Abstract
Background: In prior research no differences have been found in 1-year mortality in pts with HF who participated in exercise interventions vs usual care. In HF-ACTION, over half of exercise pts were not fully adherent to the exercise intervention, even early into the trial. Understanding associations of exercise-related factors and 1-year mortality might lead to new interventions that promote exercise adherence. Methods. Using a prospective, correlational design, out-pts with chronic HF from 6 clinics completed questionnaires on demographics, comorbidites, and factors thought to be important in exercise capability and adherence (fatigue, depression, functional status, knowledge about exercise expectations, value of exercise, barriers/benefits of exercise, and exercise self-efficacy). Investigators provided 1-year survival data. Cox proportional hazards models were used to test for significance of the effects of variables of interest on survival. P-values for estimates of comparisons of hazard within levels of categorical variables were from tests based on z-statistics. If more than 2 categories, multiple comparisons were made to test for differences in the hazard ratios between each pair of categories. Continuous variables were categorized using cut scores. Results. Of the cohort of 492 pts (mean (SD) age 63 (± 13.6) yrs; LVEF 34.9% (± 14.8%); BMI 29.3 (± 6.73) kg/ml/m2; 40.3% ; male, 64.8%; Caucasian, 76.2%; married, 58.9%; NYHA-FC III/IV, 30.9%) 21 (4.2%) died within 1 year after enrollment. Only 46% reported exercising at a moderate-vigorous level. Pt characteristics associated with mortality were older age (p=0.037), no one to confide in (p=0.046) and NYHA-FC (p=0.001). Of exercise factors, mortality was reduced in pts with higher knowledge about exercise expectations (p=0.019), higher value for being active (p=0.002) and exercising (p=0.007), longer 6MWT distance (p=0.005), higher exercise self-efficacy (p=0.033) and reports of exercising at a moderate-vigorous level compared with no-infrequent exercise patterns (p=0.036). Conclusion. Among stable, out-pts with HF, many exercise-related factors were associated with 1-year mortality. Healthcare providers need to clearly communicate the value of exercise, explain details of moderate-vigorous exercise expectations and develop processes to increase self-efficacy for exercise to promote moderate-vigorous exercise behaviors and ongoing adherence to exercise.