Lack of social support can hinder exercise programs for heart failure patients

November 19, 2015 – DCRI Fellow Lauren Cooper, MD, and her colleagues found that patients who reported more sources of social support exercised more than those who reported fewer sources of support.

Psychosocial barriers can pose a significant problem for heart failure patients who are trying to get sufficient exercise, according to a recent study by DCRI researchers.

The study, which appears in the current issue of Circulation: Heart Failure, sought to understand how these factors make it difficult for patients to adhere to regular exercise routine, and how a lack of exercise can affect outcomes for heart failure patients.

lauren-cooper-newsExercise is known to be beneficial for heart failure patients with reduced ejection fraction. Yet caregivers often find that their patients have trouble maintaining regular exercise regimens, even in a clinical setting. In this study, DCRI Fellow Lauren Cooper, MD, and her colleagues analyzed patient data from Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION), which randomized heart-failure patients to follow or not follow an exercise-training program.

For this analysis, Cooper and her team examined data from 2,279 heart failure patients enrolled in a 36-session supervised exercise program for three months, followed by two years of home exercise. These patients were also asked to complete an assessment of potential social barriers and sources of social support for their exercise programs.

Patients’ adherence to their exercise programs was measured by minutes of exercise per week. Each patient’s level of adherence was categorized as poor (less than 90 minutes per week), partial (90 or more minutes per week for three months, then  less than 120 minutes per week thereafter), or full (90 or more minutes per week for three months, then 120 or more minutes per week). Cardiopulmonary exercise testing was completed at baseline, 3 months, 12 months, and 24 months.

The researchers found that exercise adherence in general was poor. Patients who had poor adherence were more likely to be younger, female, African-American, and have higher body mass index scores.  Patients with poor adherence also had significantly worse baseline exercise capacity and reported a lower quality of life and higher levels of depression compared with patients with full adherence and partial adherence.

Patients who reported having more sources of social support exercised more than those who reported fewer sources of support. Similarly, patients with fewer barriers to exercise exercised more than those with more barriers to exercise. Higher reported sources of social support were not associated with all-cause death or hospitalization or with cardiovascular death or heart failure hospitalization. However, the researchers reported a significant interaction between the randomization group and reported barriers to exercise adherence.

Although the researchers cautioned that this study does not establish a link between more perceived sources of social support and improved outcomes, they noted that higher levels of social support tended to be associated with higher levels of exercise adherence.

“Patients, family members, and healthcare providers should work together to find solutions to the barriers preventing a patient from participating in structured exercise programs, because exercise programs can help patients manage their condition,”  Cooper said in a journal news release.

In addition to Cooper, other Duke authors included Robert J. Mentz, MD; Jie-Lena Sun, MS; Phillip J. Schulte, PhD; and William E. Kraus, MD.