Elsevier

Applied Nursing Research

Volume 24, Issue 4, November 2011, Pages 207-214
Applied Nursing Research

Original Article
A self-directed adherence management program for patients with heart failure completing combined aerobic and resistance exercise training

https://doi.org/10.1016/j.apnr.2009.08.003Get rights and content

Abstract

This study measured the impact of the Exercise Adherence Management Program (EAMP) provided to 20 patients with heart failure (HF) who participated in a combined resistance and aerobic exercise training program during two 12-week phases. The EAMP included strategies designed to support exercise self-efficacy and adherence. Results indicate that an improvement in exercise self-efficacy occurred during the study period, whereas exercise adherence declined during the unsupervised phase. The highest rated adherence strategy for helpfulness and self-efficacy was group sessions. The study supports the use of adherence strategies based on self-efficacy in exercise programs for patients with HF.

Introduction

Numerous studies have documented improved physiological and quality of life outcomes associated with exercise training for patients with heart failure (HF). Aerobic and more recently resistance exercise are both reported beneficial for patients with HF. Exercise is difficult for most patients, but the commonly reported symptoms of fatigue and dyspnea make continued exercise especially difficult for patients with HF. It is reported that as few as 30% of patients with HF participate in exercise (Ni et al., 1999). Despite the importance of adherence to the benefits of exercise, there is little understanding of the process of exercise adherence or of ways to improve it. The purpose of this study was to assess the impact of the Exercise Adherence Management Program (EAMP) provided to patients with HF participating in a combined aerobic and resistance exercise training program.

Section snippets

Aerobic and resistance exercise and HF

The most common and earliest complaint in patients with HF is exercise intolerance; yet, exercise is reported beneficial for HF (Piña et al., 2003). Aerobic exercise has been reported to improve HF, but more recently, the inclusion of resistance training, alone and in conjunction with aerobic exercise, is also reported to be beneficial. Outcomes associated with combined resistance and aerobic exercise programs include reduced HF symptoms, increased exercise capacity, increased physical

Aims

The specific aims of the study are the following:

  • 1.

    Compare weekly exercise patterns for aerobic and resistance exercise over the 24-week study period.

  • 2.

    Compare adherence outcomes for aerobic exercise (frequency, duration, intensity, and percent of goal achievement) to adherence outcomes for resistance exercise (frequency and goal achievement) during two 12-week phases of adherence management.

  • 3.

    Assess change in exercise self-efficacy (Cardiac Exercise Self-Efficacy Instrument [CESEI]) from baseline to

Sample

The sample for this study was the 22 subjects in the intervention group of a randomized controlled trial (RCT) that tested the effects of an exercise training protocol (HEART Camp, Pozehl [PI]; R15NR009215). The subjects in the RCT were recruited from a midwestern HF clinic, were adults with an ejection fraction (EF) of 40% or less, and had been receiving optimum, stable pharmacological therapy for at least 3 months. Patients were excluded if they had disorders preventing exercise participation

Demographics

The sample was 55% male (11 males, 9 females) and 95% Caucasian (1 African American). Mean age was 59.9±3.8 years, and mean EF was 32.73% ± 6.1%.

Aim 1. Comparison of weekly exercise patterns for aerobic and resistance exercise over the 24-week study period

Weekly exercise frequency trended down throughout the study. Weekly aerobic exercise participation was highest in the first 10 weeks (Phase 1) and peaked at Week 8. Participation patterns for resistance exercise were similar to aerobic exercise. Highest frequency occurred in the first 8 weeks of Phase 1 and in Week 4 of Phase 2 (Week 16). Lowest

Exercise adherence and EAMP

The exercise training program for participants in this study was relatively demanding (5 days per week), especially for patients with HF who have not routinely exercised in the last 12 months as required for participation in this study. Less than 11% of patients with HF report exercising 5 days per week (Schweitzer et al., 2007). Patients in this study achieved nearly 73% of the 24 weeks combined frequency goals for aerobic and resistance exercise while maintaining duration and intensity

Conclusions

This study is one of few to trend weekly adherence for both resistance and aerobic exercise and to measure adherence to the exercise components of duration and intensity. Despite a challenging exercise protocol involving two types of exercise on 5 days per week, patients participating in the EAMP met on average 75% of frequency goals and 105% of duration and intensity goals, although frequency declined for both types of exercise in the self-management phase. Patients improved in exercise

Acknowledgment

Funding for this study was provided by National Institutes of Health Grant R15NR009215. This work was supported by the Clinical Research Center at the Nebraska Medical Center and the University of Nebraska Medical Center.

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