Clinical effectiveness and cost-effectiveness of the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) facilitated self-care rehabilitation intervention in heart failure patients and caregivers: rationale and protocol for a multicentre randomised controlled trial Perceived barriers and enablers to participation in a community-tailored physical activity program with Indigenous Australians in a regional and rural setting: a qualitative study Rehabilitation Enablement in Chronic Heart Failure—a facilitated self-care rehabilitation intervention in patients with heart failure with preserved ejection fraction (REACH-HFpEF) and their caregivers: rationale and protocol for a single-centre pilot randomised controlled trial Appropriateness and acceptability of a Tele-Yoga intervention for people with heart failure and chronic obstructive pulmonary disease: qualitative findings from a controlled pilot study Increasing exercise capacity and quality of life of patients with heart failure through Wii gaming: the rationale, design and methodology of the HF‐Wii study; a multicentre randomized controlled trial Qualitative outcomes of progressive resistance exercise for people with COPD Optimising self-care support for people with heart failure and their caregivers: development of the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) intervention using intervention mapping Why older people do not participate in leisure time physical activity: a survey of activity levels, beliefs and deterrents. The effect of a tailored message intervention on heart failure readmission rates, quality of life, and benefit and barrier beliefs in persons with heart failure. A Motivational Counseling Approach to Improving Heart Failure Self-Care: Mechanisms of Effectiveness Prevalence of heart failure and systolic ventricular dysfunction in older Australians: the Canberra Heart Study. Heart Failure 2012 Effects of an exercise adherence intervention on outcomes in patients with heart failure. Combined aerobic and resistance exercise program improves task performance in patients with heart failure. Patients with rotator cuff tendinopathy can successfully self-manage, but with certain caveats: a qualitative study. Cognitive Function and Treatment Adherence in Older Adults With Heart Failure Social-Ecological, Motivational and Volitional Factors for Initiating and Maintaining Physical Activity in the Context of HIV Evaluation of a Web-based education and counseling pilot program for older heart failure patients. A telephone-delivered empowerment intervention with patients diagnosed with heart failure. The effects of nursing interventions to enhance mental health and quality of life among individuals with heart failure. Contribution of Major Lifestyle Risk Factors for Incident Heart Failure in Older Adults Patients' views of physical activity as treatment for depression: a qualitative study. Depressive Symptomatology, Exercise Adherence, and Fitness Are Associated With Reduced Cognitive Performance in Heart Failure
Introduction The Rehabilitation EnAblement in CHronic Heart Failure ( REACH-HF ) trial is part of a research programme design ed to develop and evaluate a health professional facilitated , home-based , self-help rehabilitation intervention to improve self-care and health-related quality of life in people with heart failure and their caregivers . The trial will assess the clinical effectiveness and cost-effectiveness of the REACH-HF intervention in patients with systolic heart failure and impact on the outcomes of their caregivers . Methods and analysis A parallel two group r and omised controlled trial with 1:1 individual allocation to the REACH-HF intervention plus usual care ( intervention group ) or usual care alone ( control group ) in 216 patients with systolic heart failure ( ejection fraction < 45 % ) and their caregivers . The intervention comprises a self-help manual delivered by specially trained facilitators over a 12-week period . The primary outcome measure is patients ’ disease-specific health-related quality of life measured using the Minnesota Living with Heart Failure question naire at 12 months ’ follow-up . Secondary outcomes include survival and heart failure related hospitalisation , blood biomarkers , psychological well-being , exercise capacity , physical activity , other measures of quality of life , patient safety and the quality of life , psychological well-being and perceived burden of caregivers at 4 , 6 and 12 months ’ follow-up . A process evaluation will assess fidelity of intervention delivery and explore potential mediators and moderators of changes in health-related quality of life in intervention and control group patients . Qualitative studies will describe patient and caregiver experiences of the intervention . An economic evaluation will estimate the cost-effectiveness of the REACH-HF intervention plus usual care versus usual care alone in patients with systolic heart failure . Ethics and dissemination The study is approved by the North West — Lancaster Research Ethics Committee ( ref 14/NW/1351 ) . Findings will be disseminated via journals and presentations to publicise the research to clinicians , commissioners and service users . Trial registration number IS RCT N86234930 ; Pre- results Background Aboriginal and Torres Strait Isl and er people have higher rates of chronic disease and a lower life expectancy than non-Indigenous Australians . In non-urban areas these health disparities are even larger . The aim of this qualitative study was to explore perceived barriers and enablers to attending an eight-week physical activity program in a rural and regional setting which aim ed to improve health outcomes , but had a low attendance rate . Methods Thirty-four Indigenous Australians participated in the intervention from the rural ( n = 12 ) and the regional ( n = 22 ) community .  Qualitative semi-structured individual interviews were conducted at the follow-up health assessment s with 12 participants . A thematic network analysis was undertaken to examine the barriers and enablers to participation in the program . Results Overall , there were positive attitudes to , and high levels of motivation towards , the physical activity program . Enablers to participation were the inclusion of family members , no financial cost and a good relationship with the principal investigator , which was strengthened by the community-based participatory approach to the program design . Barriers to program attendance were mostly beyond the control of the individuals , such as ‘ sorry business ’ , needing to travel away from the community and lack of community infrastructure . Conclusions More consideration is needed prior to implementation of programs to underst and how community-specific barriers and enablers will affect attendance to the program . Trial registration ACTRN12616000497404 . Registered 18 April 2016 Introduction The Rehabilitation EnAblement in CHronic Heart Failure in patients with Heart Failure ( HF ) with preserved ejection fraction ( REACH-HFpEF ) pilot trial is part of a research programme design ed to develop and evaluate a facilitated , home-based , self-help rehabilitation intervention to improve self-care and quality of life ( QoL ) in heart failure patients and their caregivers . We will assess the feasibility of a definitive trial of the REACH-HF intervention in patients with HFpEF and their caregivers . The impact of the REACH-HF intervention on echocardiographic outcomes and bloodborne biomarkers will also be assessed . Methods and analysis A single-centre parallel two-group r and omised controlled trial ( RCT ) with 1:1 individual allocation to the REACH-HF intervention plus usual care ( intervention ) or usual care alone ( control ) in 50 HFpEF patients and their caregivers . The REACH-HF intervention comprises a REACH-HF manual with supplementary tools , delivered by trained facilitators over 12 weeks . A mixed methods approach will be used to assess estimation of recruitment and retention rates ; fidelity of REACH-HF manual delivery ; identification of barriers to participation and adherence to the intervention and study protocol ; feasibility of data collection and outcome burden . We will assess the variance in study outcomes to inform a definitive study sample size and assess methods for the collection of re source use and intervention delivery cost data to develop the cost-effectiveness analyses framework for any future trial . Patient outcomes collected at baseline , 4 and 6 months include QoL , psychological well-being , exercise capacity , physical activity and HF-related hospitalisation . Caregiver outcomes will also be assessed , and a sub study will evaluate impact of the REACH-HF manual on resting global cardiovascular function and bloodborne biomarkers in HFpEF patients . Ethics and dissemination The study is approved by the East of Scotl and Research Ethics Service ( Ref : 15/ES/0036 ) . Findings will be disseminated via journals and presentations to clinicians , commissioners and service users . Trial registration number IS RCT N78539530 ; Pre- results Background Heart failure ( HF ) and chronic obstructive pulmonary disease ( COPD ) are highly prevalent and associated with a large symptom burden , that is compounded in a dual HF- COPD diagnosis . Yoga has potential benefit for symptom relief ; however functional impairment hinders access to usual yoga classes . We developed a Tele-Yoga intervention and evaluated it in a controlled pilot trial . This paper reports on the appropriateness and acceptability of the intervention and the evaluation design . Methods A controlled , non-r and omised trial was conducted of an 8-week Tele-Yoga intervention versus an educational control ( information leaflets mailed to participants with one phone call a week ) . Biweekly one-hour Tele-Yoga classes were implemented via multipoint videoconferencing that connected participants to live classes via an Internet connection to their televisions . Semi-structured qualitative interviews were conducted with participants post study exit to explore reasons for and experiences of participating , including views of study outcome measures and physiological tests . Transcribed interviews were analysed using thematic content analysis . Results Fifteen people participated in the pilot study ( 7 in the intervention group , 8 in the control ) . Of these , 12 participants were interviewed , 6 in each group , mean age 71.2 years ( SD 10.09 ) ; 3 were male . Themes are reported in the following categories : acceptability and appropriateness of the intervention , potential active ingredients of the intervention , acceptability and appropriateness of the control , participation in the research , and acceptability of the testing procedures . The intervention was acceptable and appropriate : the intervention group reported enjoying yoga and valuing the home-based aspect and participants described a high symptom burden and social isolation . However , technological problems result ed in poor video-streaming quality for some participants . Potential active ingredients included physical postures , breathing exercises and guidance in relaxation and meditation . The educational control intervention was acceptable and appropriate , with participants reporting little effect on their well-being and no impact on mechanisms hypothesised to explain yoga ’s effectiveness . The question naires and home physiological testing were acceptable to participants . Conclusions Tele-Yoga is an acceptable and appropriate intervention in people with HF and COPD and further research is warranted to refine the technology used in its delivery . Findings provide guidance for research ers working in tele- interventions , yoga , and similar population s . Trial registration Clinical Trials.gov Identifier : NCT02078739 ( 4 March 2014 ) Aims Exercise is known to be beneficial for patients with heart failure ( HF ) , and these patients should therefore be routinely advised to exercise and to be or to become physically active . Despite the beneficial effects of exercise such as improved functional capacity and favourable clinical outcomes , the level of daily physical activity in most patients with HF is low . Exergaming may be a promising new approach to increase the physical activity of patients with HF at home . The aim of this study is to determine the effectiveness of the structured introduction and access to a Wii game computer in patients with HF to improve exercise capacity and level of daily physical activity , to decrease healthcare re source use , and to improve self‐care and health‐related quality of life . Methods and results A multicentre r and omized controlled study with two treatment groups will include 600 patients with HF . In each centre , patients will be r and omized to either motivational support only ( control ) or structured access to a Wii game computer ( Wii ) . Patients in the  control  group will receive advice on physical activity and will be contacted by four telephone calls . Patients in the Wii group also will receive advice on physical activity along with a Wii game computer , with instructions and training . The primary endpoint will be exercise capacity at 3 months as measured by the 6 min walk test . Secondary endpoints include exercise capacity at 6 and 12 months , level of daily physical activity , muscle function , health‐related quality of life , and hospitalization or death during the 12 months follow‐up . Conclusion The HF‐Wii study is a r and omized study that will evaluate the effect of exergaming in patients with HF . The findings can be useful to healthcare professionals and improve our underst and ing of the potential role of exergaming in the treatment and management of patients with HF . Trial registration The outcomes of quantitative investigations examining the effectiveness of exercise interventions for people with COPD are limited by the small number of measurement tools that can be included . In contrast , qualitative inquiry allows broader exploration of the perceived outcomes of an intervention . The purpose of this investigation is to explore the qualitative outcomes of a progressive resistance exercise ( PRE ) program for people with COPD . People with COPD , enrolled in a r and omized controlled trial of PRE , were invited to participate in two semi-structured interviews conducted at the end ( 12 weeks ) and 12 weeks after the training intervention ( 24 weeks ) . Interviews were audiotaped , transcribed and then coded independently by two research ers . Themes relating to training outcomes were then developed and described . Twenty-two participants were interviewed at 12 weeks , and 19 participants at 24 weeks . After PRE , participants reported a range of physical gains , particularly with regard to improved strength and reduced breathlessness during daily activities . Improved control and confidence during activities of daily living were important psychological benefits perceived by people with COPD , as was the social support experienced during group training sessions . At 24 weeks , confidence persisted despite a perceived plateau or dissipation of physical gains .  People with COPD reported physical , psychological and social benefits after PRE , which had a positive effect on activity performance . Although the perceived physical benefits of training were not prominent at 24 weeks , feelings of increased confidence and control persisted . Chronic Respiratory Disease 2007 ; 4 : Background We aim ed to establish the support needs of people with heart failure and their caregivers and develop an intervention to improve their health-related quality of life . Methods We used intervention mapping to guide the development of our intervention . We identified “ targets for change ” by synthesis ing research evidence and international guidelines and consulting with patients , caregivers and health service providers . We then used behaviour change theory , expert opinion and a taxonomy of behaviour change techniques , to identify barriers to and facilitators of change and to match intervention strategies to each target . A patient and public involvement group helped to identify patient and caregiver needs , refine the intervention objectives and strategies and deliver training to the intervention facilitators . A feasibility study ( IS RCT N25032672 ) involving 23 patients , 12 caregivers and seven trained facilitators at four sites assessed the feasibility and acceptability of the intervention and quality of delivery and generated ideas to help refine the intervention . Results The Rehabilitation Enablement in Chronic Heart Failure ( REACH-HF ) intervention is a comprehensive self-care support programme comprising the “ Heart Failure Manual ” , a choice of two exercise programmes for patients , a “ Family and Friends Re source ” for caregivers , a “ Progress Tracker ” tool and a facilitator training course . The main targets for change are engaging in exercise training , monitoring for symptom deterioration , managing stress and anxiety , managing medications and underst and ing heart failure . Secondary targets include managing low mood and smoking cessation . The intervention is facilitated by trained healthcare professionals with specialist cardiac experience over 12 weeks , via home and telephone contacts . The feasibility study found high levels of satisfaction and engagement with the intervention from facilitators , patients and caregivers . Intervention fidelity analysis and stakeholder feedback suggested that there was room for improvement in several areas , especially in terms of addressing caregivers ’ needs . The REACH-HF material s were revised accordingly . Conclusions We have developed a comprehensive , evidence -informed , theoretically driven self-care and rehabilitation intervention that is grounded in the needs of patients and caregivers . A r and omised controlled trial is underway to assess the effectiveness and cost-effectiveness of the REACH-HF intervention in people with heart failure and their caregivers BACKGROUND Regular physical activity has been shown to have many health benefits . However , many older people are physically inactive . OBJECTIVE To investigate why older people are reluctant to participate in leisure time physical activity and to identify strategies to encourage increased activity . DESIGN Cross-sectional survey . SETTING 16 general practice s in Dundee , Scotl and . METHODS 409 r and omly selected older people ( 65 - 84 years ) who lived independently were interviewed at home . Forty-six percent of those invited to take part were recruited into the study . RESULTS Levels of knowledge about the specific health benefits of physical activity were high . Almost all participants ( 95 % ) believed that physical activity was beneficial and 79 % believed that they did enough to keep healthy . However , 36 % did no leisure time physical activity and a further 17 % did less than 2 hours per week . Regression modelling identified 11 factors that exerted significant independent effects on levels of leisure time physical activity .  The most powerful deterrent was lack of interest ( OR = 7.8 ) . Other factors included lack of daily access to a car , shortness of breath , joint pain , dislike of going out alone or in the evening , perceived lack of fitness , lack of energy , doubting that exercise can lengthen life , not belonging to a group and doubting that meeting new people is beneficial . CONCLUSIONS Increasing leisure time physical activities poses major challenges . Beliefs about desirable levels of activity in older people would need to be changed . Action would be needed to relieve physical symptoms and address fears about perceived ability to undertake physical activity . Finally , easily accessible facilities would be needed to encourage participation in physical activity OBJECTIVE The purpose of this study was to determine the effect of a tailored message intervention on heart failure readmission rates , quality of life , and health beliefs in persons with heart failure ( HF ) . DESIGN This r and omized control trial provided a tailored message intervention during hospitalization and 1 week and 1 month after discharge . Theoretic framework The organizing framework was the Health Belief Model . SUBJECTS Seventy persons with a primary diagnosis of chronic HF were included in the study . RESULTS HF readmission rates and quality of life did not significantly differ between the treatment and control groups . Health beliefs , except for benefits of medications , significantly changed from baseline in the treatment group in directions posited by the Health Belief Model . CONCLUSIONS A tailored message intervention changed the beliefs of the person with HF in regard to the benefits and barriers of taking medications , following a sodium-restricted diet , and self-monitoring for signs of fluid overload . Future research is needed to explore the effect of health belief changes on actual self-care behaviors Background : Self-care is an integral component of successful heart failure ( HF ) management . Engaging patients in self-care can be challenging . Methods : Fifteen patients with HF enrolled during hospitalization received a motivational intervention design ed to improve HF self-care . A mixed method , pretest posttest design was used to evaluate the proportion of patients in whom the intervention was beneficial and the mechanism of effectiveness . Participants received , on average , 3.0 ± 1.5 home visits ( median 3 , mode 3 , range 1 - 6 ) over a three-month period from an advanced practice nurse trained in motivational interviewing and family counseling . Quantitative and qualitative data were used to judge individual patients in whom the intervention produced a clinical ly significant improvement in HF self-care . Audiotaped intervention sessions were analyzed using qualitative methods to assess the mechanism of intervention effectiveness . Results : Congruence between quantitative and qualitative judgments of improved self-care revealed that 71.4 % of participants improved in self-care after receiving the intervention . Analysis of transcribed intervention sessions revealed themes of 1 ) communication ( reflective listening , empathy ) ; 2 ) making it fit ( acknowledging cultural beliefs , overcoming barriers and constraints , negotiating an action plan ) ; and , 3 ) bridging the transition from hospital to home ( providing information , building skills , activating support re sources ) . Conclusion : An intervention that incorporates the core elements of motivational interviewing may be effective in improving HF self-care , but further research is needed OBJECTIVE To estimate the prevalence of heart failure ( HF ) and left ventricular ( LV ) systolic dysfunction in a population -based sample of older Australians . DESIGN , SETTING AND PARTICIPANTS A cross-sectional survey of 2000 r and omly selected residents of Canberra , aged 60 - 86 years , conducted between February 2002 and June 2003 . Participants were assessed by history , physical examination by a cardiologist , and echocardiography . MAIN OUTCOME MEASURES Age- and sex-specific prevalence rates of clinical HF and LV systolic dysfunction ( defined as LV ejection fraction < or = 50 % ) . RESULTS Of 1846 people eligible for our study , 1388 ( 75 % ) agreed to participate and 1275 completed all investigations ( mean age , 69.4 years ; 50 % men ) . In the study sample , 72 subjects ( 5.6 % ; 95 % CI , 4.4%-7.1 % ) had clinical HF that had been previously diagnosed and was confirmed by our assessment . A further 0.6 % ( 95 % CI , 0.3%-1.2 % ) had undiagnosed clinical HF ( ie , evidence of structural heart disease and symptoms/signs of cardiac insufficiency without a previous diagnosis of clinical HF ) . Thus , the overall prevalence of clinical HF in the sample was 6.3 % ( 95 % CI , 5.0%-7.7 % ) . Clinical HF increased in prevalence with advancing age ( a 4.4-fold increase from the 60 - 64-years age group to the 80 - 86-years age group ; P < 0.0001 ) . Of the 75 subjects ( 5.9 % ; 95 % CI , 4.7%-7.3 % ) with LV systolic dysfunction , 44 ( 59 % ) were in the pre clinical stage of disease . CONCLUSION Diagnosed HF cases represent the " tip of the iceberg " for the national burden of HF and LV systolic dysfunction . Clinical ly identifiable HF cases can remain undiagnosed , and the majority of people with LV systolic dysfunction are in a pre clinical stage of the disease Heart failure has been named “ the growing epidemic . ” Over the last decade , the annual number of heart failure hospitalizations has almost doubled with approximately 50 % of patients being rehospitalized within 6 months of discharge [ 1 ] . The complex array of physiologic , psychological , social , and health care delivery issues makes it a challenging chronic disease to manage . Underst and ing the epidemiology and pathophysiology of the syndrome , identifying the predictors and their strength of association with outcomes , and using the available diagnostic modalities cost-effectively are essential in order to devise effective prevention interventions and implement novel therapeutic approaches to curb this epidemic . In this special issue , we have invited a few papers that address such issues and explain why despite the emergence of novel therapeutic approaches , that promise life prolongation and hospital length reduction , this patient population will still be needing rehospitalization and will often have a poor prognosis . This special issue is the extension of an effort that was initiated in 2011 with the first heart-failure-focused issue [ 2 ] . In the pathophysiology section , S. M. R. Kazemi-Bajestani et al. describe the opportunities and challenges of targeting the angiotensin converting enzyme 2 (ACE2)/Ang II/Ang1–7 and apelin/APJ pathways as novel therapeutic modalities in heart failure [ 3 ] . ACE2 and the apelin/APJ are two important peptide systems which exert diverse effects on the cardiovascular system . Dysregulation of such systems may be involved in the predisposition to cardiovascular diseases whereas enhancing their action may have important therapeutic effects . In the same section , D. Lindner et al. provide a comprehensive review on the protective function of signal transducer and activator of transcription 3 ( STAT3 ) in CVB3-induced myocarditis [ 4 ] . The transcription factor ( STAT3 ) is an important mediator of the inflammatory process , and in this original research the investigators examine the role of STAT3 in viral myocarditis and its possible role in the development to dilated cardiomyopathy . Considering the high mortality rate and the availability of life-saving therapies like transplantation and left ventricular assist devices , accurate prognosis determination in HF is clinical ly important . Taking into account the mediocre performance of current established prediction models , such as the Seattle Heart Failure Model [ 5–7 ] , the work by H. Fukuta et al. [ 8 ] on the prognostic value of left ventricular diastolic dysfunction in patients undergoing cardiac catheterization for coronary artery disease sheds light on this extremely important topic . A shared underst and ing of medical conditions between patients and their health care providers has been shown to improve self-care and outcomes [ 9 ] . In the comorbidity section , we demonstrate how certain comorbid conditions may affect patients ' decision-making capacity and interfere with their ability to comply with treatment requirements , recognize and self-manage disease worsening symptoms . Among others , cognitive impairment is increasingly recognized as a common adverse consequence of HF , whereby phenomena such as microembolism , chronic or intermittent cerebral hypoperfusion , and /or impaired cerebral vessel reactivity may lead to cerebral hypoxia and ischemic brain damage . Cognitive decline in HF is characterized by deficits in one or more cognition domains , including attention , memory , executive function , and psychomotor speed . E. Dardiotis et al. [ 10 ] , in a comprehensive review , underscore the importance for healthcare professionals to become familiar with assessment of cognitive performance using st and ardized screening instruments in their routine evaluations of HF patients . Another comorbidity gaining increasing attention in HF patients is depression . There are several pathophysiological mechanisms as well as behavioral processes linking depression and HF . Equally important is screening for depression and there are several valid and reliable screening tools to identify patients at greater risk . Consultation should be provided by a multidisciplinary team , consisting of cardiologists , psychiatrists , and hospital or community nurses so as to carefully plan , execute , and evaluate medical intervention and implement lifestyle changes . D. Mastrogiannis et al. [ 11 ] systematic ally review the existing knowledge regarding current definitions , prognostic implication s , pathophysiological mechanisms , and current and future treatment options in patients with depression and HF . Evidence from the literature supports the possibility of a pathophysiological relationship between cognitive impairment , depression , and HF . Yet , very few studies have sought to investigate this relationship . The paper by Z. N. Sohani and Z. Samaan review s current literature on the association between depression and cognitive impairment  in persons with HF and explores possible mechanisms explaining this complex triad [ 12 ] . Heart failure through neurohumoral activation induces alterations of cardiac metabolism , such as insulin resistance , and promotes increased utilization of noncarbohydrate substrates for energy production [ 13 , 14 ] . Fasting blood ketone bodies as well as fat oxidation have been shown to be increased in this patient population . The result is depletion of myocardial ATP , phosphocreatine , and creatine kinase , leading to decreased efficiency of mechanical work . A direct approach to manipulate cardiac energy metabolism consists in modifying substrate utilization by the failing heart . Trimetazidine , perhexiline , and ranolazine directly inhibit fatty acid oxidation and have been used to increase the ischemic threshold in patients with effort angina . Current research is supporting the concept that shifting the energy substrate preference away from fatty acid metabolism and toward glucose metabolism could be an effective adjunctive treatment in patients with HF . These agents have been shown to improve both glucose metabolism and left ventricular function in diabetic patients with left ventricular dysfunction . In the pharmacotherapy section , we provide a systematic review , in which N. Signoretta et al. [ 15 ] discuss the beneficial therapeutic effects of modulation of cardiac metabolic substrates utilization in patients with HF . In the advanced heart failure section , we provide a thorough review on the current status of mechanical circulatory support in patients with advanced HF . Management of the advanced HF patients with the numerous comorbidities [ 16 , 17 ] requires a significant amount of health care re sources and is becoming a major public health problem . As therapeutical strategies for HF have been refined , the number of patients suffering from the end-stage disease has exp and ed dramatically . Although heart transplantation still represents the gold st and ard therapeutical approach , the shortage of donors universally has made the implantation of mechanical circulatory support devices a well-established management for this disease . The systematic review by K. Spiliopoulos et al. [ 18 ] , outlines the current status of mechanical circulatory support in this patient population . In the chronic follow-up section , we deal with telemonitoring , a novel diagnostic modality that has been suggested to be beneficial for HF patients , targeting optimization of their chronic followup . Telemonitoring is viewed as a means of recording physiological data ( such as body weight , heart rate , arterial blood pressure electrocardiogram recordings , and other data ) by portable devices and transmitting these data remotely ( via a telephone line , a mobile phone , or a computer ) to a server where they can be stored , review ed , and analyzed by the research team . In a systematic review of all r and omized clinical trials evaluating telemonitoring in chronic HF , G. Giamouzis et al. [ 19 ] assess whether telemonitoring provides any substantial benefit in this patient population . We hope that the readers of the journal will find the topics as interesting and important as we did . Gregory Giamouzis George Giannakoulas Javed Butler John A. Elefteriades Carsten Tschope Filippos The purpose of this study was to determine how an exercise adherence intervention affects the physiological , functional , and quality of life outcomes of patients with heart failure ( HF ) . Sixteen HF patients were r and omly assigned to an  exercise-only group  ( n = 8) or to an  exercise-with-adherence group ( n = 8) . Two of the 16 people  died from nonexercise related causes during the study and were not included in the analysis . The intervention was tested over a 24-week period in which patients participated in a 12-week supervised exercise program ( Phase 1 ) followed by 12 weeks of unsupervised home exercise ( Phase 2 ) . The intervention format was one of individualized graphic feedback on exercise goals and participation and problem-solving support by nurses . Results indicate that patients who received the intervention exercised more frequently and experienced improved outcomes during both phases . The adherence intervention may encourage HF patients to continue to exercise and thereby maintain the health benefits gained in both phases of an exercise program OBJECTIVES To assess the effects of a home-based aerobic and resistance training program on the physical function of adults with New York Heart Association ( NYHA ) class II and III patients and systolic heart failure ( HF ) . DESIGN R and omized controlled trial . SETTING Home based . PARTICIPANTS Stable patients ( N=24 ; mean age , 60 ± 10 y ; left ventricular ejection fraction , 25 % ± 9 % ; 50 % white ; 50 % women ) with New York Heart Association ( NYHA ) classes II and III ( NYHA class III , 58 % ) systolic heart failure ( HF ) . INTERVENTION A 12-week progressive home-based program of moderate-intensity aerobic and resistance exercise . Attention control wait list participants performed light stretching and flexibility exercises . MAIN OUTCOME MEASURES A 10-item performance-based physical function measure , the Continuous Scale Physical Functional Performance test ( CS-PFP10 ) , was the major outcome variable and included specific physical activities measured in time to complete a task , weight carried during a task , and distance walked . Other measures included muscle strength , HRQOL ( Minnesota Living With Heart Failure Question naire , Epworth Sleepiness Scale ) , functional capacity ( Duke Activity Status Index ) , and disease severity ( brain natriuretic peptide ) levels . RESULTS After the exercise intervention , 9 of 10 specific task activities were performed more rapidly , with increased weight carried by exercise participants compared with the attention control wait list group . Exercise participants also showed significant improvements in CS-PFP10 total score ( P<.025 ) , upper and lower muscle strength , and HRQOL ( P<.001 ) compared with the attention control wait list group . Adherence rates were 83 % and 99 % for the aerobic and resistance training , respectively . CONCLUSIONS Patients with stable HF who participate in a moderate-intensity combined aerobic and resistance exercise program may improve performance of routine physical activities of daily living by using a home-based exercise approach . Performance-based measures such as the CS-PFP10 may provide additional insights into physical function in patients with HF that more commonly used exercise tests may not identify . Early detection of subtle changes that may signal declining physical function that are amenable to intervention potentially may slow further loss of function in this patient population OBJECTIVES Evidence has emerged supporting the value of loaded exercises for rotator cuff tendinopathy but there are barriers that might prevent implementation of this intervention in the real-world . The purpose of this study was to explore these potential barriers with participants involved in a pilot r and omised controlled trial ( RCT ) investigating a self-managed loaded exercise intervention . DESIGN A qualitative study within the framework of a mixed methods design . Data were collected using individual interviews and analysed using the framework method . SETTING One private physiotherapy clinic in northern Engl and . PARTICIPANTS Six patients and two physiotherapists were purposively sample d from those allocated to the  self-managed exercise group  within the RCT . RESULTS Three themes were generated : ( 1 ) Expectations and preferences , ( 2 ) characteristics of an unsuccessful outcome , ( 3 ) characteristics of a successful outcome . Most patients expressed expectations contrary to the philosophy of a self-managed approach . But this did not serve as a barrier when the intervention was offered within a positive and supporting environment where patients understood the reasons for undertaking the exercise , effectively self-monitored and engaged with pro-active follow-up . An early and appreciable response to therapy was also a key factor influencing continuing engagement with the exercise programme . CONCLUSION With certain caveats including the need to recognise and respond to individual characteristics , implement effective knowledge translation strategies and the need to engage with appropriately timed pro-active follow-up , the potential to implement programmes of self-managed loaded exercise for patients with rotator cuff tendinopathy in the real-world and in further research studies appears feasible but challenging Objective Treatment recommendation and guidelines for patients with heart failure ( HF ) can be complex , and past work has shown that patients with HF demonstrate low rates of adherence to recommended health behaviors . Although previous work has identified several medical , demographic , and psychosocial predictors of the capacity to adhere to treatment recommendations of persons with HF , little is known about the contribution of cognitive impairment to reported treatment adherence in this population . Methods A total of 149 persons with HF ( mean [ st and ard deviation ] = 68.08 [ 10.74 ] years ) completed a brief fitness assessment and neuropsychological testing . Treatment adherence was assessed using the  Heart Failure Compliance Question naire , a brief measure that asks participants to report their adherence to a variety of recommended health behaviors ( i.e. , medication management , diet , and exercise , among others ) . Results The percentage of participants who reported poor overall adherence was 16.1 % , with particularly high rates of nonadherence to dietary and exercise recommendations . Hierarchical regression analyses adjusting for possible confounds revealed that reduced performance on attention ( & bgr ; = .26 , p = .01 ) , executive function ( & bgr ; = .18 , p = .04 ) , and language ( & bgr ; = .22 , p = .01 ) was associated with poorer overall adherence . Follow-up analyses showed that these cognitive domains were associated with behaviors such as keeping doctor appointments , medication management , and dietary recommendations ( p < .05 for all ) . Conclusions The current findings demonstrate that cognitive function is an independent contributor to adherence in older adults with HF . Prospect i ve studies that objective ly measure treatment adherence are needed to clarify these findings and identify possible strategies to improve outcomes in this population . Trial Registration : clinical trials.gov Identifier : NCT00871897 Sport and exercise can have several health benefits for people living with HIV . These benefits can be achieved through different types of physical activity , adapting to disease progression , motivation and social-ecological options . However , physical activity levels and adherence to exercise are generally low in people living with HIV . At the same time , high drop-out rates in intervention studies are prevalent ; even though they often entail more favourable conditions than interventions in the natural setting s. Thus , in the framework of an intervention study , the present study aims to explore social-ecological , motivational and volitional correlates of South African women living with HIV with regard to physical activity and participation in a sport and exercise health promotion programme . The qualitative data was produced in the framework of a non-r and omised pre-post intervention study that evaluated structure , processes and outcomes of a 10-week sport and exercise programme .  All 25 participants of the programme were included in this analysis , independent of compliance . Data was produced through question naires , participatory group discussion s , body image pictures , research diaries and individual semi-structured interviews . All participants lived in a low socioeconomic , disadvantaged setting . Hence , the psychological correlates are context ualised and social-ecological influences on perception and behaviour are discussed . The results show the importance of considering social-cultural and environmental influences on individual motives , perceptions and expectancies , the fear of disclosure and stigmatisation , sport and exercise-specific group dynamics and self-supporting processes . Opportunities and strategies to augment physical activity and participation in sport and exercise programmes in the context of HIV are discussed Web-based communication has been reported as a feasible management tool for heart failure ( HF ) patients and has also been documented to positively impact quality of life ( QOL ) . The feasibility and effectiveness of a Web-based educational and HF management program among older HF patients ( 60 years and older ) , however , have not been previously explored . Therefore , a prospect i ve study was conducted . QOL ( physical and mental health ) and perceived control ( PC ) scores of 40 participants were measured ( baseline and 3 months ) and retrospectively compared with an age- and sex-matched control group of 40 patients receiving HF care as usual .  Between-group differences over time were statistically significant in the QOL mental health component and PC scores . The authors ' findings demonstrate the beneficial effects of a Web-based program on QOL and PC in older patients with HF . This approach may be potentially beneficial in delivering educational and behavioral support to this high-risk group in ways that are affordable and accessible BACKGROUND Heart failure ( HF ) is a major public health problem . Case management by nurses using telephone follow-up has been suggested as a convenient and effective mechanism to promote the self-management of HF . Similarly , a patient empowerment approach to the management of chronic disease has been suggested as one that may nurture self-management in individuals with chronic illness . OBJECTIVE The purpose of this study was to examine the effects of a telephone-delivered empowerment intervention ( EI ) on clinical ly and theoretically relevant outcomes in patients with HF , including purpose ful participation in goal attainment , self-management of HF , and perception of functional health . The EI was guided by Rogers ' Science of Unitary Human Beings person-environment process . METHODS A convenience sample of men and women aged 21 years and older with a clinical diagnosis of HF was obtained from a metropolitan hospital located in the southwestern United States . The participants were r and omly assigned to the control group ( n = 45 ) or EI group ( n = 45 ) . All participants received st and ardized HF patient education ; the intervention group also received an EI delivered through telephone follow-up calls from a registered nurse . Repeated- measures analysis of variance was used to evaluate intervention effects . RESULTS The telephone-delivered EI  facilitated self-management of HF through self-care activities in EI group members . CONCLUSION The knowledge gained from this study provides a beginning underst and ing of strategies to enhance health care providers ' ability to facilitate self-management of HF among patients diagnosed with HF Heart failure ( HF ) is a progressive , debilitating syndrome with significant physical and psychological comorbidities . As psychosocial variables have been found to contribute to HF morbidity and mortality , methods to improve mental health and quality of life have been explored . This study examined the effects of mutual goal setting and supportive-educative nursing interventions on mental health and quality of life . An experimental , repeated- measures design with a convenience sample of 88 participants was used . The mutual goal setting nursing intervention was found to significantly support improved mental health and quality of life in this population over a 6-month period Objectives The goal of this study was to determine the relative contribution of major lifestyle factors on the development of  heart failure ( HF ) in older adults . Background HF incurs high morbidity , mortality , and health care costs among adults ≥65 years of age , which is the most rapidly growing segment of the U.S. population . Methods We prospect ively investigated separate and combined associations of lifestyle risk factors with  incident HF ( 1,380 cases ) over 21.5 years among 4,490 men and women in the Cardiovascular Health Study , which is a community-based cohort of older adults . Lifestyle factors included 4  dietary patterns ( Alternative Healthy Eating Index , Dietary Approaches to Stop Hypertension , an American Heart Association 2020 dietary goals score , and a Biologic pattern , which was constructed using previous knowledge of cardiovascular disease dietary risk factors ) , 4  physical activity metrics ( exercise intensity , walking pace , energy expended in leisure activity , and walking distance )  , alcohol intake ,  smoking , and  obesity  . Results No dietary pattern was associated with developing HF ( p > 0.05 ) . Walking pace and leisure activity were associated with a 26 % and 22 % lower risk of HF , respectively ( pace > 3 mph vs. < 2 mph ; hazard ratio [ HR ] : 0.74 ; 95 % confidence interval [ CI ] : 0.63 to 0.86 ; leisure activity ≥845 kcal/week vs. < 845 kcal/week ; HR : 0.78 ; 95 % CI : 0.69 to 0.87 ) . Modest alcohol intake , maintaining a body mass index < 30 kg/m2 , and not smoking were also independently associated with a lower risk of HF . Participants with ≥4 healthy lifestyle factors had a 45 % ( HR : 0.55 ; 95 % CI : 0.42 to 0.74 ) lower risk of HF . Heterogeneity by age , sex , cardiovascular disease , hypertension medication use , and diabetes was not observed . Conclusions Among older U.S. adults , physical activity , modest alcohol intake , avoiding obesity , and not smoking , but not dietary patterns , were associated with a lower risk of HF BACKGROUND Clinical guidance recommends physical activity to manage patients with persistent subthreshold depressive symptoms or mild-to-moderate depression . However , little is known regarding the acceptability of physical activity as a treatment for  depression  from patients ' perspective . AIM To explore patients ' views of physical activity for the treatment of depression in the context of primary care . DESIGN OF STUDY In-depth interviews were held with 33 participants taking part in a r and omised controlled trial assessing the effectiveness of physical activity for the management of depression . SETTING Primary care . RESULTS Most participants perceived physical activity to be an acceptable treatment for depression . The mechanisms by which physical activity could enhance mood were attributed to a number of subjective benefits including biochemical pathways , providing a source of distraction from negative thoughts , and a sense of purpose . Participants who expressed a belief that their depression was caused by biochemical mechanisms reported activity that ' raised the heartbeat ' as most beneficial , while those who believed depression was situational in origin tended to state the benefits of less-aerobic activities , such as walking . Many participants reported low motivation and a lack of confidence as barriers to undertaking physical activity . These patients suggested that medication could be helpful for initiating and maintaining activity . CONCLUSION Patients view physical activity as an effective treatment for depression . However , they vary in their views about how physical activity might impact on depression , what intensity and form of activity is necessary to enhance mood , and the barriers to undertaking activity . This variation suggests the need for GPs to elicit patients ' views on physical activity as a treatment , and offer interventions that are tailored to the needs and expectations of individual patients Objective : Depression is common in heart failure ( HF ) and associated with reduced cognitive function . The current study used Structrual Equation Modeling to examine whether depression adversely impacts cognitive function in HF through its adverse affects on exercise adherence and cardiovascular fitness . Method : 158 HF patients completed neuropsychological testing , physical fitness test , Beck Depression Inventory-II ( BDI-II ) , and measures assessing exercise adherence and physical exertion .  Results : The model demonstrated excellent model fit and increased scores on the BDI-II negatively affected exercise adherence and cardiovascular fitness . There was a strong inverse association between cardiovascular fitness and cognitive function . Sobel test showed a significant indirect pathway between the BDI-II and cognitive function through cardiovascular fitness . Discussion : This study suggests depression in HF may adversely impact cognitive function through reduced cardiovascular fitness . Prospect i ve studies are needed to determine whether treatment of depression can lead to better lifestyle behaviors and ultimately improve neurocognitive outcomes in HF
How individuals responded to their diagnosis and their altered physical status related to their activity levels , as did the degree of encouragement to exercise coming from family , friends , and professionals .
These findings can be connected to the theory of behavioral change developed by B and ura , known as social cognitive theory ( SCT ) .
SCT may be a useful framework for developing interventions to support patients with HF in undertaking and maintaining regular exercise patterns .
These were issues referred to in papers for the systematic review that appear to be particularly related to exercise adherence
OBJECTIVES Keeping physically active has been shown to bring positive outcomes for patients diagnosed with heart failure ( HF ) .
However , a number of individuals with this health problem do not undertake regular exercise .
A review of extant qualitative research was conducted to explore what it can tell us about barriers and enablers to physical activity among people with HF .