title: What can we learn from patients with heart failure about exercise adherence? A systematic review of qualitative papers.
abstract: OBJECTIVE
  Keeping physically active has been shown to bring positive outcomes for patients diagnosed with heart failure (HF). However, a number of individuals with this health problem do not undertake regular exercise. A review of extant qualitative research was conducted to explore what it can tell us about barriers and enablers to physical activity among people with HF.
  
  
  METHODS
  A systematic search, involving electronic databases and endeavors to locate gray literature, was carried out to identify relevant qualitative studies published from 1980 onward. Data from retrieved papers were combined using framework analysis. Papers read in full numbered 32, and 20 were included in the review.
  
  
  RESULTS
  Synthesis of results from the 20 studies resulted in 4 main themes: Changing soma, negative emotional response, adjusting to altered status, and interpersonal influences. How individuals responded to their diagnosis and their altered physical status related to their activity levels, as did the degree of encouragement to exercise coming from family, friends, and professionals. These findings can be connected to the theory of behavioral change developed by Bandura, known as social cognitive theory (SCT).
  
  
  CONCLUSIONS
  SCT may be a useful framework for developing interventions to support patients with HF in undertaking and maintaining regular exercise patterns. Specific components of SCT that practitioners may wish to consider include self-efficacy and outcome expectancies. These were issues referred to in papers for the systematic review that appear to be particularly related to exercise adherence.
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK. stephanie.tierney@manchester.ac.uk
authors.forename: Stephanie
authors.initials: S
authors.lastname: Tierney
authors.forename: Mamas
authors.initials: M
authors.lastname: Mamas
authors.forename: Dawn
authors.initials: D
authors.lastname: Skelton
authors.forename: Stephen
authors.initials: S
authors.lastname: Woods
authors.forename: Martin K
authors.initials: MK
authors.lastname: Rutter
authors.forename: Martin
authors.initials: M
authors.lastname: Gibson
authors.forename: Ludwig
authors.initials: L
authors.lastname: Neyses
authors.forename: Christi
authors.initials: C
authors.lastname: Deaton
mesh_terms: D005081:Exercise Therapy; D015438:Health Behavior; D006333:Heart Failure / Q000523:psychology* / Q000534:rehabilitation*; D006801:Humans; D009043:Motor Activity; D010349:Patient Compliance