title: Physical activity in patients with heart failure: barriers and motivations with special focus on sex differences.
abstract: BACKGROUND
  Adherence to recommendations for physical activity is low in both male and female patients with heart failure (HF). Men are more physically active than women. In order to successfully promote physical activity, it is therefore essential to explore how much and why HF patients are physically active and if this is related to sex. The aim of this study was therefore to evaluate physical activity in HF patients, to describe the factors related to physical activity, and to examine potential barriers and motivations to physical activity with special focus on sex differences.
  
  
  METHODS
  The study had a cross-sectional survey design. HF patients living at home received a questionnaire during May-July 2014, with questions on physical activity (from the Short Form-International Physical Activity Questionnaire), and potential barriers and motivations to physical activity.
  
  
  RESULTS
  A total of 154 HF patients, 27% women, with a mean age of 70±10 were included. In total, 23% of the patients reported a high level of physical activity, 46% a moderate level, and 34% a low level. Higher education, self-efficacy, and motivation were significantly associated with a higher amount of physical activity. Symptoms or severity of the disease were not related to physical activity. All the potential barriers to exercise were reported to be of importance. Psychological motivations were most frequently rated as being the most important motivation (41%) to be physically active. Physical motivations (33%) and social motivations were rated as the least important ones (22%). Women had significantly higher total motivation to be physically active. These differences were found in social, physical, and psychological motivations.
  
  
  CONCLUSIONS
  One-third of the HF patients had a low level of physical activity in their daily life. Severity of the disease or symptoms were not related, whereas level of education, exercise self-efficacy, and motivation were important factors to take into account when advising a HF patient about physical activity. Women reported higher motivation to be physically active than men, but there was no difference in the reported level of physical activity.
authors.affiliation: Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Leonie
authors.initials: L
authors.lastname: Klompstra
authors.affiliation: Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.affiliation: Department of Medical and Health Sciences, Division of Nursing, Linköping University, Linköping, Sweden ; Department of Cardiology, Linköping University, Linköping, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Strömberg
keywords: barriers; heart failure; motivation; physical activity; self-efficacy; sex differences