Effects of the HEART camp intervention on adherence to exercise in patients with heart failure

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Background: Patients with heart failure (HF) have poor adherence to the recommended guidelines of30 minutes of moderate intensity exercise five days per week. The importance of adherence to exercise is underscored by recent data showing that lack ofadherence to recommended exercise leads toincreased risk for mortality and HF readmission. Thepurpose of this randomized controlled trial was toevaluate the effect of the HEART Camp (HC) protocol (multi-component intervention) on long-term adherence to exercise. Hypothesis: Subjects in theHEART Camp (HC) intervention group will have better adherence to exercise than the enhanced usual care (EUC) group over time (6, 12 and 18 months). Methods: A prospective randomized two-group (HC and EUC) repeated measures experimental design was used. Both groups received access to theexercise facility and 9 exercise training sessions in a 3-week run-in period. Group educational sessions and an exercise coach provided the interventioncomponents (knowl-edge, attitudes, self-efficacy, behavioral self-management skills and social support). Adherence (defined as 80% of therecommended 150 minutes of exercise) was mea-sured by an exercise diary with heart rate monitor validation of self-report. Results: The sample consisted of 191 subjects with a mean age of 60.9 + 11.4 years; 53.9% were male; EF was 39.9 + 13.1%; 54.5% were NYHA Class II and 36.6% were Class III; 53.4% were Caucasian and 45.5% were African-American. Chi-square analysis of adherence data showed no significant group differences at 6 months (P=.443). Both 12 and 18-month adherence in the HC group (42 and 35.2% respectively) were significantly higher (P <.05) than the EUC group (27.8 and 19.3% respectively). See Fig. 1. An analysis of potential moderators of the intervention showed no significance for age, gender, race, marital status, or NYHA Class. Moderator effects were found for BMI with the HC intervention showing efficacy across thelevels of BMI while higher BMI in the EUC had lower adherence levels. The HC intervention improved adherence in subjects with higher EF while adherence in the EUC group was worse with higher EF Conclusions: The multi-component HC interventionsignificantly improved exercise adherence at 12 and 18 months. Providing subjects with access and 9 sessions of training improved short-term adherencein the EUC group.





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