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Background Despite exercise being one of few strategies to improve outcomes for individuals with heart failure with preserved ejection fraction (HFpEF), exercise clinical trials in HFpEF are plagued by poor interventional adherence. Over the last 2 decades, our research team has developed, tested, and refined Heart failure Exercise And Resistance Training (HEART) Camp, a multicomponent behavioral intervention to promote adherence to exercise in HF. We evaluated the effects of this intervention designed to promote adherence to exercise in HF focusing on subgroups of participants with HFpEF and heart failure with reduced ejection fraction (HFrEF). Methods and Results This randomized controlled trial included 204 adults with stable, chronic HF. Of those enrolled, 59 had HFpEF and 145 had HFrEF. We tested adherence to exercise (defined as ≥120 minutes of moderate-intensity [40%–80% of heart rate reserve] exercise per week validated with a heart rate monitor) at 6, 12, and 18 months. We also tested intervention effects on symptoms (Patient-Reported Outcomes Measurement Information System-29 and dyspnea-fatigue index), HF-related health status (Kansas City Cardiomyopathy Questionnaire), and physical function (6-minute walk test). Participants with HFpEF (n = 59) were a mean of 64.6 ± 9.3 years old, 54% male, and 46% non-White with a mean ejection fraction of 55 ± 6%. Participants with HFpEF in the HEART Camp intervention group had significantly greater adherence compared with enhanced usual care at both 12 (43% vs 14%, phi = 0.32, medium effect) and 18 months (56% vs 0%, phi = 0.67, large effect). HEART Camp significantly improved walking distance on the 6-minute walk test (η2 = 0.13, large effect) and the Kansas City Cardiomyopathy Questionnaire overall (η2 = 0.09, medium effect), clinical summary (η2 = 0.16, large effect), and total symptom (η2 = 0.14, large effect) scores. In the HFrEF subgroup, only patient-reported anxiety improved significantly in the intervention group. Conclusions A multicomponent, behavioral intervention is associated with improvements in long-term adherence to exercise, physical function, and patient-reported outcomes in adults with HFpEF and anxiety in HFrEF. Our results provide a strong rationale for a large HFpEF clinical trial to validate these findings and examine interventional mechanisms and delivery modes that may further promote adherence and improve clinical outcomes in this population. Clinical Trial Registration : URL: https://clinicaltrials.gov/. Unique identifier: NCT01658670

Background: Regular exercise training has beneficial effects on quality of life, physical function, depression and anxiety in individuals with heart failure. Unfortunately, individuals with heart failure have low levels of adherence to exercise. Thus, studies are needed to assess intervention strategies which may enhance clinical outcomes. Aim: The aim of this study was to identify the components of the HEART Camp intervention, which contributed to optimizing clinical outcomes. Methods: The Heart Failure Exercise and Resistance Training Camp (HEART Camp) was a randomized controlled trial to evaluate the effect of a multicomponent intervention on adherence to exercise (6, 12 and 18 months) compared to an enhanced usual care group. This study assessed various components of the intervention on the secondary outcomes of physical function, health-related quality of life, depression, anxiety, and fatigue. Results: Individuals participating ( n=204) in this study were 55.4% men and the average age was 60.4 (11.5) years. A combination of individualized and group-based strategies demonstrated clinical improvements, HEART Camp versus enhanced usual care groups, in physical function, positive trends in health-related quality of life and positive changes in the minimally important differences for depression, anxiety, and fatigue. Conclusions: Individualized coaching by an exercise professional and group-based educational sessions were identified as important components of patient management contributing to improvements in the secondary outcomes of physical function, health-related quality of life, depression, anxiety and fatigue.

Background Exercise is safe and provides considerable benefits for patients with heart failure (HF) including improved function, quality of life, and symptoms. However, patients with HF have difficulty initiating and adhering to an exercise regimen. To improve adherence, our team developed Heart Failure Exercise and Resistance Training (HEART) Camp, a multicomponent, theory-driven intervention that was efficacious in a randomized controlled trial of long-term adherence to exercise in patients with HF. Identifying active components of efficacious interventions is a priority. Purpose The purpose of this study is to use mediation analysis to determine which interventional components accounted for long-term adherence to exercise in patients with HF. Methods This study included 204 patients with HF enrolled in a randomized controlled trial. Instruments measuring interventional components were completed at baseline, 6, 12, and 18 months. Hierarchical linear models generated slope estimates to be used as predictors in logistic regression models. Significant variables were tested for indirect effects using path analyses with 1,000 bootstrapped estimates. Results Significant mediation effects were observed for the interventional components of negative attitudes (β NA = 0.368, s.e. = 0.062, p < .001), self-efficacy (β SE = 0.190, s.e. = 0.047, p < .001), and relapse management (β RM = 0.243, s.e. = 0.076, p = .001). Conclusions These findings highlight improving attitudes, self-efficacy, and managing relapse as key interventional components to improve long-term adherence to exercise in patients with HF. Future interventions targeting adherence to exercise in patients with HF and other chronic illnesses should consider the incorporation of these active components.

Aims A cardiopulmonary exercise (CPX) test is considered the gold standard in evaluating maximal oxygen uptake. This study aimed to evaluate the predictive validity of equations provided by Burr et al., Ross et al., Adedoyin et al., and Cahalin et al. in predicting peak VO2 from 6 min walk test (6MWT) distance in patients with heart failure (HF). Methods and Results New York Heart Association Class I-III HF patients performed a maximal effort CPX test and two 6MWTs. Correlations between CPX VO2 peak and the predicted VO2 peak, coefficient of determination (R-2), and mean absolute percentage error (MAPE) scores were calculated. P-values were set at 0.05. A total of 106 participants aged 62.5 +/- 11.5 years completed the tests. The mean VO2 peak from CPX testing was 16.4 +/- 3.9 mL/kg/min, and the mean 6MWT distance was 419.2 +/- 93.0 m. The predicted mean VO2 peak (mL/kg/min) by Burr et al., Ross et al., Adedoyin et al., and Cahalin et al. was 22.8 +/- 8.8, 14.6 +/- 2.1, 8.30 +/- 1.4, and 16.6 +/- 2.8. A significant correlation was observed between the CPX test VO2 peak and predicted values. The mean difference (0.1 mL/kg/min), R-2 (0.97), and MAPE (0.14) values suggest that the Cahalin et al. equation provided the best predictive validity. Conclusions The equation provided by Cahalin et al. is simple and has a strong predictive validity, and researchers may use the equation to predict mean VO2 peak in patients with HF. Based on our observation, equations to predict individual maximal oxygen uptake should be used cautiously. Funding Agencies|NHLBI of the National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Heart Lung & Blood Institute (NHLBI) [R01HL112979]

Background Few exercise training studies in patients with heart failure (HF) report adherence to guideline-recommended 150 minutes of moderate-intensity exercise per week, and no studies have focused on a primary outcome of adherence. Methods and Results This randomized controlled trial evaluated the effect of a multicomponent intervention, Heart Failure Exercise and Resistance Training (HEART) Camp, on adherence to exercise (after 6, 12, and 18 months) compared with an enhanced usual care (EUC) group. Patients (n = 204) were 55.4% male, overall average age was 60.4 years, and 47.5% were nonwhite. The HEART Camp group had significantly greater adherence at 12 (42%) and 18 (35%) months compared with the EUC group (28% and 19%, respectively). No significant difference (P > .05) was found at 6 months. The treatment effect did not differ based on patient's age, race, gender, marital status, type of HF (preserved or reduced ejection fraction) or New York Heart Association functional class. Left ventricular ejection fraction (LVEF) significantly moderated the treatment effect, with greater adherence at higher LVEF. Conclusions The multicomponent HEART Camp intervention showed efficacy with significant effects at 12 months and 18 months. Adherence levels remained modest, indicating a need for additional research to address methods and strategies to promote adherence to exercise in patients with HF.

Background Few studies report objective accelerometer-measured daily physical activity levels in patients with heart failure (HF). Objective We examined baseline accelerometer-measured physical activity from the Heart Failure Exercise and Resistance Training Camp trial, a federally funded (R01-HL112979) 18-month intervention study to promote adherence to exercise in patients with HF. Factors associated with physical activity levels were also explored. Methods Patients with diagnosed HF (stage C chronic HF confirmed by echocardiography and clinical evaluation) were recruited from 2 urban medical centers. Physical activity energy expenditure and the number of minutes of moderate or vigorous physical activity (MVPA) were obtained from 7 full days of measurement with the accelerometer (Actigraph Model GT3X, Pensacola, Florida) for 182 subjects who met minimum valid wear time parameters. Additional measures of health-related factors were included to explore the association with physical activity levels. Results Subjects had 10.2 ± 10.5 minutes of MVPA per day. Total physical activity energy expenditure was 304 ± 173 kcal on average per day. There were 23 individuals (12.6%) who met the recommended goal of 150 minutes of MVPA per week. Men, whites, New York Heart Association class II, and subjects with better physical function had significantly higher levels of activity. Conclusions Consistent with previous research, patients with HF are not meeting recommended guidelines for 150 minutes of MVPA per week.

Background: Use of wrist-worn activity monitors has increased over the past few years; however, the use of the Fitbit® Charge HR (FCHR) in a community setting in patients with heart failure has not been tested. Purpose: The purpose of the study was to assess the feasibility, practicality and acceptability of utilizing the FCHR to validate self-reported exercise diaries and monitor exercise in community dwelling patients with heart failure. Methods: Thirty heart failure patients (12 females and 18 males) aged 64.7 ± 11.5 years were provided with a FCHR. Participants were provided with an exercise routine and for eight weeks, recorded their exercise sessions in self-reported exercise diaries and used the FCHR to record those exercise sessions. Results: Exercise data from the self-reported exercise diaries were validated with data from the FCHR. Participants’ perception and acceptance of using the FCHR was positive. Validation of exercise and physical activity interventions using the FCHR appears feasible and acceptable in patients with heart failure. Conclusion: Wrist-worn activity monitors can be useful for objective measurement of exercise adherence and monitoring of physical activity in patients with heart failure in a community setting.

The use of the internet and newer activity monitors such as the Fitbit Charge HR to improve exercise adherence is limited. The primary aim of the Move on Virtual Engagement (MOVE-HF) was to investigate the effects of group social support by internet-based synchronized face-to-face video and objective physical activity feedback on adherence to recommended exercise guidelines.Thirty stable heart failure patients (New York Heart Association class I-III), aged 64.7±11.5 years, were randomly assigned to an experimental or comparison group. Participants were provided a handout on self-care in heart failure, an exercise routine, a Fitbit Charge HR and were asked to wear the Fitbit Charge HR daily, and record their exercise sessions using both the Fitbit Charge HR and exercise diaries. In addition, participants in the experimental group connected to Vidyo software, once a week, for 8 weeks, for a 45-minute face-to-face online group discussion/education session.Overall Vidyo session attendance was 68%, with 73% of participants attending five or more sessions. Adherence to exercise was 58.8% in the experimental group and 57.3% in the comparison group. The experimental group perceived receiving social support through the internet-based synchronized face-to-face video meetings but due to a small sample size and lack of adequate power, no significant impact on exercise adherence was observed. Participants commented that feedback regarding physical activity from the Fitbit Charge HR was helpful and motivational.Delivering social support by internet-based synchronized face-to-face video is feasible with heart failure patients. However, more investigations are needed to understand its impact on exercise adherence.

Use of wrist-worn activity monitors has increased over the past few years; however, the use of the Fitbit® Charge HR (FCHR) in a community setting in patients with heart failure has not been tested.The purpose of the study was to assess the feasibility, practicality and acceptability of utilizing the FCHR to validate self-reported exercise diaries and monitor exercise in community dwelling patients with heart failure.Thirty heart failure patients (12 females and 18 males) aged 64.7 ± 11.5 years were provided with a FCHR. Participants were provided with an exercise routine and for eight weeks, recorded their exercise sessions in self-reported exercise diaries and used the FCHR to record those exercise sessions.Exercise data from the self-reported exercise diaries were validated with data from the FCHR. Participants' perception and acceptance of using the FCHR was positive. Validation of exercise and physical activity interventions using the FCHR appears feasible and acceptable in patients with heart failure.Wrist-worn activity monitors can be useful for objective measurement of exercise adherence and monitoring of physical activity in patients with heart failure in a community setting.

The estimated cost of treating patients with HF in the United States is expected to more than double by 2030.65 This forecast of the impact of HF in the United States should serve as a call to action. Despite well-documented benefits, participation in exercise training and CR programs by patients with HF remains low. In this article, standards and guidelines for exercise and CR in HF were reviewed. Although traditional CR had core components, it lacked care management specific for HF. Chronic stable HF patients can safely exercise; however, there are many unique needs that are not currently addressed at the patient, system, and provider levels. As we face economic and political forces that are expected to require major change to the health care delivery system, it becomes even more important to capitalize on the advantages that come with team-based care. CR has always served as a model of team-based care; however, the model must now include professionals with HF expertise to guide patients in safe exercise and self-management strategies appropriate for this chronically ill population.

Few studies have examined risk-reducing interventions in spouses of coronary artery bypass patients. This study examined the effects of the Partners Together in Health (PaTH) intervention versus usual care on cardiovascular risk factors. Spouses in the experimental group ( n = 17/group) attended cardiac rehabilitation with patients and made the same physical activity and healthy eating changes as patients. Spouses in the usual care group attended educational classes with patients. Spouses’ 30-year cardiovascular risk was calculated using the Lifetime Risk Scale before and after cardiac rehabilitation (3 months), and at 6 months. Spouses in both groups significantly reduced 30-year risk scores at 3 and 6 months. Exercise was the key ingredient in lowering risk. There was a trend toward reduction in systolic blood pressure and an increase in high-density lipoprotein cholesterol in both groups. Although there were no group differences, having spouses participate in cardiac rehabilitation with the patient was effective for reducing spouses’ cardiovascular risk.

PURPOSE: The purpose of this study was to examine health-related quality-of-life (HRQOL) outcomes in coronary artery bypass surgery (CABS) patients and partners enrolled together in cardiac rehabilitation versus a usual care group. METHODS: After CABS, couples were randomly assigned to the Partners Together in Health (PaTH) intervention (n = 17) or usual care (n = 17) groups. Health-related quality-of-life was operationalized as physical function (SF-36 Physical Functioning subscale), depression (Patient Health Questionnaire), and marital adjustment (Dyadic Adjustment Scale). Data were measured in patients and partners at the start (T1) and end of cardiac rehabilitation (T2), and 3 months after cardiac rehabilitation (T3). Nonparametric statistics were used to examine changes over time and differences between groups. RESULTS: Patients in both groups, and partners in the PaTH group, significantly improved physical function between T1 and T2. At T1, 18% of patients and 6% of partners were depressed. At T2 and T3, only 3% of patients and no partners were depressed. Almost 12% of patients and partners were maritally distressed at T1. At T2 and T3, patients' marital distress was unchanged, but more partners reported marital distress (15%). CONCLUSIONS: This study adds to our understanding of the trajectory of HRQOL outcomes after CABS for patients and partners. These findings demonstrated promise for the PaTH intervention. Future testing of the intervention is warranted in a larger sample. Because patients and partners are impacted by CABS as a shared life experience, couple-centered interventions may improve HRQOL outcomes more than individually focused interventions.

The effects of depression on patients with heart failure (HF) are substantial, yet the predictors remain unclear. The predictors of cognitive/affective and somatic depression in stable HF patients were studied. Using a cross-sectional design, 150 HF outpatients were recruited at two mid-Western HF clinics. Predictors included dyspnea with activities of daily living, family and friend social support, and loneliness; age and gender were control variables. All constructs were measured using standardized instruments. Structural equation modeling (SEM) showed that cognitive/affective depression was predicted by greater dyspnea and loneliness, whereas somatic depression was predicted by more dyspnea and friend support. Also, greater dyspnea was related to more loneliness and less friend support; less friend support was related to loneliness. Women reported more dyspnea and loneliness. Since cognitive/affective and somatic depression have different predictors, further study is warranted to identify HF patients at risk for depression and to establish interventions targeted at improving depression.

This article examined the intervention fidelity strategies used and lessons learned in a translational study. In this study, the behavioral intervention was delivered within an existing clinical practice environment, outpatient cardiac rehabilitation (CR). The primary lessons learned were that the fidelity components of design, training, and delivery of the intervention were the most different from fidelity strategies used in typical intervention studies. The design component needed to take into account the unique characteristics of the clinical environments where the study was conducted and build these unique differences into the study design. Training and delivery of the intervention was different because existing CR staff delivered the intervention in this study; which is unlike typical intervention studies where research staff are trained to deliver the intervention. Monitoring receipt and enactment fidelity components were similar to monitoring in usual intervention studies probably because these components focus on monitoring the behaviors of the research participant. Translational research presents unique challenges and requires the development of a flexible and novel intervention fidelity plan tailored to a particular study.

PURPOSE The purpose of this study was to compare an Exercise Training Group (EX) with an Attention-Control Group (AT-C) to more specifically assess the impact of exercise training on individuals with heart failure (HF). METHODS Forty-two individuals with HF were randomized to AT-C or EX that met with the same frequency and format of investigator interaction. Baseline, 12- and 24-week measurements of B-type naturetic peptide (BNP), 6-minute walk test (6-MWT), and the Kansas City Cardiomyopathy Questionnaire (KCCQ) were obtained. RESULTS BNP tended to increase in the AT-C while remaining stable in the EX over time. A clinically significant increase in 6-MWT was demonstrated by the EX but not the AT-C. The EX achieved a clinically significant change on the KCCQ at 12 weeks, with further improvement by 24 weeks, while the AT-C demonstrated a clinically significant change at 24 weeks. CONCLUSIONS Attention alone was inadequate to positively impact BNP levels or 6-MWT distances, but did have a positive impact on quality of life after 24 weeks. Although exercise offers enhanced benefits, individuals with HF unable to participate in an exercise program may still gain quality of life benefits from participation in a peer-support group that discusses topics pertinent to HF.

Background and Purpose: We evaluated the psychometric properties of the functioning component of the Late-Life Function and Disability Instrument (LLFDI) in individuals with heart failure (HF). Methods: Factor analyses were used (N= 151) to assess the dimensionality and structure of the basic and advanced lower extremity function subscales. Rasch model scores were compared to the raw means of the items. Results: Rasch scores correlated with the raw means of the items atr= .96, indicating raw means are comparable to the more complicated Rasch analysis in estimating physical functioning using the basic and advanced subscales. Conclusions: The lower extremity physical functioning subscales of the LLFDI have potential as a clinical assessment tool to identify HF patients who are at high risk for functional limitations.

Heart failure (HF) is considered a condition primarily associated with the older population, with approximately 80% of individuals admitted to the hospital with a diagnosis of HF being over the age of 65 years. With the 'aging of the population' in the United States the incidence of HF is expected to continue to rise. Therefore many of the older individuals seen by physical therapists for an array of conditions will have HF as a primary diagnosis or comorbidity which needs to be addressed in developing their plan of care. Current evidence supports the safety and efficacy of exercise training as a component in the overall medical management of individuals with stable HF regardless of age. The primary aims of this article are to review the benefits associated with exercise training in individuals with HF and present the current recommendations for aerobic, resistance and inspiratory muscle exercise training along with recommendations for monitoring and modifying exercise training programs. Clinically, exercise training has been shown to have a significant effect on improving functional capacity, oxygen consumption, 6-minute walk test distances, symptoms, self-efficacy for exercise, and quality of life of individuals with HF. It is important that physical therapists adequately challenge individuals with HF with appropriate exercise intensities, while closely monitoring their patients, in order to achieve optimal functional benefits and quality of life.

This study measured the impact of the Exercise Adherence Management Program (EAMP) provided to 20 patients with heart failure (HF) who participated in a combined resistance and aerobic exercise training program during two 12-week phases. The EAMP included strategies designed to support exercise self-efficacy and adherence. Results indicate that an improvement in exercise self-efficacy occurred during the study period, whereas exercise adherence declined during the unsupervised phase. The highest rated adherence strategy for helpfulness and self-efficacy was group sessions. The study supports the use of adherence strategies based on self-efficacy in exercise programs for patients with HF.

Background This study tested the effects of a multicomponent exercise training intervention called “Heart Failure Exercise And Training Camp” (HEART CAMP). The intervention was theoretically derived from Bandura's social cognitive theory. Methods An experimental repeated-measures design was used. Participants were randomized to the HEART CAMP intervention group (n = 22) or the attention control group (n = 20). Participants were compared on self-efficacy for exercise, symptoms, physical function, and quality of life over 12 weeks. Results The intervention group had a 31% increase in cardiac exercise self-efficacy and significantly fewer symptoms compared with the attention control group. Quality of life increased significantly in both groups. Conclusion A theory-based intervention improved self-efficacy for exercise and symptoms in patients with heart failure.

Dyspnea limits physical activity and functional status in heart failure patients. This feasibility study examined effects of a diaphragmatic breathing retraining (DBR) intervention delivered over 8 weeks with follow-up at 5 months. The intervention group ( n = 18) was trained at baseline and received four telephone calls. An attention control group ( n = 18) received four telephone calls with general health information. Results from linear mixed model analysis with effect sizes (η2) showed dyspnea improved in both groups, with little difference between groups. Compared with attention alone, the intervention increased physical activity (calories expended; η2 = .015) and functional status (η2 = .013) across the 5-month follow-up and increased activity counts at 8 weeks (η2 = .070). This intervention was feasible and demonstrated promising effects on activity and function but not by reducing dyspnea. Patients may have increased physical activity because of instructions to use DBR during activities of daily living. Further exploration of the intervention’s underlying physiological effect is needed.

BACKGROUND Despite proven efficacy of cardiac rehabilitation (CR) in helping patients initiate physical activity and healthy eating changes, less than 50% of CR participants maintain changes 6 months later. OBJECTIVE The objective of this feasibility study was to test the Partners Together in Health (PaTH) intervention versus usual care in improving physical activity and healthy eating behaviors in coronary artery bypass graft surgery patients and their spouses. METHODS An experimental, 2-group (n = 17 couples/group), repeated-measures design was used. Coronary artery bypass surgery patients in both groups participated in phase II outpatient CR. Spouses in the PaTH group attended CR with the patient and were asked to make the same physical activity and healthy eating changes as patients did. Spouses in the usual care attended educational classes with patients. It was theorized that "2 persons would be better than 1" at making changes and sticking with them in the long-term. Physical activity behavior was measured using the Actiheart accelerometer; the activity biomarker was an exercise tolerance test. Eating behavior was measured using 3-day food records; the biomarker was the lipid profile. Data were collected at baseline (entrance in CR), at 3 months (post-CR), and at 6 months. Changes over time were examined using Mann-Whitney U statistics and effect sizes. RESULTS The PaTH intervention was successful primarily in demonstrating improved trends in healthy eating behavior for patients and spouses. No differences were found between the PaTH and usual care patients or spouses at 3 or 6 months in the number of minutes per week of physical activity. By 6 months, patients in both groups were, on average, below the national guidelines for PA recommendations (≥150 min/wk at >3 metabolic equivalents). CONCLUSIONS The couple-focused PaTH intervention demonstrated promise in offsetting the decline in dietary adherence typically seen 6 months after CR.

The aim of this study was to assess whether the Energy Expenditure Index (EEI), based on heart rate (HR) adjusted for speed, was a clinical indicator of the Oxygen Consumption Index (OCI), oxygen consumption (VO(2)) adjusted for speed, during self-paced walking in children with spastic diplegia cerebral palsy (CP) and children without physical disabilities (ND). Ten children with spastic diplegia CP and 15 children who are ND participated. VO(2) and HR were measured at rest and during self-paced ambulation using an AeroSport KB1-C portable metabolic system, and the EEI and OCI were calculated. A fair to good correlation (r = 0.61) between EEI and OCI was found for children with spastic diplegia CP ambulating at self-paced speeds while only a moderate correlation (r = 0.40) was found for children who are ND. The results suggest that the EEI may be a useful clinical indicator of OCI at self-paced ambulation speeds in children with spastic diplegia CP and warrants further investigation.

Background: Adherence to the Heart Failure Society of America (HFSA) 2010 guidelines recommending 30 minutes of supervised moderate intensity exercise five days per week is difficult for patients with heart failure (HF). Innovative programs are needed to assist HF patients to adhere to long-term exercise. The objective of this prospective randomized two-group repeated measures experimental design is to determine the efficacy of a behavioral exercise training intervention on long-term adherence to exercise at 18 months in patients with heart failure. Methods/Design: A sample size of 246 subjects with heart failure will be recruited over a 3 year period. All subjects receive a cardiopulmonary exercise test and 9 supervised exercise training sessions during a 3 week run-in period prior to randomization. Subjects completing at least 6 of 9 training sessions are randomized to the HEART Camp Intervention group (HC) or to a standard care (SC) exercise group. The HC intervention group receives cognitive-behavioral strategies that address the intervention components of knowledge, attitudes, self-efficacy, behavioral self-management skills and social support. The SC group is provided access to the exercise facility and regular facility staff for the 18 month study period. The primary aim is to evaluate the effect of HEART Camp on adherence to exercise, with our central hypothesis that the HC group will have significantly better adherence to exercise at 18 months. Secondary aims include evaluating which components of the HEART Camp intervention mediate the effects of the intervention on adherence; evaluating the effect of HEART Camp on specific health outcomes; exploring selected demographic variables (race, gender, age) as potential moderators of the effect of the HEART Camp intervention on adherence; and exploring the perceptions and experiences that contextualize exercise adherence. Discussion: The HEART Camp intervention is the first to test a multi-component intervention designed to improve long-term adherence to exercise behavior in patients with HF. Improving long-term adherence to exercise is the logical first step to ensure the required dose of exercise that is necessary to realize beneficial health outcomes and reduce costs in this burdensome chronic illness. Trial registration: Clincaltrials.gov NCT01658670.

The purpose of this study was to describe psychological effects and exercise adherence during a multicomponent exercise training intervention.A sample of 42 patients with heart failure were randomized into an exercise (INV) group (n = 22) and an attention control (AC) group (n = 20). The exercise protocol included two 12-week phases, a structured phase and a self-managed phase. The psychological responses assessed were mood states and exercise self-efficacy. To meet the second purpose of the study, the exercise group was dichotomized based on the number of sessions completed to create two adherence subgroups.Results indicate self-efficacy improved for the INV group and was maintained during the self-management phase. The adherence subgroups demonstrated different patterns for weekly exercise. Depression and confusion scores improved for the high-adherence group in contrast to worsening for the low-adherence group.Results suggest a need for further study of the psychological responses of exercise adherence for patients with heart failure.The study indicates the importance of continuous assessment of exercise participation and longer term adherence support for patients with heart failure.

Decreased prostacyclin synthesis by atherosclerotic vascular tissue has been demonstrated in both adult animal models and man. The purpose of this study was to determine whether the decrease in prostacyclin synthesis by the vessel wall was evident during the initial stages of atherosclerosis development and thus a potential contributor to atherogenesis. Thirty-two Yucatan miniature swine entered the study at 3 months of age and were placed on either an atherogenic or regular diet for 10, 30, 90, or 180 days. At that time, the thoracic and abdominal aorta were harvested. Pairs of discs were punched out of the distal thoracic aorta and placed in Krebs Henseleit HEPES buffer. The buffer was then exchanged for either fresh buffer or stimulated with calcium ionophore A23187 (10 −4 m ). Aliquots were collected at 10 min for analysis of prostacyclin production by radioimmunoassay of its stable metabolite 6-keto-prostaglandin F 1α . Thoracic aorta sections were prepared for atherosclerosis assessment by light microscopy, and the abdominal aorta was stained with Sudan IV. No significant differences were noted between the diet groups at 10 and 30 days. After 90 days, a significant difference was noted ( P P > 0.05) were noted between the diet groups with regard to the basal and stimulated rates of prostacyclin production. Our findings showed that prostacyclin synthesis was not altered during the initial development or early progression of aortic atherosclerosis induced by hypercholesterolemia.

Purpose The Talk Test is a method for recommending exercise intensity on the basis of the ability of an individual to carry on a conversation during exercise and has been associated with defining the upper recommended limits of exercise intensity for cardiorespiratory training. The purpose of this study was to assess the validity of a novel variation of the Talk Test method, the "Counting Talk Test" (CTT), as a semiquantitative approach for estimating exercise intensity in healthy individuals. Methods Forty young adults (22.5 +/- 2.3 years) participated in 2 maximal treadmill tests on separate days. The first test was performed to determine maximum heart rate (HR) and oxygen uptake (VO2) and to allow participants to habituate to the testing protocol. During the second session, participants were instructed in the CTT method. HR, rating of perceived exertion (RPE), blood pressure, and CTT were recorded at rest and at each test stage. Correlation analyses were conducted among the variables. Results Correlation coefficients values, r = -0.93, -0.92, and -0.86, were found between the %CTT and percentage of heart rate reserve (%HRR), percentage of VO2-reserve (%VO2R), and RPE, respectively. Conclusions The CTT has concurrent validity with the criterion measure of VO2R as well as to the more commonly utilized measures of HRR and RPE for estimating relative exercise intensity in young adults. Exercising at a level at which individuals could count to half to one third of their resting CTT value corresponded with American College of Sports Medicine's recommendations for moderate to vigorous exercise intensity.

The purpose of this study was to test the psychometric properties of a new measure, the Meaning in Heart Disease instrument (MHD), in persons who underwent percutaneous coronary intervention (PCI). Within 1 year of PCI, 232 persons completed the MHD and construct validity measures (SF-36v2™, Hospital Anxiety and Depression Scale). Study aims were examined using reliability analysis, factor analysis, and correlations. After factor analysis, four scales reflecting the theoretical concepts central to the conceptual framework of the instrument emerged—Disrupted Meaning (α = .93), Refocusing Global Meaning (α = .92), Searching for Answers (α = .82), and Ignoring Heart Disease (α = .77). Convergent and divergent validity was supported, in part, for all scales. The MHD had strong support for its validity and will be useful in testing nursing interventions aimed at helping individuals integrate heart disease into the life experience.

Oxygen consumption (VO2) is the criterion standard for determining energy expenditure during activity. Newer technologies have resulted in the development of portable metabolic gas analyzers capable of measuring VO2 during a wide range of physical activities in the field. Unfortunately, use of these devices is still limited due to the cost, availability and skill level required to utilize this newer technology. However, there is an instrument which may be utilized. Accelerometers are a type of physical activity monitor that provide estimates of energy expenditure and may potentially be of more practical use in the clinical setting. Purpose: This study was designed to compare estimates of energy expenditure using two different accelerometers to VO2 during self-paced walking speeds in children with spastic diplegia cerebral palsy (CP) and in healthy children (HLT). Methods: Ten HLT children and five children with spastic diplegia CP participated in this pilot study (age range: 7.5-17.5 years). Subjects ambulated at self-paced speeds on a level surface wearing a Caltrac accelerometer and a BioTrainer-Pro accelerometer, while VO2 was measured simultaneously with an AeroSport KB1-C portable metabolic gas analyzer. Results: Both accelerometers overestimated caloric expenditure in HLT children. In the children with spastic diplegia CP, we found no significant differences in the mean caloric expenditure estimated by the accelerometers and VO2 (p= 0.62). Conclusions: Preliminary findings suggest accelerometers may have potential as a means of estimating energy expenditure during ambulation in children with spastic diplegia CP, which could be useful to clinicians evaluating therapeutic interventions. Further research is indicated.

Atherosclerosis found early in life suggests that it may arise from fetal adaptations during development in utero. We evaluated the effect of a maternal atherogenic diet on atherosclerosis development in offspring. Aortic fat deposition was evaluated by Sudan IV staining and coronary atherosclerosis was assessed histologically. Sows were fed an atherogenic diet (ath) or standard diet (std) throughout gestation. Twelve neonates (six per maternal diet group) were evaluated with no significant differences noted (P>0.05) in serum lipids or aortic fat deposition and there was no evidence of coronary atherosclerosis. Twenty offspring (10 per maternal diet group) were followed for 5 months forming the pubertal age group. Half of these swine received an atherogenic (ATH) diet (std-ATH and ath-ATH) and half received a standard (STD) diet (std-STD and ath-STD). Pubertal age swine on the ATH diet had significantly greater (P

This research examined 65 rural elderly residents' perception of their physical activity as compared to their functional capacity. Men's, but not women's, perceptions of their physical activity were correlated with their functional capacity.