[Home exercise therapy in chronic congestive heart failure: observational study of factors affecting adherence to the program].
BACKGROUND
Physical training has proven to be a valid and effective therapeutic tool capable of counteracting muscle changes that occur in chronic heart failure (CHF) patients. Nevertheless, few studies have analyzed the frequency of use of this therapy and the reasons for any reduced compliance and adherence to the prescription. The aim of this study was to quantify the frequency of the participation of CHF patients in a program of domiciliary physical training and to analyze the factors that can influence adherence to the program.


METHODS
Three hundred and twenty-two consecutive CHF patients (ejection fraction 28 +/- 7%) in a stable condition with optimized medical therapy performed a cardiopulmonary test, including determination of peak oxygen consumption, at baseline and after 9 +/- 3 months. All the patients had participated in sessions of health education on the relationship between illness/physical activity. The prescription of physiotherapy was decided by the physician on the basis of each patient's clinical need assessed in the diagnostic-therapeutic management. The patient referred for physiotherapy entered a therapeutic strategy that included sessions of training on anaerobic threshold, self-management of the session, and formulation of a domiciliary physical training program. During the follow-up evaluation the patients were asked to complete a questionnaire, which investigated the relationship between several factors and the patient's adherence to the physical training program, which was objectively evaluated by the change in peak oxygen consumption recorded at the end of the training, taking into account the spontaneous variations found in the control group.


RESULTS
Two hundred and eighty-two of the patients (88%) satisfied the criteria for inclusion in the study. Only 61 (22%) of them were judged to have adhered to the recommended physical training. Type of employment (chi 2 = 7.08, p < 0.02), the state of retirement (chi 2 = 8.9, p < 0.01), ischemic etiology (chi 2 = 5.91, p < 0.01), compatibility with employment (chi 2 = 15.8, p < 0.0004), availability of suitable domestic conditions (chi 2 = 14.5, p < 0.0008), the structure of the training program (chi 2 = 22.33, p < 0.0001) and a learning phase in a gym (chi 2 = 71.33, p < 0.0001) were significantly correlated at univariate analysis with the performance of the physical training. Multivariate analysis identified the structure of the training program (odds ratio 9.6, 95% confidence interval 2.8-33) and a learning phase in a gym (odds ratio 49.6, 95% confidence interval 11-210.8) as independent factors (r2 = 0.48) determining adherence to the physical training program.


CONCLUSIONS
Adherence to unmonitored, recommended domiciliary physical training appears to be modest even in patients who have been in-patients in a cardiac rehabilitation center. Various factors seem to influence the adherence of the patient to this therapy, but structural factors, such as the organization and learning of the program, more strongly influenced the patient's subsequent compliance.
Capomolla
Soccorso
S
Divisione di Cardiologia Fondazione S. Maugeri Clinica del Lavoro e della Riabilitazione, IRCCS Istituto Scientifico di Montescano Via per Montescano 27040 Montescano, PV. scapomolla@fsm.it
Ceresa
Monica
M
Civardi
Agostina
A
Lupo
Angela
A
Ventura
Anna
A
Scabini
Milena
M
Leonelli
Patrizia
P
Salvaneschi
Giulia
G
Petocchi
Alessandra
A
Pinna
GianDomenico
G
Ferrari
Marina
M
Febo
Oreste
O
Caporotondi
Angelo
A
Guazzotti
Giampaolo
G
La Rovere
Maria Teresa
MT
Gnemmi
Marco
M
Maestri
Roberto
R
Cobelli
Franco
F
D000328:Adult; D000368:Aged; D018450:Disease Progression; D004630:Emergencies; D004651:Employment; D005081:Exercise Therapy; D005190:Family; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006699:Home Care Services; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010349:Patient Compliance / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D012017:Referral and Consultation; D012107:Research Design; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors