Efficacy of interventions to increase physical activity for people with heart failure: a meta-analysis
Authors: Amirova Aliya , Fteropoulli Theodora , Williams Paul , Haddad Mark 
Published: April 2021

Objectives

This meta-analysis aims to 1) evaluate the efficacy of physical activity interventions in heart failure and 2) to identify intervention characteristics significantly associated with the interventions’ efficacy.

Methods

Randomised controlled trials reporting intervention effects on physical activity in heart failure were combined in a meta-analysis using a random-effect model. Exploratory meta-analysis was performed by specifying the general approach (e.g. cardiac rehabilitation), strategies used (e.g. action planning), setting (e.g. centre-based), mode of delivery (e.g. face-to-face or online), facilitator (e.g. nurse), contact time, and behaviour change theory use as predictors in the random-effect model.

Results

Interventions (n=21) had a significant overall effect (SMD = 0.54,95% CI: [0.13; 0.95], p < 0.005). Combining an exercise programme with behaviour change intervention was found efficacious (SMD = 1.26, 95% CI: [0.26; 2.26], p < 0.05). Centre-(SMD = 0.98, 95% CI: [0.35; 1.62],p < 0.001), and group-based (SMD = 0.89, 95 % CI: [0.29; 1.50],p < 0.001) delivery by a physiotherapist (SMD = 0.84, 95% CI: [0.03; 1.65]], p < 0.01) were significantly associated with efficacy. The following strategies were identified efficacious: prompts/cues (SMD = 3.29, 95% CI: [1.97; 4.62]), credible source (SMD=2.08, 95% CI:[0.95;3.22]), adding objects to the environment (SMD=1.47, 95% CI:[0.41;2.53]), generalisation of the target behaviour (SMD=1.32, 95% CI:[0.22;2.41]), monitoring of behaviour by others without feedback (SMD=1.02, 95% CI:[0.05;1.98]), self-monitoring of outcome(s) of behaviour (SMD=0.79, 95% CI:[0.06;1.52]), graded tasks (SMD=0.73, 95% CI:[0.22;1.24]), behavioural practice/rehearsal (SMD=0.72, 95% CI:[0.26;1.18]), action planning (SMD=0.62, 95% CI:[0.03;1.21]), and goal setting (behaviour) (SMD=0.56, 95% CI:[0.03;1.08]).

Conclusion

The meta-analysis suggests intervention characteristics that may be suitable for promoting physical activity in heart failure. There is moderate evidence in support of an exercise programme combined with a behaviour change intervention delivered by a physiotherapist in a group- and centre-based settings.

What is already known about this subject?

Individuals diagnosed with heart failure (HF) are advised to engage in physical activity. However, physical activity levels remain extremely low in this population group. Cardiac Rehabilitation (CR) is routinely offered to newly diagnosed HF patients. CR is multifaceted; It is unknown which specific components result in physical activity improvements once the programme has ended. It is essential to understand how best to improve everyday physical activity engagement in HF.

What does this study add?

This meta-analysis assessed what constitutes a successful physical activity intervention designed for individuals living with HF. The findings pinpoint specific intervention features and component that contribute to physical activity improvements in HF. Centre-based interventions that are delivered by a physiotherapist, in group format, that combine exercise with behaviour change intervention are promising for attaining physical activity improvements

How might this impact on clinical practice?

The findings of this meta-analysis may inform physical activity intervention designed for individuals diagnosed with HF. There is a need for additional training for physiotherapists in delivering behaviour change interventions alongside an exercise programme that includes the identified efficacious strategies.

Note: all statistics are reported using Word Build-in: “Equation.”