Abstract 17617: Predictors of Exercise in Ambulatory Patients with Heart Failure

Abstract

Background: Although clinical guidelines encourage moderate-vigorous exercise in patients with heart failure (HF), adherence is poor. The purpose of this study was to identify determinants of adherence to moderate-vigorous exercise, so that targeted interventions can be developed. Methods. Using a prospective, correlational design, ambulatory patients with chronic HF from 6 ambulatory clinics in the Midwest and Northeast US and Sweden completed surveys on functional status, current and previous exercise, fatigue, depression, and barriers, knowledge, attitudes, values, and confidence about exercise. Logistic regression models were used to estimate the odds of being a moderate-vigorous exerciser, adjusting for patient characteristics. Results. The cohort of 492 patients had mean (SD) age 63 (±13.6) years; ejection fraction 34.9% (± 14.8%); and BMI 29.3 (± 6.73) kg/ml/m2. Other characteristics were 40.3% ischemic HF etiology; 64.8% male; 76.2% Caucasian; 58.9% married; 30.9% NYHA class III/IV and a low fatigue level of 2.1 (± 0.8) on a 1-5 scale. Only 46% exercised moderately-vigorously and mean (SD) exercise knowledge was poor, 35% (± 0.2%) on a 0-100% scale. After adjusting for patient characteristics such as BMI, gender, smoking status, and insurance type, 18 factors were significantly associated with moderate-vigorous exercise. Those that increased the OR for moderate-vigorous exercise were perceptions of very good health, OR 8.57 (95% CI: 4.09, 19.18); higher self-confidence for exercise, OR 5.74 (3.8, 8.95); lower barriers, OR 3.41 (2.36, 5.06); better attitudes, OR 3.01 (2.2, 4.2); higher perceived value, OR 2.58 (1.83, 3.71); more benefits/motivators, OR 2.25 (1.64, 3.15); all P<0.001 and higher knowledge, OR 1.26 (1.01, 1.57), P=0.04. Conclusion. Among ambulatory patients with chronic HF, knowledge of exercise expectations is low and less than one-half exercise regularly. Adherence to moderate-vigorous exercise is modifiable. Patients need to understand what moderate-vigorous exercise means and its benefits and value related to HF. Interventions that improve confidence and decrease barriers may enhance exercise adherence.