Understanding barriers and enablers of physical activity among patients with heart failure: a systematic review of qualitative studies

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Abstract

Purpose: Exercise is considered an important component of therapy for patients with heart failure (HF), with positive effects on symptoms, physical function, psychological status, and hospitalisation. However sustained adherence to physical activity is low in this group, and there is a need to understand patients’ perspectives about exercise. A review of relevant qualitative research was conducted to explore what it can tell us about barriers and enablers to physical activity among individuals with HF. Methods: A systematic search was carried out to identify relevant qualitative papers published from 1980 onwards. No qualitative studies focusing on exercise were found, but papers that included discussion of physical activity as part of exploration of patients’ views of HF were reviewed. Three researchers were involved in decisions about inclusion of papers based on relevance to the review's aims and assessment of methodological quality. Data from accepted papers were combined using framework analysis. Papers read in full numbered 32; the final review consisted of 20 of these investigations. Results: Four main themes were identified from reviewed studies: Changing soma (an ageing and altered body), negative emotional response (fear and low mood), adjusting to altered status (accepting HF and managing despite this condition), interpersonal influences (having a supportive family and healthcare professionals). How individuals responded to their diagnosis and their altered physical status impacted activity levels, as did the degree of encouragement to exercise coming from close others.Conclusions: These themes identify important issues impacting physical activity in patients with HF. Findings can be related to the theory of behavioural change developed by Bandura, known as Social Cognitive Theory (SCT). Specific components of SCT that may be relevant to physical activity include self-efficacy (confidence in being able to exercise), outcome expectancies (weighing up the benefits and costs of exercising) and goal setting (planning targets to achieve in relation to exercise). A theoretical approach could prove useful when developing interventions to increase adherence to physical activity.

Keyword(s)

Heart failure; Physical activity; Systematic review

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