Factors Predicting Physical Activity in Patients with Heart Failure

Abstract

Introduction: It is evident that physical activity is a non-pharmacological treatment that can improve health outcomes for patients with heart failure. To date, knowledge and factors associated with physical activity remain limited, particularly among Thai patients with heart failure. 

Objective: To evaluate the level of physical activity of patients with heart failure and to investigate the association between hemoglobin levels, fear of movement, family support, and trust in healthcare providers and their predictive power over physical activities. 

Design: A cross-sectional correlational predictive research using Roy’s adaptation model as a research framework. 

Methodology: The sample consisted of 146 patients attending the Department of Internal Medicine and Heart Failure Clinic at a super tertiary hospital from March to June 2022. They were purposive selected based on the inclusion criteria of having stable symptoms of heart failure, no illnesses or conditions that limited their physical movements, having hemoglobin levels tested within six months, and being discharge from the hospital for more than one month from the date of data collection. Data were collected using a demographics and history of illness questionnaire, the Tampa scale for kinesiophobia, the social support scale for exercise behavior, the healthcare relationship trust scale, and the Global Physical Activity Questionnaire. These instruments were validated for quality by experts and tested for reliability prior to use in data collection. The reliability for the entire questionnaire ranged from .78-.98. Data were analyzed using descriptive statistics, Chi square test, Point-biserial correlation and Logistic regression analysis with a significance level of .05. 

Results: The findings of this study revealed that 61.6% of the patients were males, with an average age of 61.05 years (SD = 14.41). Out of 146 participants, 63% had insufficient physical activities (M = 588.49 MET, SD = 574.89). The mean hemoglobin levels were slightly higher than normal in males (M = 13.1, SD = 2.00), while females had hemoglobin lower than normal levels (M = 11.6, SD = 1.90). The levels of fear of movement and family support were low (M = 34.27, SD = 5.19 and M = 23.98, SD = 11.96, respectively). The participants reported a high level of trust in healthcare providers (M = 36.38, SD = 7.58). Chi-square tests and Point-biserial correlation were used to analyze the correlations of the variables. It was found that hemoglobin levels, fear of movement, and family support were significantly and positively correlated with physical activity of the patients (χ2 = 6.201, p< .05, r_bi = -.254, p< .01, r_bi = .321, p<.01) respectively. The Binary logistic regression analysis revealed that normal hemoglobin levels (OR = 2.877, 95%CI = 1.32, 6.27, p<.01), fear of movement (OR = 0.891, 95%CI = 0.83, 0.96, p<.01), and family support (OR = 1.060, 95%CI = 1.02, 1.10, p<.01) were significant predictors of physical activity in patients with heart failure. The predictive power of these variables together could explain approximately 25.6 %. 

Recommendations: To promote patients with heart failure to perform sufficient physical activity, nurses need to evaluate, manage, and monitor their patients properly to maintain at least their normal hemoglobin levels. Additional approaches should focus on educating the patients about physical activity and providing accessible health services with family involvement. This can help reduce fear of movement and increase family supports towards increasing physical activity levels among patients.