title: Psychosocial Factors, Exercise Adherence, and Outcomes in Heart Failure Patients: Insights From Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION).
abstract: BACKGROUND
  Psychosocial factors may influence adherence with exercise training for heart failure (HF) patients. We aimed to describe the association between social support and barriers to participation with exercise adherence and clinical outcomes.
  
  
  RESULTS
  Of patients enrolled in Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION), 2279 (97.8%) completed surveys to assess social support and barriers to exercise, resulting in the perceived social support score (PSSS) and barriers to exercise score (BTES). Higher PSSS indicated higher levels of social support, whereas higher BTES indicated more barriers to exercise. Exercise time at 3 and 12 months correlated with PSSS (r= 0.09 and r= 0.13, respectively) and BTES (r=-0.11 and r=-0.12, respectively), with higher exercise time associated with higher PSSS and lower BTES (All P<0.005). For cardiovascular death or HF hospitalization, there was a significant interaction between the randomization group and BTES (P=0.035), which corresponded to a borderline association between increasing BTES and cardiovascular death or HF hospitalization in the exercise group (hazard ratio 1.25, 95% confidence interval 0.99, 1.59), but no association in the usual care group (hazard ratio 0.83, 95% confidence interval 0.66, 1.06).
  
  
  CONCLUSIONS
  Poor social support and high barriers to exercise were associated with lower exercise time. PSSS did not impact the effect of exercise training on outcomes. However, for cardiovascular death or HF hospitalization, exercise training had a greater impact on patients with lower BTES. Given that exercise training improves outcomes in HF patients, assessment of perceived barriers may facilitate individualized approaches to implement exercise training therapy in clinical practice.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00047437.
authors.affiliation: From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.). lauren.b.cooper@duke.edu.
authors.forename: Lauren B
authors.initials: LB
authors.lastname: Cooper
authors.affiliation: From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.).
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.affiliation: From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.).
authors.forename: Jie-Lena
authors.initials: JL
authors.lastname: Sun
authors.affiliation: From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.).
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Schulte
authors.affiliation: From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.).
authors.forename: Jerome L
authors.initials: JL
authors.lastname: Fleg
authors.affiliation: From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.).
authors.forename: Lawton S
authors.initials: LS
authors.lastname: Cooper
authors.affiliation: From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.).
authors.forename: Ileana L
authors.initials: IL
authors.lastname: Piña
authors.affiliation: From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.).
authors.forename: Eric S
authors.initials: ES
authors.lastname: Leifer
authors.affiliation: From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.).
authors.forename: William E
authors.initials: WE
authors.lastname: Kraus
authors.affiliation: From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.).
authors.forename: David J
authors.initials: DJ
authors.lastname: Whellan
authors.affiliation: From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.).
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Keteyian
authors.affiliation: From the Duke Clinical Research Institute (L.B.C., R.J.M., J.-L.S., P.J.S., C.M.O'C.), and Department of Medicine (L.B.C., R.J.M., W.E.K., C.M.O'C.), Duke University School of Medicine, Durham, NC; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C., E.S.L.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Division of Cardiology, Jefferson Medical College, Philadelphia, PA (D.J.W.); and Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.).
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
mesh_terms: D000368:Aged; D015444:Exercise; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000523:psychology* / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011788:Quality of Life; D012944:Social Support; D013318:Stroke Volume; D016896:Treatment Outcome
keywords: exercise; exercise therapy; heart failure; patients; social support