Corvera-Tindel Teresita, Doering Lynn V, Gomez Teresita, Dracup Kathleen
Nursing Department, Greater Los Angeles, Veterans Affairs Health Care System, Los Angeles, Calif. 90073, USA.
J Cardiovasc Nurs. 2004 Jul-Aug;19(4):269-77; quiz 278-9. doi: 10.1097/00005082-200407000-00006.
BACKGROUND/OBJECTIVES: Exercise training is an emerging therapy in heart failure (HF). However, factors influencing noncompliance to exercise have not been evaluated. We assessed clinical factors, functional status, and emotional predictors of noncompliance to a 12-week home walking exercise program.
Using a correlational design, we evaluated noncompliance of 39 HF patients (aged 63.2 +/- 10.1 years, left ventricular ejection fraction 29.5% +/- 8.0%, peak oxygen consumption 14.1 +/- 3.7 mL/kg/min, HF duration 37.5 +/- 32.9 months, 74% New York Heart Association class II) to home walking exercise. Noncompliance was defined as (1) completion of the 12-week program with 60% or less of prescribed weekly walking duration (noncompliant completers); or (2) failure to complete the 12-week program (dropouts). Univariate analyses (chi-square or t test) and multivariate backward logistic regression were performed to identify clinical factors (body mass index, comorbidities, and HF duration), functional status (peak VO2), and emotional dysphoria (anxiety, hostility, depression) predictive of noncompliance to training.
Mean compliance was 35% +/- 30% (945/2700 minutes) for noncompliant patients (n = 13) and 99% +/- 13% (2673/2700 minutes) for compliant patients (n = 26). In the multivariate analysis, higher comorbidity (odds ratio [OR]: 2.7, confidence interval [CI]: 1.11-6.71), longer HF duration (OR: 1.1, CI: 1.01-1.13), lower hostility (OR: 0.47, CI: 0.24-0.91), and lower body mass index (OR: 0.76, CI: 0.58-0.98) were predictive of noncompliance to exercise training in patients with HF.
Noncompliance should be monitored carefully in HF patients with multiple comorbidities, longer HF duration, lower body mass index, and lower hostility scores. In this subgroup of HF patients, tailored exercise prescriptions may enhance compliance to an exercise program.
背景/目的：运动训练是心力衰竭（HF）领域一种新兴的治疗方法。然而，影响运动依从性的因素尚未得到评估。我们评估了12周家庭步行运动计划中不依从运动的临床因素、功能状态和情绪预测因素。
采用相关性设计，我们评估了39例HF患者（年龄63.2±10.1岁，左心室射血分数29.5%±8.0%，峰值耗氧量14.1±3.7 mL/kg/min，HF病程37.5±32.9个月，74%为纽约心脏协会II级）的家庭步行运动依从性。不依从定义为：（1）完成12周计划，但每周规定步行时长的完成率为60%或更低（不依从完成者）；或（2）未完成12周计划（退出者）。进行单因素分析（卡方检验或t检验）和多因素向后逻辑回归，以确定预测HF患者运动不依从的临床因素（体重指数、合并症和HF病程）、功能状态（峰值VO2）和情绪烦躁（焦虑、敌意、抑郁）。
不依从患者（n = 13）的平均依从率为35%±30%（945/2700分钟），依从患者（n = 26）的平均依从率为99%±13%（2673/2700分钟）。在多因素分析中，较高的合并症（比值比[OR]：2.7，置信区间[CI]：1.11 - 6.71）、较长的HF病程（OR：1.1，CI：1.01 - 1.13）、较低的敌意（OR：0.47，CI：0.24 - 0.91）和较低的体重指数（OR：0.76，CI：0.58 - 0.98）可预测HF患者运动训练不依从。
对于合并多种疾病、HF病程较长、体重指数较低且敌意得分较低的HF患者，应仔细监测其不依从情况。在这一HF患者亚组中，量身定制的运动处方可能会提高运动计划的依从性。
