| Heart failure,a complex group of clinical syndromes caused by structural or functional abnormalities of the heart resulting in increased intracardiac pressure and/or insufficient cardiac output at rest and/or during exercise,is predominantly chronic heart failure.Exercise intolerance is a hallmark of chronic heart failure and an important care issue for heart failure patients,and guidelines and studies have confirmed that exercise rehabilitation can effectively improve exercise tolerance.However,exercise rehabilitation in China started late,patient participation is low,and a prominent problem at home and abroad is that patients’ adherence with exercise during exercise rehabilitation is poor,making exercise rehabilitation ineffective in achieving its intended benefits.Self-efficacy refers to the self-belief or belief that people need to be able to perform a particular task and plays a key role in the initiation and maintenance of healthy behaviors.Increasing self-efficacy can enable people with chronic conditions to maintain exercise autonomy over a longer period,increase exercise adherence and delay the need for care.Therefore,this study will use self-efficacy theory as a framework to construct a scientific and comprehensive walking exercise intervention program applicable to patients with chronic heart failure and conduct applied research,to help this group to participate in the exercise,increase exercise tolerance,improve exercise adherence,reduce anxiety and depression,and improve quality of life.Objective:The purpose of this study was to develop an appropriate walking exercise intervention program for patients with chronic heart failure based on self-efficacy theory;and to investigate its intervention effects on exercise tolerence,exercise adherence,exercise self-efficacy,anxiety and depression,and quality of life in this group of patients,to provide new ideas and methods for the rehabilitation care of patients with chronic heart failure.Methods:This study is divided into two parts,the first part is the construction of the intervention protocol: this study was guided by self-efficacy theory,combined with guidelines for the management of chronic heart failure,a literature search,and group discussion to form the first draft of the intervention protocol.The final draft of the intervention was revised after 2 rounds of Delphi expert consultation and participant interviews.The second part is the application of the intervention protocol: a prospective randomized controlled trial was conducted in this study.549 patients with chronic heart failure were recruited in the cardiology department of a tertiary care hospital in Changchun.82 were finally identified after screening for inclusion and exclusion criteria and randomly allocated to the intervention and control groups,41 in each group.The duration of the intervention in this study was 3 months,with the control group using walking exercise rehabilitation and the intervention group using a walking exercise intervention program based on self-efficacy theory on top of this,with outcome indicators collected at baseline and 3 months after discharge respectively.The primary outcome indicators were exercise tolerance and exercise adherence,and the secondary outcome indicators were exercise self-efficacy,anxiety and depression,and quality of life.SPSS 26.0 was used to analyze the study data.Results:1.Construction of the intervention program.(1)This study combined self-efficacy theory and literature review to develop a first draft of an intervention protocol through group discussion.(2)After Delphi’s expert correspondence,the first draft was revised based on expert opinion and subject interview results to form the final draft.(i)The intervention format was set as during hospitalization: face-to-face,one-to-one format;after discharge: a combination of personal WeChat and WeChat group format;and telephone intervention if the patient or the patient’s family did not provide feedback on We Chat.(ii)The duration of the intervention was 3 months,with 12 interventions :2 interventions during hospitalization;1 intervention every week in the 1st and 2nd months after discharge,and 1 intervention every 2 weeks in the 3rd month after discharge.(iii)The content of the intervention was based on the 4 points of self-efficacy theory that most influence self-efficacy: mastery experience,vicarious experience,verbal persuasion,and physiologic and affective states as the framework of the intervention,resulting in 4 primary indicators,13 secondary indicators and 15 tertiary indicators of content.2.Application of the intervention program.(1)The differences in demographic information between the two study groups at baseline in terms of age,gender,education level,marital status,type of health insurance,home location,NYHA cardiac function class,duration of heart failure,number of chronic conditions,and whether they currently smoked were not statistically significant(P>0.05)and were comparable.There were also no significant differences in exercise tolerance,exercise self-efficacy,anxiety,depression,or quality of life(P>0.05).(2)Intervention effect of exercise tolerance: After 3 months of intervention,the6-minute walk distance was 372.79±65.09 in the intervention group and 334.95±74.96 in the control group when compared within the group,and both had an improvement in exercise tolerance compared to baseline(P<0.001),but only the improvement of the intervention group was clinically significant;the improvement of the intervention group was higher than that of the control group when comparing between groups(P<0.05).(3)Intervention effect of exercise adherence: after 3 months of intervention,the percentage of complete and better adherence in the intervention group was 71.8%,compared with 30.8% in the control group,and the exercise adherence of the intervention group was significantly higher than that of the control group(P<0.05).(4)Intervention effect of exercise self-efficacy: After 3 months of intervention,the score of exercise self-efficacy in the intervention group was 47.74±11.95 and that in the control group was 33.49±9.44,the difference was statistically significant(P<0.001).(5)Intervention effects on anxiety and depression: after 3 months of intervention,the anxiety score of the intervention group was lower than the anxiety score of the control group,with a significant difference(P<0.001);the depression score of the intervention group was lower than the depression score of the control group,with a significant difference(P<0.001).(6)Effect of intervention on quality of life: After three interventions,the total quality of life scores,physical dimension scores,emotional dimension scores,and other dimension scores of the intervention group were all lower than those at baseline when compared within the group(P<0.001),while only the physical domain scores of the control group were statistically significantly different from those at baseline(P<0.05).When comparing between groups,the intervention group had lower total quality of life scores,physical dimension scores,emotional dimension scores,and other dimension scores than the control group,and the difference was statistically significant(P<0.05).Conclusion:1.This study constructs a self-efficacy theory-based walking exercise intervention program for patients with chronic heart failure.2.The program can enhance exercise tolerance and improve exercise adherence in patients with chronic heart failure.3.The program can improve exercise self-efficacy,reduce anxiety and depression,and improve the quality of life in patients with chronic heart failure.4.The program is a scientific,safe,and effective intervention for patients with chronic heart failure and has not led to adverse events. |
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