Physical training in patients with chronic heart failure: level of involvement, as well as psychosocial, anamnestic and iatrogenic factors that determine the motivation to practice

Introduction Physical exercise (PE) is a necessary part in the treatment of patients with chronic heart failure (CHF), which is stated in the European Society of Cardiology guidelines and the Russian Heart Failure Society guidelines. However, this type of non-drug treatment is still not sufficiently used in HF patients in Russia.
Aim To study the current involvement of HF patients in PT and to describe psychosocial factors that influence the patients’ willingness to exercise and potential barriers and motivations for PE.
Methods This study was designed as an in-moment survey. Patients with CHF who visited clinics in 7 cities of the Russian Federation in 2018 as a part of European Heart Failure Awareness Days were provided with a self-administered questionnaire containing questions about their social and educational status, attitude to PT as a method of treatment, and factors motivating and demotivating them to participation in training sessions. The survey participants were also asked a question about their source of information about exercise in HF. Physicians filled in the items describing HF clinical manifestations (left ventricular ejection fraction (EF) and HF functional class (FC)). Code numbers were used for further identification of the participants and to protect their confidentiality. Statistical analysis was performed with the StatXcat-8 program. Limits of exact confidence intervals (CIs) were provided both for fractions and parameters of polynomial distribution. CI limits for differences and fractions were calculated using MOVER. Age was analyzed using the PAST program.
Results The study included 560 patients with HF; 52 % of them were women (mean age, 64; 95 % CI: 63–65 years). Women were 3 years older than men (95 % CI: 1.3–4.9 years). 501 (89.5 %) patients had FC II–III; 265 (49 %) patients had HF with low EF. 350 (62 %) patients had comorbidities: 41.4 % of patients had diabetes mellitus and 25.4 % of patients had arthritis. Only 91 (17 %) patients reported exercising. Patients younger than 65 exercised significantly more frequently than older ones (odds ratio (OR), 1.7, 95 % CI: 1.0–2.7, р<0.001). Patients with higher education had better chances to be involved in PT or were more anxious to start training (OR, 2.7; 95 % CI: 1.6–4.7, р<0.001). The capability for influencing the disease was the major motivation for PT for both sexes. Probability of this answer was 48 % (95 % CI: 33–61) for men and 46 % (95 % CI: 29–63) for women. 62 % of patients indicated poor health as the major barrier for participation in PT. Only 55 % of patients knew that PT could be a method for HF treatment, and only 50 % were informed about that by their physician.
Conclusion The factors that positively influence the willingness to exercise include male sex, higher level of education, younger age, and better perception of the own health condition. 62 % of patients indicated poor health as the major barrier for participation in training. On the whole, the awareness of patients about PT benefits for health in HF was low. To our opinion, this was a serious factor of the extremely low involvement of patients in PT. Only 55 % of patients knew that PT could be a method for HF treatment, and, furthermore, only 50 % of patients received this information from their physicians.

1. Doukky R, Mangla A, Ibrahim Z, Poulin M-F, Avery E, Collado FM et al. Impact of Physical Inactivity on Mortality in Patients with Heart Failure. The American Journal of Cardiology. 2016;117(7):1135–43. DOI: 10.1016/j.amjcard.2015.12.060

2. Mareev V.Yu., Fomin I.V., Ageev F.T., Begrambekova Yu.L., Vasyuk Yu.A., Garganeeva A.A. et al. Russian Heart Failure Society, Russian Society of Cardiology. Russian Scientific Medical Society of Internal Medicine Guidelines for Heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiia. 2018;58 (6S): 8–164. [Russian: Мареев В. Ю., Фомин И. В., Агеев Ф. Т., Беграмбекова Ю. Л., Васюк Ю. А., Гарганеева А. А. и др. Клинические рекомендации ОССН – РКО – РНМОТ. Сердечная недостаточность: хроническая (ХСН) и острая декомпенсированная (ОДСН). Диагностика, профилактика и лечение. Кардиология. 2018;58(6S):8-164]. DOI: 10.18087/cardio.2475

3. Piepoli MF, Davos C, Francis DP, Coats AJ. Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH). BMJ. 2004;328(7433):189. DOI: 10.1136/bmj.37938.645220.EE

4. Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJS, Dalal H et al. Exercise-based rehabilitation for heart failure. The Cochrane Database of Systematic Reviews. 2014;4:CD003331. DOI: 10.1002/14651858.CD003331.pub4

5. Taylor RS, Davies EJ, Dalal HM, Davis R, Doherty P, Cooper C et al. Effects of exercise training for heart failure with preserved ejection fraction: A systematic review and meta-analysis of comparative studies. International Journal of Cardiology. 2012;162(1):6–13. DOI: 10.1016/j.ijcard.2012.05.070

6. Smart NA, Haluska B, Jeffriess L, Leung D. Exercise training in heart failure with preserved systolic function: a randomized controlled trial of the effects on cardiac function and functional capacity. Congestive Heart Failure (Greenwich, Conn.). 2012;18(6):295–301. DOI: 10.1111/j.1751-7133.2012.00295.x

7. O’Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ et al. Efficacy and Safety of Exercise Training in Patients with Chronic Heart Failure: HF-ACTION Randomized Controlled Trial. JAMA. 2009;301(14):1439. DOI: 10.1001/jama.2009.454

8. Blumenthal JA, Babyak MA, O’Connor C, Keteyian S, Landzberg J, Howlett J et al. Effects of Exercise Training on Depressive Symptoms in Patients with Chronic Heart Failure: The HF-ACTION Randomized Trial. JAMA. 2012;308(5):465–74. DOI: 10.1001/jama.2012.8720

9. Pogosova N.V., Sokolova O.Yu., Yufereva Yu.M., Osipova I.V., Ryamzina I.N. First Results of Analysis of the Russian Part of the European Register on Cardiac Rehabilitation EuroCaReD (European Cardiac Rehabilitation Database). Kardiologiia. 2015;55(2):49–56. [Russian: Погосова Н. В., Соколова О. Ю., Юферева Ю. М., Осипова И. В., Рямзина И. Н. Первые результаты анализа российской части европейского регистра по кардиореабилитации (European Cardiac Rehabilitation Database - EuroCaReD) с участием 13 стран. Кардиология. 2015;55(2):49–56]

10. Ben Gal T, Piepoli MF, Corrà U, Conraads V, Adamopoulos S, Agostoni P et al. Exercise programs for LVAD supported patients: A snapshot from the ESC affiliated countries. International Journal of Cardiology. 2015;201:215–9. DOI: 10.1016/j.ijcard.2015.08.081

11. McArthur D, Dumas A, Woodend K, Beach S, Stacey D. Factors influencing adherence to regular exercise in middle-aged women: a qualitative study to inform clinical practice. BMC Women’s Health. 2014;14:49. DOI: 10.1186/1472-6874-14-49

12. Pitanga FJG, Lessa I, Barbosa PJB, Barbosa SJO, Costa MC, Lopes A da S. Factors associated with leisure time physical inactivity in black individuals: hierarchical model. PeerJ. 2014;2:e577. DOI: 10.7717/peerj.577

13. Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U. Global physical activity levels: surveillance progress, pitfalls, and prospects. The Lancet. 2012;380(9838):247–57. DOI: 10.1016/S0140-6736(12)60646-1

14. Dontje ML, Krijnen WP, de Greef MHG, Peeters GGMEE, Stolk RP, van der Schans CP et al. Effect of diagnosis with a chronic disease on physical activity behavior in middle-aged women. Preventive Medicine. 2016;83:56–62. DOI: 10.1016/j.ypmed.2015.11.030

15. Kim H-Y. Statistical notes for clinical researchers: Chi-squared test and Fisher’s exact test. Restorative Dentistry & Endodontics. 2017;42(2):152. DOI: 10.5395/rde.2017.42.2.152

16. Louis TA, Zeger SL. Effective communication of standard errors and confidence intervals. Biostatistics. 2008;10(1):1–2. DOI: 10.1093/biostatistics/kxn014

17. Dolansky MA, Stepanczuk B, Charvat JM, Moore SM. Women’s and Men’s Exercise Adherence After a Cardiac Event. Research in Gerontological Nursing. 2010;3(1):30–8. DOI: 10.3928/19404921-20090706-03

18. Flora PK, Anderson TJ, Brawley LR. Illness perceptions and adherence to exercise therapy in cardiac rehabilitation participants. Rehabilitation Psychology. 2015;60(2):179–86. DOI: 10.1037/a0039123

19. Lobelo F, de Quevedo IG. The Evidence in Support of Physicians and Health Care Providers as Physical Activity Role Models. American Journal of Lifestyle Medicine. 2016;10(1):36–52. DOI: 10.1177/1559827613520120

20. Frank E, Wright EH, Serdula MK, Elon LK, Baldwin G. Personal and professional nutrition-related practices of US female physicians. The American Journal of Clinical Nutrition. 2002;75(2):326–32. DOI: 10.1093/ajcn/75.2.326

21. Meshefedjian GA, Gervais A, Tremblay M, Villeneuve D, O’Loughlin J. Physician smoking status may influence cessation counseling practices. Canadian Journal of Public Health. 2010;101(4):290–3. PMID: 21033533

22. Bleich SN, Bennett WL, Gudzune KA, Cooper LA. Impact of Physician BMI on Obesity Care and Beliefs. Obesity. 2012;20(5):999–1005. DOI: 10.1038/oby.2011.402

23. Fomin I.V. Chronic heart failure in Russian Federation: what do we know and what to do. Russian Journal of Cardiology. 2016;8:7–13. [Russian: Фомин И.В. Хроническая сердечная недостаточность в Российской Федерации: что сегодня мы знаем и что должны делать. Российский Кардиологический Журнал. 2016;8:7-13]. DOI: 10.15829/1560-4071-2016-8-7-13