University of Nebraska Medical Center, College of Nursing, Nebraska Medical Center, Omaha, NE.
University of Nebraska Medical Center, College of Allied Health, Omaha, NE.
Ann Behav Med. 2021 Oct 4;55(10):1031-1041. doi: 10.1093/abm/kaab002.
Exercise is safe and provides considerable benefits for patients with heart failure (HF) including improved function, quality of life, and symptoms. However, patients with HF have difficulty initiating and adhering to an exercise regimen. To improve adherence, our team developed Heart Failure Exercise and Resistance Training (HEART) Camp, a multicomponent, theory-driven intervention that was efficacious in a randomized controlled trial of long-term adherence to exercise in patients with HF. Identifying active components of efficacious interventions is a priority.
The purpose of this study is to use mediation analysis to determine which interventional components accounted for long-term adherence to exercise in patients with HF.
This study included 204 patients with HF enrolled in a randomized controlled trial. Instruments measuring interventional components were completed at baseline, 6, 12, and 18 months. Hierarchical linear models generated slope estimates to be used as predictors in logistic regression models. Significant variables were tested for indirect effects using path analyses with 1,000 bootstrapped estimates.
Significant mediation effects were observed for the interventional components of negative attitudes (β NA = 0.368, s.e. = 0.062, p < .001), self-efficacy (β SE = 0.190, s.e. = 0.047, p < .001), and relapse management (β RM = 0.243, s.e. = 0.076, p = .001).
These findings highlight improving attitudes, self-efficacy, and managing relapse as key interventional components to improve long-term adherence to exercise in patients with HF. Future interventions targeting adherence to exercise in patients with HF and other chronic illnesses should consider the incorporation of these active components.
运动对心力衰竭（HF）患者是安全且有益的，包括改善功能、生活质量和症状。然而，HF 患者在开始和坚持运动方案方面存在困难。为了提高依从性，我们的团队开发了心力衰竭运动和阻力训练（HEART）营，这是一种多组分、基于理论的干预措施，在 HF 患者长期坚持运动的随机对照试验中是有效的。确定有效的干预措施的有效成分是当务之急。
本研究旨在通过中介分析确定哪些干预成分可解释 HF 患者长期坚持运动的原因。
这项研究纳入了 204 名 HF 患者，他们参加了一项随机对照试验。在基线、6、12 和 18 个月时完成了测量干预成分的工具。分层线性模型生成斜率估计值，作为逻辑回归模型的预测值。使用路径分析对显著变量进行间接效应检验，采用 1000 次 bootstrap 估计值。
观察到干预成分中的负面态度（β NA = 0.368，s.e. = 0.062，p <.001）、自我效能（β SE = 0.190，s.e. = 0.047，p <.001）和复发管理（β RM = 0.243，s.e. = 0.076，p =.001）具有显著的中介效应。
这些发现强调了改善态度、自我效能和管理复发是提高 HF 患者长期坚持运动的关键干预成分。未来针对 HF 患者和其他慢性病患者的依从性的干预措施应考虑纳入这些有效成分。
