Predictors of noncompliance to exercise training in heart failure.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Nursing Department, Greater Los Angeles, Veterans Affairs Health Care System, Los Angeles, Calif. 90073, USA. Teresita.Corvera@med.va.gov
Teresita
T
Corvera-Tindel
Lynn V
LV
Doering
Teresita
T
Gomez
Kathleen
K
Dracup
D000203:Activities of Daily Living; D000368:Aged; D000704:Analysis of Variance; D015992:Body Mass Index; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003152:Community Health Nursing; D015897:Comorbidity; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000523:psychology* / Q000534:rehabilitation; D006699:Home Care Services; D006791:Hostility; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009042:Motivation; D011237:Predictive Value of Tests; D055656:Prescriptions; D011446:Prospective Studies; D016312:Treatment Refusal / Q000523:psychology*; D016138:Walking