"The Biobehavioral Effects of Gentle Stretching in Patients with Heart Failure"

Exercise is a Class 1A Recommendation to improve the lives of patients with heart failure (HF) and an essential component of effective self-care, yet less than one-third adhere to physical activity guidelines and less than 3% attend cardiac rehabilitation (CR). Alternative models of CR that use either an alternative setting (i.e. home-based) or an alternative exercise potentially mitigate barriers to CR and exercise adherence yet there has been little published regarding the patient experiences with these models nor specifically the experiences of patients with HF. To fill this gap, three manuscripts are presented in this dissertation.
The first manuscript presents a qualitative systematic review of 25 studies assessing the patient experiences of alternative models of CR. All alternative models of CR were found to be physically, psychologically, and/or socially beneficial to patients. Participants described facilitators and barriers that were influential in the decision to initiate or continue exercise.
The second manuscript presents participant experiences with a gentle non-aerobic home-based exercise program called the GEtting iNTo Light Exercise – Heart Failure Randomized Controlled Trial (GENTLE-HF RCT) for patients with HF wherein all participants had greater than or equal to 80% adherence and 64% of participants came more than was asked. Characteristics of super-adherers are described. Thematic statements with illustrative excerpts describe what participants stated was important for initiation and continuation of long-term adherence to exercise.
The third manuscript explores whether social isolation and loneliness, which are prevalent among patients with HF and known to affect other self-care behaviors, can predict HF self-care. This was a cross-sectional secondary analysis of the GENTLE-HF RCT using multiple linear regression. Patients who were less socially isolated engaged in better HF self-care; loneliness had no relationship with HF self-care.
For more than a decade, the leading HF authorities have designated exercise as a Class 1A Recommendation to improve the outcomes of patients with HF, yet we have failed in helping patients to initiate and adhere to exercise. This dissertation provides a meaningful step forward in understanding how we can best improve how we help patients with HF engage in exercise, an essential component of effective self-care. For many of our patients, it is not a “couch to 5K”, it is “couch to standing up”.