Physical training in patients with chronic heart failure: level of involvement, as well as psychosocial, anamnestic and iatrogenic factors that determine the motivation to practice
Authors: Begrambekova Yu. L. , Efremushkina A. Yu. , Kozhedub Ya. A. , Smirnova E. A. , Terekhovskaya Yu. V. , Adonina E. V. , Petchina I. V. , Malenkova V. Yu. , Fendrikova S. V. , Skibitsky V. V. , Lelyavina T. A. , Kuular I. A. , Khromov-Borisov N. N. , Karanadze N. A. 
Published: May 2020

Introduction Physical exercise (PE) is a necessary part in the treatment of patients with chronic heart failure (CHF), which is stated in the European Society of Cardiology guidelines and the Russian Heart Failure Society guidelines. However, this type of non-drug treatment is still not sufficiently used in HF patients in Russia.Aim To study the current involvement of HF patients in PT and to describe psychosocial factors that influence the patients’ willingness to exercise and potential barriers and motivations for PE.Methods This study was designed as an in-moment survey. Patients with CHF who visited clinics in 7 cities of the Russian Federation in 2018 as a part of European Heart Failure Awareness Days were provided with a self-administered questionnaire containing questions about their social and educational status, attitude to PT as a method of treatment, and factors motivating and demotivating them to participation in training sessions. The survey participants were also asked a question about their source of information about exercise in HF. Physicians filled in the items describing HF clinical manifestations (left ventricular ejection fraction (EF) and HF functional class (FC)). Code numbers were used for further identification of the participants and to protect their confidentiality. Statistical analysis was performed with the StatXcat-8 program. Limits of exact confidence intervals (CIs) were provided both for fractions and parameters of polynomial distribution. CI limits for differences and fractions were calculated using MOVER. Age was analyzed using the PAST program.Results The study included 560 patients with HF; 52 % of them were women (mean age, 64; 95 % CI: 63–65 years). Women were 3 years older than men (95 % CI: 1.3–4.9 years). 501 (89.5 %) patients had FC II–III; 265 (49 %) patients had HF with low EF. 350 (62 %) patients had comorbidities: 41.4 % of patients had diabetes mellitus and 25.4 % of patients had arthritis. Only 91 (17 %) patients reported exercising. Patients younger than 65 exercised significantly more frequently than older ones (odds ratio (OR), 1.7, 95 % CI: 1.0–2.7, р<0.001). Patients with higher education had better chances to be involved in PT or were more anxious to start training (OR, 2.7; 95 % CI: 1.6–4.7, р<0.001). The capability for influencing the disease was the major motivation for PT for both sexes. Probability of this answer was 48 % (95 % CI: 33–61) for men and 46 % (95 % CI: 29–63) for women. 62 % of patients indicated poor health as the major barrier for participation in PT. Only 55 % of patients knew that PT could be a method for HF treatment, and only 50 % were informed about that by their physician.Conclusion The factors that positively influence the willingness to exercise include male sex, higher level of education, younger age, and better perception of the own health condition. 62 % of patients indicated poor health as the major barrier for participation in training. On the whole, the awareness of patients about PT benefits for health in HF was low. To our opinion, this was a serious factor of the extremely low involvement of patients in PT. Only 55 % of patients knew that PT could be a method for HF treatment, and, furthermore, only 50 % of patients received this information from their physicians.