Psychosocial Factors, Exercise Adherence, and Outcomes in Heart Failure Patients: Insights From Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION)

Lauren B. Cooper, Robert J. Mentz, Jie Lena Sun, Phillip Schulte, Jerome L. Fleg, Lawton S. Cooper, Ileana L. Piña, Eric S. Leifer, William E. Kraus, David J. Whellan, Steven J. Keteyian, Christopher M. O'Connor

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background - Psychosocial factors may influence adherence with exercise training for heart failure (HF) patients. We aimed to describe the association between social support and barriers to participation with exercise adherence and clinical outcomes. Methods and Results - Of patients enrolled in Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION), 2279 (97.8%) completed surveys to assess social support and barriers to exercise, resulting in the perceived social support score (PSSS) and barriers to exercise score (BTES). Higher PSSS indicated higher levels of social support, whereas higher BTES indicated more barriers to exercise. Exercise time at 3 and 12 months correlated with PSSS (r=0.09 and r=0.13, respectively) and BTES (r=-0.11 and r=-0.12, respectively), with higher exercise time associated with higher PSSS and lower BTES (All P<0.005). For cardiovascular death or HF hospitalization, there was a significant interaction between the randomization group and BTES (P=0.035), which corresponded to a borderline association between increasing BTES and cardiovascular death or HF hospitalization in the exercise group (hazard ratio 1.25, 95% confidence interval 0.99, 1.59), but no association in the usual care group (hazard ratio 0.83, 95% confidence interval 0.66, 1.06). Conclusions - Poor social support and high barriers to exercise were associated with lower exercise time. PSSS did not impact the effect of exercise training on outcomes. However, for cardiovascular death or HF hospitalization, exercise training had a greater impact on patients with lower BTES. Given that exercise training improves outcomes in HF patients, assessment of perceived barriers may facilitate individualized approaches to implement exercise training therapy in clinical practice.

Original languageEnglish (US)
Pages (from-to)1044-1051
Number of pages8
JournalCirculation: Heart Failure
Volume8
Issue number6
DOIs
StatePublished - Nov 1 2015
Externally publishedYes

Fingerprint

Heart Failure
Exercise
Psychology
Social Support
Hospitalization
Confidence Intervals
Exercise Therapy
Random Allocation

Keywords

  • exercise
  • exercise therapy
  • heart failure
  • patients
  • social support

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Psychosocial Factors, Exercise Adherence, and Outcomes in Heart Failure Patients : Insights From Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION). / Cooper, Lauren B.; Mentz, Robert J.; Sun, Jie Lena; Schulte, Phillip; Fleg, Jerome L.; Cooper, Lawton S.; Piña, Ileana L.; Leifer, Eric S.; Kraus, William E.; Whellan, David J.; Keteyian, Steven J.; O'Connor, Christopher M.

In: Circulation: Heart Failure, Vol. 8, No. 6, 01.11.2015, p. 1044-1051.

Research output: Contribution to journalArticle

Cooper, Lauren B. ; Mentz, Robert J. ; Sun, Jie Lena ; Schulte, Phillip ; Fleg, Jerome L. ; Cooper, Lawton S. ; Piña, Ileana L. ; Leifer, Eric S. ; Kraus, William E. ; Whellan, David J. ; Keteyian, Steven J. ; O'Connor, Christopher M. / Psychosocial Factors, Exercise Adherence, and Outcomes in Heart Failure Patients : Insights From Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION). In: Circulation: Heart Failure. 2015 ; Vol. 8, No. 6. pp. 1044-1051.
@article{8e864b7952044e248378a4c3e8ce5b96,
title = "Psychosocial Factors, Exercise Adherence, and Outcomes in Heart Failure Patients: Insights From Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION)",
abstract = "Background - Psychosocial factors may influence adherence with exercise training for heart failure (HF) patients. We aimed to describe the association between social support and barriers to participation with exercise adherence and clinical outcomes. Methods and Results - Of patients enrolled in Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION), 2279 (97.8{\%}) completed surveys to assess social support and barriers to exercise, resulting in the perceived social support score (PSSS) and barriers to exercise score (BTES). Higher PSSS indicated higher levels of social support, whereas higher BTES indicated more barriers to exercise. Exercise time at 3 and 12 months correlated with PSSS (r=0.09 and r=0.13, respectively) and BTES (r=-0.11 and r=-0.12, respectively), with higher exercise time associated with higher PSSS and lower BTES (All P<0.005). For cardiovascular death or HF hospitalization, there was a significant interaction between the randomization group and BTES (P=0.035), which corresponded to a borderline association between increasing BTES and cardiovascular death or HF hospitalization in the exercise group (hazard ratio 1.25, 95{\%} confidence interval 0.99, 1.59), but no association in the usual care group (hazard ratio 0.83, 95{\%} confidence interval 0.66, 1.06). Conclusions - Poor social support and high barriers to exercise were associated with lower exercise time. PSSS did not impact the effect of exercise training on outcomes. However, for cardiovascular death or HF hospitalization, exercise training had a greater impact on patients with lower BTES. Given that exercise training improves outcomes in HF patients, assessment of perceived barriers may facilitate individualized approaches to implement exercise training therapy in clinical practice.",
keywords = "exercise, exercise therapy, heart failure, patients, social support",
author = "Cooper, {Lauren B.} and Mentz, {Robert J.} and Sun, {Jie Lena} and Phillip Schulte and Fleg, {Jerome L.} and Cooper, {Lawton S.} and Pi{\~n}a, {Ileana L.} and Leifer, {Eric S.} and Kraus, {William E.} and Whellan, {David J.} and Keteyian, {Steven J.} and O'Connor, {Christopher M.}",
year = "2015",
month = "11",
day = "1",
doi = "10.1161/CIRCHEARTFAILURE.115.002327",
language = "English (US)",
volume = "8",
pages = "1044--1051",
journal = "Circulation: Heart Failure",
issn = "1941-3297",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Psychosocial Factors, Exercise Adherence, and Outcomes in Heart Failure Patients

T2 - Insights From Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION)

AU - Cooper, Lauren B.

AU - Mentz, Robert J.

AU - Sun, Jie Lena

AU - Schulte, Phillip

AU - Fleg, Jerome L.

AU - Cooper, Lawton S.

AU - Piña, Ileana L.

AU - Leifer, Eric S.

AU - Kraus, William E.

AU - Whellan, David J.

AU - Keteyian, Steven J.

AU - O'Connor, Christopher M.

PY - 2015/11/1

Y1 - 2015/11/1

N2 - Background - Psychosocial factors may influence adherence with exercise training for heart failure (HF) patients. We aimed to describe the association between social support and barriers to participation with exercise adherence and clinical outcomes. Methods and Results - Of patients enrolled in Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION), 2279 (97.8%) completed surveys to assess social support and barriers to exercise, resulting in the perceived social support score (PSSS) and barriers to exercise score (BTES). Higher PSSS indicated higher levels of social support, whereas higher BTES indicated more barriers to exercise. Exercise time at 3 and 12 months correlated with PSSS (r=0.09 and r=0.13, respectively) and BTES (r=-0.11 and r=-0.12, respectively), with higher exercise time associated with higher PSSS and lower BTES (All P<0.005). For cardiovascular death or HF hospitalization, there was a significant interaction between the randomization group and BTES (P=0.035), which corresponded to a borderline association between increasing BTES and cardiovascular death or HF hospitalization in the exercise group (hazard ratio 1.25, 95% confidence interval 0.99, 1.59), but no association in the usual care group (hazard ratio 0.83, 95% confidence interval 0.66, 1.06). Conclusions - Poor social support and high barriers to exercise were associated with lower exercise time. PSSS did not impact the effect of exercise training on outcomes. However, for cardiovascular death or HF hospitalization, exercise training had a greater impact on patients with lower BTES. Given that exercise training improves outcomes in HF patients, assessment of perceived barriers may facilitate individualized approaches to implement exercise training therapy in clinical practice.

AB - Background - Psychosocial factors may influence adherence with exercise training for heart failure (HF) patients. We aimed to describe the association between social support and barriers to participation with exercise adherence and clinical outcomes. Methods and Results - Of patients enrolled in Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION), 2279 (97.8%) completed surveys to assess social support and barriers to exercise, resulting in the perceived social support score (PSSS) and barriers to exercise score (BTES). Higher PSSS indicated higher levels of social support, whereas higher BTES indicated more barriers to exercise. Exercise time at 3 and 12 months correlated with PSSS (r=0.09 and r=0.13, respectively) and BTES (r=-0.11 and r=-0.12, respectively), with higher exercise time associated with higher PSSS and lower BTES (All P<0.005). For cardiovascular death or HF hospitalization, there was a significant interaction between the randomization group and BTES (P=0.035), which corresponded to a borderline association between increasing BTES and cardiovascular death or HF hospitalization in the exercise group (hazard ratio 1.25, 95% confidence interval 0.99, 1.59), but no association in the usual care group (hazard ratio 0.83, 95% confidence interval 0.66, 1.06). Conclusions - Poor social support and high barriers to exercise were associated with lower exercise time. PSSS did not impact the effect of exercise training on outcomes. However, for cardiovascular death or HF hospitalization, exercise training had a greater impact on patients with lower BTES. Given that exercise training improves outcomes in HF patients, assessment of perceived barriers may facilitate individualized approaches to implement exercise training therapy in clinical practice.

KW - exercise

KW - exercise therapy

KW - heart failure

KW - patients

KW - social support

UR - http://www.scopus.com/inward/record.url?scp=84947773865&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84947773865&partnerID=8YFLogxK

U2 - 10.1161/CIRCHEARTFAILURE.115.002327

DO - 10.1161/CIRCHEARTFAILURE.115.002327

M3 - Article

C2 - 26578668

AN - SCOPUS:84947773865

VL - 8

SP - 1044

EP - 1051

JO - Circulation: Heart Failure

JF - Circulation: Heart Failure

SN - 1941-3297

IS - 6

ER -