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Physical activity in patients with heart failure: motivations, self-efficacy and the potential of exergaming
Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Adherence to recommendations for physical activity is low in patients with heart failure (HF). It is essential to explore to what extent and why patients with HF are physically active. Self-efficacy and motivation for physical activity are important in becoming more physically active, but the role of self-efficacy in the relationship between motivation and physical activity in patients with HF is unknown. Alternative approaches to motivate and increase self-efficacy to exercise are needed. One of these alternatives might be using exergames (games to improve physical exercise). Therefore, it is important to obtain more knowledge on the potential of exergaming to increase physical activity.

The overall aim was to describe the physical activity in patients with HF, with special focus on motivations and self-efficacy in physical activity, and to describe the potential of exergaming to improve exercise capacity.

Methods: Study I (n = 154) and II (n = 101) in this thesis had a cross-sectional survey design. Study III (n = 32) was a 12-week pilot intervention study, including an exergame platform at home, with a pretest-posttest design. Study IV (n = 14) described the experiences of exergaming in patients who participated in the intervention group of a randomized controlled study in which they had access to an exergame platform at home.

Results: In total, 34% of the patients with HF had a low level of physical activity, 46% had a moderate level, 23% reported a high level. Higher education, higher selfefficacy, and higher motivation were significantly associated with a higher amount of physical activity. Barriers to exercise were reported to be difficult to overcome and psychological motivations were the most important motivations to be physically active. Women had significantly higher total motivation to be physically active. Self-efficacy mediated the relationship between exercise motivation and physical activity; motivation leads to a higher self-efficacy towards physical activity.

More than half of the patients significantly increased their exercise capacity after 12 weeks of using an exergame platform at home. Lower NYHA-class and shorter time since diagnosis were factors significantly related to the increase in exercise capacity. The mean time spent exergaming was 28 minutes per day. Having grandchildren and being male were related to more time spent exergaming.

The analysis of the qualitative data resulted in three categories describing patients’ experience of exergaming: (i) making exergaming work, (ii) added value of exergaming, (iii) no appeal of exergaming.

Conclusion: One-third of the patients with HF had a low level of physical activity in their daily life. Level of education, exercise self-efficacy, and motivation were important factors to take into account when advising patients with HF about physical activity. In addition to a high level of motivation to be physically active, it is important that patients with HF have a high degree of exercise self-efficacy.

Exergaming has the potential to increase exercise capacity in patients with HF. The results also showed that this technology might be suitable for some patients while others may prefer other kinds of physical activity.

Abstract [nl]

Achtergrond: Het aantal patiënten met hartfalen (HF) dat zich kan houden aan de aanbevolen lichamelijke activiteit is over het algemeen klein. Het is essentieel om te onderzoeken in hoeverre en waarom patiënten met HF lichamelijk actief zijn. Het hebben van self-efficacy (een persoonlijke overtuiging dat hij/zij capabel is om te doen wat nodig is om een taak te volbrengen op een bepaald kwaliteitsniveau) en motivatie voor lichamelijke activiteit is belangrijk om meer lichamelijk actief te worden. Het is echter niet duidelijk wat de rol van self-efficacy is in relatie tot motivatie en lichamelijke activiteit bij patiënten met HF. Alternatieve benaderingen zijn nodig om patiënten te motiveren lichamelijk actiever te zijn en de self-efficacy te verhogen. Een van de mogelijke alternatieven om patiënten met HF te helpen lichamelijk actiever te zijn is de inzet van exergames: computerspellen om fysieke activiteit te bevorderen. Er is tot nu toe geen onderzoek is gedaan naar de inzet van exergaming bij patiënten met hartfalen en de mogelijkheden van exergaming om patiënten te stimuleren tot meer lichamelijke activiteit.

Het doel van dit proefschrift is het beschrijven van de lichamelijke activiteit van patiënten met HF met extra aandacht voor de motivatie en self-efficacy ten opzichte van lichamelijke activiteit. Een tweede doel is om inzicht te krijgen in de mogelijkheid om exergaming te gebruiken om de lichamelijke activiteit van patiënten met HF te verhogen.

Methode: In dit proefschrift worden gegevens van 4 studies beschreven (studie I-IV). Studie I (n = 154) en II (n = 101) hebben een crosssectioneel survey design. Studie III (n = 32) is een 12 weken durende pilot-interventie studie met een pretest-posttest design waarbij patiënten 12 weken lang een exergame platform thuis konden gebruiken. Studie IV (n = 14) beschrijft de ervaringen van patiënten die deelnamen aan de interventiegroep van een gerandomiseerde studie waarin zij een exergame platform thuis kregen.

Resultaten: In totaal hebben 34% van alle patiënten met hartfalen een laag niveau van lichamelijke activiteit, 46% had een matig niveau, en 23% een hoog niveau. Een hoger opleidingsniveau, self-efficacy en motivatie significant werd geassocieerd met een hogere hoeveelheid lichamelijke activiteit. Het bleek dat barrières voor fysieke activiteit moeilijk te overbruggen waren. Met betrekking tot motivatie, bleek dat psychologische motivatie de belangrijkste drijfveer was om fysiek actief te zijn. Verder bleek dat vrouwen een significant hogere motivatie voor fysieke activiteit hebben dan mannen.

Een ander belangrijk resultaat was dat self-efficacy de relatie tussen motivatie en lichamelijke activiteit beïnvloedt; motivatie leidt tot een hogere self-efficacy wat leidt tot hogere fysieke activiteit.

Met betrekking tot de resultaten van exergaming bleek dat de inspanningscapaciteit van meer dan de helft van de patiënten aanzienlijk was toegenomen na 12 weken gebruik gemaakt te hebben van een exergame platform thuis. Patiënten met een lager NYHA-klasse en een kortere tijd na de diagnose verhogen significant meer hun inspanningscapaciteit. Ook bleek dat het hebben van een partner en kleinkinderen gerelateerd is aan meer tijd besteden aan exergaming.

De analyse van de ervaringen van patiënten in de kwalitatieve studie resulteerde in drie categorieën: (i) zorgen dat exergaming werkt, (ii) toegevoegde waarde van exergaming, (iii) geen aantrekking tot exergaming.

Conclusie: Een derde van de patiënten met HF heeft een laag niveau van lichamelijke activiteit in hun dagelijks leven. Opleidingsniveau, self-efficacy en motivatie zijn belangrijke factoren om rekening mee te houden bij het geven van advies aan patiënten met HF betreffende fysieke activiteit. Naast een hoge motivatie tot bewegen is het belangrijk dat patiënten met HF een hoog niveau van self-efficacy hebben om fysiek actief te zijn.

Exergaming heeft potentie om inspanningscapaciteit bij patiënten met HF te verhogen. Uit de resultaten blijkt ook dat deze techniek geschikt is voor een deel van de patiënten, terwijl een deel van de patiënten wellicht liever andere vormen van lichamelijke activiteit beoefenen.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. , 96 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1508
Keyword [en]
Heart failure, physical activity, exercise, motivation, self-efficacy, exergame
Keyword [nl]
Hartfalen, lichamelijke activiteit, bewegen, motivatie, self-efficacy, exergame
National Category
Physiotherapy Sport and Fitness Sciences Nursing Other Medical Sciences not elsewhere specified
Identifiers
URN: urn:nbn:se:liu:diva-130933DOI: 10.3384/diss.diva-130933ISBN: 9789176858400 (Print)OAI: oai:DiVA.org:liu-130933DiVA: diva2:956952
Public defence
2016-10-04, K1, Kåkenhus, Campus Norrköping, Norrköping, 09:00 (English)
Opponent
Supervisors
Available from: 2016-08-31 Created: 2016-08-31 Last updated: 2016-09-01Bibliographically approved
List of papers
1. Physical activity in patients with heart failure: barriers and motivations with special focus on sex differences
Open this publication in new window or tab >>Physical activity in patients with heart failure: barriers and motivations with special focus on sex differences
2015 (English)In: Patient Preference and Adherence, ISSN 1177-889X, E-ISSN 1177-889X, Vol. 9, 1603-1610 p.Article in journal (Refereed) Published
Abstract [en]

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. Discussion: 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.

Place, publisher, year, edition, pages
DOVE MEDICAL PRESS LTD, 2015
Keyword
barriers; sex differences; heart failure; motivation; physical activity; self-efficacy
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-123091 (URN)10.2147/PPA.S90942 (DOI)000364289900001 ()26635469 (PubMedID)
Available from: 2015-12-03 Created: 2015-12-03 Last updated: 2016-08-31
2. Exergaming to increase the exercise capacity and daily physical activity in heart failure patients: a pilot study
Open this publication in new window or tab >>Exergaming to increase the exercise capacity and daily physical activity in heart failure patients: a pilot study
2014 (English)In: BMC Geriatrics, ISSN 1471-2318, Vol. 14, no 119Article in journal (Refereed) Published
Abstract [en]

Background

Regular daily physical activity is recognised as important in heart failure (HF) patients, but adherence to physical activity is low (<50%). To improve adherence to exercise in HF patients, alternative approaches to motivate and increase self-efficacy to exercise are needed. Therefore, we have studied a new phenomenon: exergames (games to improve physical exercise). The aims of the study were to assess the influence of the exergame platform Nintendo Wii on exercise capacity and daily physical activity in heart failure patients, to study factors related to exercise capacity and daily physical activity, and to assess patients’ adherence to exergaming.

Methods

A 12-week pilot study with a pretest-posttest design was conducted. The intervention consisted of an instruction on how to use the Wii and 12 weeks’ access to Wii at home. The main variables tested were exercise capacity (measured with a six-minute walking test), daily physical activity (measured with an activity monitor), and time exergaming (daily self-report with a diary). Bivariate correlations were used to assess associations between symptom experience, self-efficacy, motivation, anxiety, and depression.

Results

In total, 32 heart failure patients were included. More than half of the patients (53%) significantly increased their exercise capacity after 12 weeks. No significant difference was found in daily physical activity between baseline and 12 weeks. Lower NYHA class and shorter time since diagnosis were factors significantly related to the increase in exercise capacity. The daily mean time spent exergaming was 28 minutes, and having grandchildren and being male were related to more time spent exergaming.

Conclusion

Exergaming has the potential to increase exercise capacity in elderly, chronically ill cardiac patients. Although the daily physical activity did not change over time, exergaming was feasible for heart failure patients and might be a rehabilitation option for patients with heart failure

Place, publisher, year, edition, pages
BioMed Central, 2014
Keyword
Active video game, Adherence, Exercise capacity, Exergame, Heart failure, Physical activity
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-112402 (URN)10.1186/1471-2318-14-119 (DOI)000346030500004 ()25407612 (PubMedID)
Available from: 2014-11-25 Created: 2014-11-25 Last updated: 2016-08-31Bibliographically approved

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