title: Gaming console exercise and cycle or treadmill exercise provide similar cardiovascular demand in adults with cystic fibrosis: a randomised cross-over trial. Effects of multidisciplinary Internet-based program on management of heart failure Social cognitive determinants of physical activity in young adults: A prospective structural equation analysis A randomized trial of the addition of home-based exercise to specialist heart failure nurse care: the Birmingham Rehabilitation Uptake Maximisation study for patients with Congestive Heart Failure (BRUM-CHF) study. Effects of an exercise adherence intervention on outcomes in patients with heart failure. Heart Failure Exercise And Training Camp: effects of a multicomponent exercise training intervention in patients with heart failure. Effects of a home walking exercise program on functional status and symptoms in heart failure. Predicting long-term maintenance of physical activity in older adults. Evaluation of a 12-week home-based walking intervention for breast cancer survivors A new model of home-based telemonitored cardiac rehabilitation in patients with heart failure: effectiveness, quality of life, and adherence. Impact of a home communication intervention for coronary artery bypass graft patients with ischemic heart failure on self-efficacy, coronary disease risk factor modification, and functioning. The impact of a self-management group programme on health behaviour and healthcare utilization among congestive heart failure patients. Validity of pedometers for measuring exercise adherence in heart failure patients. Motivational interviewing to promote physical activity for people with chronic heart failure. Motivational interviewing to change quality of life for people with chronic heart failure: a randomised controlled trial.
abstract: QUESTION Does exercise using a gaming console result in similar cardiovascular dem and and energy expenditure as formally prescribed exercise in adults with cystic fibrosis ? How do these patients perceive gaming console exercise ? DESIGN R and omised cross-over trial with concealed allocation and intention-to-treat analysis . PARTICIPANTS 19 adults with cystic fibrosis admitted to hospital for treatment of a pulmonary exacerbation . INTERVENTION Participants underwent two 15-minute exercise interventions on separate days ; one involving a gaming console and one a treadmill or cycle ergometer . OUTCOME MEASURES Cardiovascular dem and was measured using heart rate and rating of perceived exertion ( RPE ) . Energy expenditure was estimated using a portable activity monitor . Perception ( enjoyment , fatigue , workload , effectiveness , feasibility ) was rated using a horizontal 10-cm visual analogue scale . RESULTS There was no significant difference in average heart rate ( mean difference 3 beats/min , 95 % CI -3 to 9 ) or energy expenditure ( 0.1 MET , 95 % CI -0.3 to 0.5 ) between the two interventions . Both interventions provided a ' hard ' workout ( RPE ∼15 ) . Gaming console exercise was rated as more enjoyable ( mean difference 2.6 cm , 95 % CI 1.6 to 3.6 ) than formal exercise but they did n't differ significantly in fatigue ( -1.0 cm , 95 % CI -2.4 to 0.3 ) , perceived effectiveness ( -0.4 cm , 95 % CI -1.2 to 0.3 ) , or perceived feasibility for inclusion in routine management ( 0.2 cm , 95 % CI -0.7 to 1.1 ) . CONCLUSION Gaming console exercise provides a similar cardiovascular dem and as traditional exercise modalities . It is feasible that adults with cystic fibrosis could include gaming console exercise in their exercise program . TRIAL REGISTRATION ACTRN12610000861055 Objectives : To develop and test the effectiveness of an Internet-based self management program by multidisciplinary health care professionals for patients with heart failure ( HF ) . Methods : The comprehensive educational material for HF was created and posted on a website . A computer with Internet connection and computer training were provided first . A secure and simple web-based recording system of vital signs and health behaviors and a mechanism for feedback regarding each participant ’s record were developed . A r and omized controlled trial with a one-year intervention was conducted using a total of 40 patients who were assessed three times in their homes . An intention-to-treat analysis used multivariate statistics . Results : The treatment group had a high ( 85 % ) adherence to the intervention . Only the treatment group showed a significant improvement in the knowledge level ( p < 0.001 ) , amount of exercise ( p = 0.001 ) , and quality of life ( p = 0.001 ) , and reduction in HF related symptoms ( dyspnea , p = 0.001 ; fatigue , p = 0.003 ; functional emotion , p < 0.001 ) , blood pressure ( systolic , p = 0.002 ; diastolic , p < 0.001 ) , frequency of emergency room visit , and length of hospital stay ( both p = 0.001 ) . Conclusions : An effective program to change one ’s behaviors in managing HF takes a multidisciplinary approach to create and provide feedback regarding a patient ’s daily record , which can be accomplished through Internet use This study used a prospect i ve design to test a model of the relation between social cognitive variables and physical activity in a sample of 277 university students .  Social support , self-efficacy , outcome expectations , and self-regulation  were measured at baseline and used to predict physical activity 8 weeks later . Results of structural equation modeling indicated a good fit of the social cognitive model to the data . Within the model , self-efficacy had the greatest total effect on physical activity , mediated largely by self-regulation , which directly predicted physical activity . Social support indirectly predicted physical activity through its effect on self-efficacy . Outcome expectations had a small total effect on physical activity , which did not reach significance . The social cognitive model explained 55 % of the variance observed in physical activity AIMS Supervised exercise can benefit selected patients with heart failure , however the effectiveness of home-based exercise remains uncertain . We aim ed to assess the effectiveness of a home-based exercise programme in addition to specialist heart failure nurse care . METHODS AND RESULTS This was a r and omized controlled trial of a home-based walking and resistance exercise programme plus specialist nurse care ( n=84 ) compared with  specialist nurse care alone ( n=85 ) in a heart failure population in the West Midl and s , UK . PRIMARY OUTCOME Minnesota Living with Heart Failure Question naire ( MLwHFQ ) at 6 and 12 months . SECONDARY OUTCOMES composite of death , hospital admission with heart failure or myocardial infa rct ion ; psychological well-being ; generic quality of life ( EQ-5D ) ; exercise capacity . There was no statistically significant difference between groups in the MLwHFQ at 6 month ( mean , 95 % CI ) ( -2.53 , -7.87 to 2.80 ) and 12 month ( -0.55 , -5.87 to 4.76 ) follow-up or secondary outcomes with the exception of a higher EQ-5D score ( 0.11 , 0.04 to 0.18 ) at 6 months and lower Hospital Anxiety and Depression Scale score ( -1.07 , -2.00 to -0.14 ) at 12 months , in favour of the exercise group . At 6 months , the control group showed deterioration in physical activity , exercise capacity , and generic quality of life . CONCLUSION Home-based exercise training programmes may not be appropriate for community-based heart failure patients The purpose of this study was to determine how an exercise adherence intervention affects the physiological , functional , and quality of life outcomes of patients with heart failure ( HF ) . Sixteen HF patients were r and omly assigned to an  exercise-only group  ( n = 8) or to an  exercise-with-adherence group ( n = 8) . Two of the 16 people  died from nonexercise related causes during the study and were not included in the analysis . The intervention was tested over a 24-week period in which patients participated in a 12-week supervised exercise program ( Phase 1 ) followed by 12 weeks of unsupervised home exercise ( Phase 2 ) . The intervention format was one of individualized graphic feedback on exercise goals and participation and problem-solving support by nurses . Results indicate that patients who received the intervention exercised more frequently and experienced improved outcomes during both phases . The adherence intervention may encourage HF patients to continue to exercise and thereby maintain the health benefits gained in both phases of an exercise program 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 B and ura 's social cognitive theory . METHODS An experimental repeated- measures design was used . Participants were r and omized 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 BACKGROUND Hospital-based exercise programs using a bicycle ergometer or a combination of exercise modalities have shown positive benefits in heart failure , but may not be readily accessible to many patients . Thus , we sought to evaluate the effects of a 12-week home walking exercise program on functional status and symptoms in patients with heart failure . METHODS A r and omized controlled trial comparing a 12-week progressive home walking exercise program ( n = 42 ) to a " usual activity " control group ( n = 37 ) was conducted in patients with heart failure ( 78 [ 99 % ] male ; mean age 62.6 + /- 10.6 years ; ejection fraction 27 % + /- 8.8 % ; 63 [ 80 % ] New York Heart Association class II ; 15[20 % ] New York Heart Association class III-IV ) from a Veterans Affairs medical center and a university-affiliated medical center .  Functional status ( peak oxygen consumption via cardiopulmonary exercise testing , 6-minute walk test , the Heart Failure Functional Status Inventory ) , and symptoms ( Dyspnea-Fatigue Index score with a postglobal rating of symptoms ) were measured at baseline and 12 weeks . RESULTS No adverse events related to exercise training occurred . Overall mean compliance to training was 74 + /- 37 % . Peak oxygen consumption and the Heart Failure Functional Status Inventory were unchanged with training . Compared to the usual activity group , the training group had significantly longer walking distances measured by the 6-minute walk test ( 1264 + /- 255 vs 1337 + /- 272 feet , P = .001 ) , and improved postglobal rating of symptoms ( P = .03 ) . CONCLUSION In patients with heart failure , a progressive home walking exercise program is acceptable , increases walking distance , and decreases global rating of symptoms BACKGROUND Considerable research has established that self-efficacy is a consistent correlate of physical activity . Additional factors , such as exercise-induced affect , social support , and value judgments , have also been identified as having the potential to influence adherence to activity . This study examined the utility of such variables in predicting the long-term exercise behavior  of older adults . METHOD In the context of a 6-month r and omized controlled trial with an 18-month follow-up , we tested the extent to which adherence during the trial , affective responses to exercise , exercise value , and social support from the exercise group had either a direct or indirect effect through the mediation of exercise self-efficacy on physical activity levels at 6- and 18-month follow-up in a sample ( N=174 ) of older adults ( M age , 66 years ) .  Structural equation modeling tested several models of exercise prediction . RESULTS The best fitting model indicated significant paths from social support , affect , and exercise frequency to efficacy at the end of the program . Efficacy , in turn , was related to physical activity at 6- and 18-month follow-up . The model accounted for 40 % of the variance in 18-month activity levels . CONCLUSION This prospect i ve study provides support for the inclusion of social cognitive variables in models of exercise adherence and highlights the pivotal role of self-efficacy in long-term exercise behavior . Subsequent trials are called for to replicate and extend these findings Goals of workTo evaluate a 12-week home-based walking intervention among breast cancer survivors and to quantify changes in  physical activity ( PA ) behaviors , body weight , and body composition in response to the intervention . Patients and methods Breast cancer survivors that were in the posttreatment period were r and omized to intervention ( n=23 ) or wait-list usual care ( n=13 ) .  PA was assessed by self-report , and in a study sub sample ( n=23 ) , by an accelerometer . Intention to treat principles were employed to estimate the intervention effect on PA behaviors , body weight , and body composition . Intervention adherence was calculated as the proportion of exercise sessions completed relative to the number of exercise sessions recommended , as reported each week on walking logs . Main results Thirty-four of 36 women r and omized ( 94 % ) completed the study . Average intervention adherence over 12 weeks was 94 % . Intervention participants reported a significantly greater increase in walking for exercise [ + 11.9 metabolic equivalent (MET)-h/week ] over time than did usual care participants ( + 1.7 MET-h/week , p=0.01 ) . Objective measures of activity also indicated that intervention participants increased their activity levels over time as compared to usual care participants [ i.e. , counts/min/day and steps/day ( p≤0.04 ) ] . No significant changes in body weight or composition were observed . Conclusion We found that a 12-week home-based walking intervention was safe and effective for increasing short-term PA levels in breast cancer survivors . Future studies are needed to assess the ability of brief interventions to facilitate the maintenance of increased activity levels and to produce favorable quality of life and risk factor outcomes AIMS Despite proven benefits of cardiac rehabilitation ( CR ) , currently proposed CR models are not acceptable for many heart failure ( HF ) patients . The purpose of this study was to evaluate a new model of home-based telemonitored cardiac rehabilitation ( HTCR ) using walking training compared with an outpatient-based st and ard cardiac rehabilitation ( SCR ) using interval training on a cycle ergometer . METHODS AND RESULTS The study included 152 HF patients ( aged 58.1 + or - 10.2 years , NYHA class II and III , ejection fraction < or = 40 % ) who were r and omized to HTCR ( n = 77 ) or SCR ( n = 75 ) . All patients underwent 8 weeks of CR . Both groups were comparable in terms of demographic and clinical characteristics and medical therapy . The effectiveness of  CR  was assessed by changes in NYHA class , peak oxygen consumption , 6-min walking test distance , and SF-36 score . Cardiac rehabilitation result ed in a significant improvement of all parameters in both groups . All patients in the HTCR group completed the 8 weeks of CR , whereas 15 patients in the SCR group ( 20 % ) discontinued CR . CONCLUSION In patients with HF , HTCR is equally as effective as SCR and provides a similar improvement in quality of life . Adherence to CR seems to be better for HTCR . Home-based telemonitored cardiac rehabilitation may be a useful alternative form of CR in patients with HF OBJECTIVE The purpose of this study is to determine the impact of a home communication intervention ( HCI ) for ischemic heart failure Coronary Artery Bypass Graft ( CABG ) patients > /= 65 years of age on self-efficacy , coronary artery disease risk factor modification and functioning posthospitalization . DESIGN A r and omized clinical trial with repeated measures was used . SAMPLE A sub sample of ischemic heart failure CABG surgery patients ( n = 35 ) was drawn from the parent study of 180 CABG patients . RESULTS HCI participants ( n = 18 ) had significantly higher adjusted mean self-efficacy scores [ F(1 , 29 ) = 6.40 , P < .05 ] and adjusted mean levels of functioning ( physical , general health , mental , and vitality functioning ) compared with the routine care group ( n = 17 ) , using repeated measures analysis of covariance with baseline scores as covariates . There were also significant effects of time on bodily pain and role emotional functioning . Significantly higher exercise adherence ( t = 3.09 , P < .01 ) and lower reported stress ( t = 3.77 , P < .01 ) at 3 months after surgery was reported by HCI subjects . CONCLUSIONS Data from this pilot study can be used to strengthen the HCI intervention with more tailored strategies for vulnerable subgroups of CABG patients AIMS The ' Chronic Disease Self-Management Programme ' ( CDSMP ) emphasizes patients ' responsibility for the day-to-day management of their condition(s ) and has shown favourable effects on health behaviour and healthcare utilization among various groups of patients with chronic conditions . However , the effects of the CDSMP among congestive heart failure ( CHF ) patients are unknown . We therefore aim ed to assess the effects of the CDSMP on health behaviour and healthcare utilization in patients with CHF . METHODS AND RESULTS This r and omized , controlled trial with 12 months of follow-up included 317 CHF patients with a slight to marked limitation of physical activity . Control patients ( n = 131 ) received usual care , consisting of regular checkups at an outpatient clinic . Intervention group patients ( n = 186 ) received usual care and participated in a 6-week self-management group programme .  Favourable effects on walking for exercise and other physical activities such as aerobic , stretching , and strength exercises , sports , and gardening were reported in the intervention group immediately after completion of the programme . The effect of the programme on other physical activities extended to 6 months of follow-up . No favourable effects were found for the other outcomes . CONCLUSION The CDSMP significantly improved physical activity  among CHF patients for up to 6 months after the end of the programme ; however , it did not affect other health behaviour outcomes or healthcare utilization BACKGROUND Measuring adherence to exercise is important to clinicians and research ers because inadequate adherence can adversely affect the effectiveness of an exercise program and cloud the relationship between exercise and clinical outcomes . Hence , assessment strategies for adherence to exercise , as with assessment strategies for other outcomes , must have demonstrated validity if they are to be employed with confidence . We conducted this study to determine the validity of pedometers as a measure of exercise adherence to a home-based walking program in heart failure patients . METHODS AND RESULTS  Exercise adherence  was measured using pedometers in 38 patients ( 74 % men ) age 54.1 + /- 11.7 years who participated in a 12-month home-based walking program .  A comparison of functional status as measured by the 6-minute walk distance and peak oxygen uptake ( VO2 max ) at 6 months into the exercise training program was made between 2 groups of participants who were thought to represent adherers and nonadherers : participants who demonstrated > or = 10 % change in pedometer scores ( n = 20 ) and those who showed no change in pedometer scores ( n = 18 ) from baseline to 6 months . Patients who showed improvements in their pedometer scores over 6 months had better functional status at 6 months ( 6-minute walk distance 1718 + /- 46 versus 1012 + /- 25 meters , F = 5.699 , P = .022 ; VO 2 max 17 + /- 0.7 versus 10 + /- 0.5 units , F = 7.162 , P = .011 ) when compared with patients whose pedometers reflected minimal change in distance walked ( ie , < or = 10 % ) . CONCLUSION Pedometers are inexpensive and readily available to both clinicians and research ers . The results of this study suggest that they may be a valid indicator of exercise adherence in heart failure patients who participate in a home-based walking program AIM This paper reports a study comparing , over a 5-month period , two different methods of increasing physical activity : a traditional exercise programme and one based on motivational interviewing . BACKGROUND Chronic heart failure is associated with poor quality of life that can be improved by increased physical activity . Patients who are directed to engage in physical activity have a record of low compliance . METHOD Sixty older aged heart failure patients were r and omly assigned to st and ard care , motivational interviewing or both treatments . The primary outcome was physical activity ( kcal/kg/day ) , with the 6-minute walk test as a secondary outcome . FINDINGS At entry , no significant differences were observed between the three groups . Following treatment , the ' motivational interviewing ' and ' both treatments ' groups reported an increase in their level and type of activities , whereas the ' st and ard care ' group did not . All groups significantly increased their 6-minute walk distance . CONCLUSIONS Motivational interviewing , which incorporates established behaviour change principles and a flexible approach to promotion of activity , increases reported physical activity in older patients with heart failure over a short period . In terms of level and type of activity , this approach gives a better outcome than st and ard care , and nurses should explore alternative strategies to promote health in this population BACKGROUND Patients with chronic heart failure have a reduced quality of life due in part to their limited range of physical activity and independence . OBJECTIVES The paper examines whether a physical activity ' lifestyle ' intervention , based on motivational interviewing , will improve quality of life at five months from baseline , compared with conventional treatment . METHODS Sixty older patients with chronic heart failure were r and omly assigned to either a ' st and ard care ' , ' motivational interviewing ' or ' both ' treatment groups for five months in 2002 . The primary outcome measures were the Medical Outcomes Short Form-36 Health Survey , the disease-specific Minnesota Living with Heart Failure question naire and the Motivation Readiness for Physical Activity scale . RESULTS There were non-significant differences between the groups at baseline for age , coronary risk factors , severity of chronic heart failure , ejection fraction , specific laboratory tests , length of hospitalisation , medication and social support . Following treatment there was a significant increase ( p<0.05 ) for three of the dimensions of the health survey in the ' motivational interviewing ' group . All groups improved their scores ( p<0.05 ) on the heart failure question naire . Over the five month period there was a general trend towards improvements in self-efficacy and motivation scores . CONCLUSIONS This study has demonstrated that a ' motivational interviewing ' intervention , incorporating behaviour change principles to promote physical activity , is effective in increasing selected aspects of a general quality of life question naire and a disease-specific quality of life question naire . Thus a ' motivational interviewing ' approach is a viable option compared with traditional exercise programming . It is important to test these motivational interviewing interventions more widely , especially to match individuals to treatments
target: Positive outcomes occurred in the short-term from interventions using approaches such as  exercise prescriptions , goal setting , feedback and problem-solving .
  However , longer-term maintenance of exercise  was less successful .
background: Physical activity is recommended for people with stable heart failure ( HF ) , because it is known to improve quality of life and health outcomes .
  However , adherence to this recommendation has been poor in many studies .
  A systematic review was conducted to examine the effectiveness of strategies used to promote exercise adherence in those with HF .