hard to overcome. 31 Educating patients on the known benefits of exercise on health outcomes can serve as an extrinsic motivator for patients with HF or HT to exercise. 35 A key factor why interventions fail to improve motivation and subsequently exercise adherence is likely because participants fail to connect the person providing the engagement. ...
The cross-sectional study enrolled 231 patients with heart failure (n = 115; 60.87% were men; mean age, 74.34 ± 12.70 years) and heart transplantation (n = 116; 72.41% were men; mean age, 56.85 ± 11.87 years) who self-reported their technology usage, physical activity, and source of motivation for exercise. Patients with heart failure were significantly older (P = .0001) than patients with heart transplantation. Physical activity levels in patients with heart failure decreased as the New York Heart Association classification increased. Patients with heart failure reported significantly lower physical activity than patients with heart transplantation (P = .0008). Smartphones were the most widely used electronic device to access the Internet in both groups. Patients with heart transplantation seemed to use more than one device to access the Internet. In both groups, patients reporting more technology usage also reported higher levels of physical activity. Patients who accessed the Internet daily reported lower levels of physical activity. Whereas patients with heart failure identified encouragement by family members as a source of motivation for exercise, patients with heart transplantation reported that they were likely to exercise if motivated by their healthcare provider. Patients with heart failure and heart transplantation have unique technological and motivational needs that need consideration for mobile health-driven interventions.
... Telemedicine refers to the use of communication and information technologies to deliver healthcare services remotely, including diagnosis, consultation, treatment, and education. Remote cardiac rehabilitation (CR) training is a rare occurrence in telemedicine [10][11][12][13], but it has gained attention recently due to the COVID-19 pandemic and the need for social distancing measures. Virtual visits provide a new approach to remote CR, which can reduce unnecessary hospital visits and lower the risk of cluster infections compared to conventional rehabilitation care [14]. ...
Backgrounds:
Cardiovascular disease (CVD) is a serious condition that poses threats to patients' quality of life and life expectancy. Cardiac rehabilitation is a crucial treatment option that can improve outcomes for CVD patients. Hybrid comprehensive telerehabilitation (HCTR) is a relatively new approach. In the context of pandemics, HCTR can minimize the risk of cluster infections by reducing hospital visits while delivering effective rehabilitation care. This study is aimed at assessing the efficacy and safety of HCTR as a secondary prevention measure for CVD patients compared to usual rehabilitation care.
Methods:
We searched PubMed, Embase, The Web of Science, The Cochrane Library, and PsychINFO for all related studies up to January 20, 2023. Two reviewers independently screened the titles and abstracts of potentially eligible articles based on the predefined search criteria. Data were analyzed using a comprehensive meta-analysis software (RevMan5.3).
Results:
Eight trials, involving 1578 participants, were included. HCTR and usual rehabilitation care provide similar effects on readmission rates (odds ratio (OR) = 0.90 (95% CI 0.69-1.17), P = 0.43) and mortality (odds ratio (OR) = 1.06 (95% CI 0.72-1.57), P = 0.76). Effects on Short Form-36 Health Status Questionnaire (SF-36) score were also similar (SMD: 1.32 (95% CI-0.48-3.11), P = 0.15). Compared with usual rehabilitation care, HCTR can improve peak oxygen uptake (VO2 peak) (SMD: 0.99 (95% CI 0.23-1.74), P = 0.01) and 6-minute walking test (6MWT) (SMD: 10.02 (95% CI 5.44-14.60), P < 0.001) of patients.
Conclusions:
Our findings indicate that HCTR is as effective as traditional rehabilitation care in reducing readmission rates and mortality and improving quality of life in patients with CVD. However, HCTR offers the added advantage of improving VO2 peak and 6MWT, measurements of cardiorespiratory fitness and functional capacity, respectively. These results suggest that HCTR can be a safe and effective alternative to traditional rehabilitation care, offering numerous benefits for CVD patients. Clinical Study Registration Number. This trial is registered with NCT02523560 and NCT02796404.
... 41 Furthermore, functional decline can be a result of non-adherence to exercise and sedentary lifestyles. 36,42 Consistent with findings in the heart transplant population, we saw a trend (P = 0.06) in the level of disability in HF patients influencing kinesiophobia in our study. 22 In addition, our findings showed a marked non-linear trend in the relationship between disability and kinesiophobia at the bivariate level, highlighting that the key moments in which the levels of disability cause a clinically striking change with respect to kinesiophobia were at its beginning and at the end with higher values of disability (see Figure 2). ...
Aim:
Patients with heart failure (HF) can exhibit kinesiophobia, an excessive, debilitating, and irrational fear of movement. The study aimed to enhance the understanding of kinesiophobia in patients with HF by analyzing associations with the following variables: musculoskeletal pain, quality of life, quality of sleep, functional capacity, disability, frailty, sex and age.
Methods and results:
In this cross-sectional study, 107 participants were included, with ages ranging from 28 to 97 years [57% men, mean age 73.18 ± 12.68 years]. Multiple regression analyses were performed with all variables, including polynomial regressions for variables with a non-linear relationship. Kinesiophobia was significantly correlated (p < .01) with musculoskeletal pain, quality of life, quality of sleep, functional capacity, disability and being at risk of frailty, while age and sex were not statistically significant. Frailty disability and musculoskeletal pain intensity were variables linearly associated with kinesiophobia, whilst quality of sleep and disability had a non-linear relationship with kinesiophobia.
Conclusions:
Kinesiophobia needs to be evaluated and better understood in patients with HF to improve physical activity and exercise adherence. This study found that musculoskeletal pain intensity, quality of sleep, disability and frailty risk have a significant association with kinesiophobia in patients with HF. Our results suggest multidimensional associations of kinesiophobia in patients with HF which require further examination and understanding.
... Cardiac rehabilitation (CR) is an essential part of care for chronic heart failure (CHF) patients to improve health outcomes including quality of life, exercise capacity, and HF-related hospitalisations [9][10][11][12][13][14][15]. Current international guidelines recommend multidisciplinary HF management, exercise training (Class I, Level A evidence), and the consideration of home telemonitoring (Class IIb, Level B evidence) for all CHF patients regardless of HF aetiology [16][17][18]. ...
... Current international guidelines recommend multidisciplinary HF management, exercise training (Class I, Level A evidence), and the consideration of home telemonitoring (Class IIb, Level B evidence) for all CHF patients regardless of HF aetiology [16][17][18]. Despite guideline recommendations, HF patients rarely participate in comprehensive CR programmes and the adherence rate during these programmes is low (approximately only 40% follows the exercise recommendations) [10,17,18]. As demonstrated by the HF-Action trial, low adherence rates are independently associated with cardiovascular mortality or HF hospitalisation [19,20]. ...
... lack of transport), psychological status (e.g. motivation, depression, and anxiety) and socio-economic status, and disease-related barriers as recurrent episodes of decompensated HF and high disability burden in elderly patients are considered to play an even more important role [3,9,10,[23][24][25]. Yet, despite the fact that preliminary analyses showed that benefits of CR are particularly high in this frail elderly population [26], previous CR meta-analyses often excluded recently hospitalised CHF patients and had a relatively low median age (63 years in CR meta-analysis vs. 77 years Danish epidemiological HF-study) [12,27]. ...
Background
Cardiac rehabilitation in patients with chronic heart failure (CHF) has favourable effects on exercise capacity, the risk at hospital (re-)admission and quality of life. Although cardiac rehabilitation is generally recommended it is still under-utilised in daily clinical practice, particularly in frail elderly patients after hospital admission, mainly due to low referral and patient-related barriers. Cardiac telerehabilitation (CTR) has the potential to partially solve these barriers. The purpose of this study is to evaluate the effects of CTR as compared to standard remote care after hospital admission on physical functional capacity in CHF patients.
Methods
In this randomised controlled trial, 64 CHF patients will be recruited during hospitalisation for acute decompensated heart failure, and randomised to CTR combined with remote patient management (RPM) or RPM alone (1:1). All participants will start with RPM after hospital discharge for early detection of deterioration, and will be up titrated to optimal medical therapy before being randomised. CTR will start after randomisation and consists of an 18-week multidisciplinary programme with exercise training by physical and occupational therapists, supported by a (remote) technology-assisted dietary intervention and mental health guiding by a physiologist. The training programme consists of three centre-based and two home-based video exercise training sessions followed by weekly video coaching. The mental health and dietary programme are executed using individual and group video sessions. A wrist-worn device enables remote coaching by the physical therapist. The web application is used for promoting self-management by the following modules: 1) goal setting, 2) progress tracking, 3) education, and 4) video and chat communication. The primary outcome measure is physical functional capacity evaluated by the Short Physical Performance Battery (SPPB) score. Secondary outcome measures include frailty scoring, recovery after submaximal exercise, subjective health status, compliance and acceptance to the rehabilitation programme, and readmission rate.
Discussion
The Tele-ADHF trial is the first prospective randomised controlled trial designed for evaluating the effects of a comprehensive combined RPM and CTR programme in recently hospitalised CHF patients. We hypothesize that this intervention has superior effects on physical functional capacity than RPM alone.
Trial registration
Netherlands Trial Registry (NTR) NL9619, registered 21 July 2021.
