Physical activity in patients with heart failure: barriers and motivations with special focus on sex differences

Figures & data

Table 1 Demographic and clinical variables in 154 heart failure patients and sex differencesa

	Total, N=154	Women, N=49	Men, N=105	Significance
Age (years)	70 (±10)	68 (±12)	70 (±9)	0.23
Education				0.24
Primary school	61 (40%)	14 (29%)	47 (45%)
Secondary school	35 (23%)	12 (25%)	33 (22%)
Higher than secondary school	30 (20%)	11 (22%)	19 (18%)
Marital status				0.34
Married/in a relationship	109 (71%)	33 (67%)	80 (76%)
Children	131 (85%)	47 (96%)	84 (80%)	0.01
NYHA class				0.75
NYHA I/II	63 (64%)	17 (59%)	46 (66%)
NYHA III/V	36 (36%)	12 (41%)	24 (34%)
Time after diagnosis (months)	33 (±31)	31 (±25)	34 (±34)	0.67
Currently smoking	14 (9%)	6 (12%)	8 (7%)	0.37
Alcohol consumption				0.00
Nothing	37 (24%)	23 (47%)	14 (13%)
One glass or less a week	51 (33%)	14 (29%)	37 (35%)
2–7 glasses a week	57 (37%)	12 (25%)	45 (43%)
More than 7 glasses a week	7 (5%)	0 (0%)	7 (7%)
Comorbidity	103 (73%)	34 (79%)	69 (70%)	0.20

Note:

a Means and standard deviations were calculated for continuous data, and absolute numbers and percentages were computed for nominal variables.

Abbreviation: NYHA, New York Heart Association.

Table 2 Physical activity in 154 HF patients and sex differencesa

	Total group, N=154	Women, N=49	Men, N=105	Significance
Physical activity (METs)b	1,173 (231–3,461)	639 (149–3,129)	1,200 (263–3,465)	0.52
Low physical activity (<600 METs)	53 (34%)	20 (41%)	33 (31%)	0.54
Moderate physical activity (600–3,000 METs)	46 (30%)	14 (29%)	21 (30%)
High physical activity (≥3,000 METs)	35 (23%)	11 (22%)	24 (23%)
Vigorous activities (minutes)	0 (25–41)	0 (0–58)	0 (0–40)	0.69
Moderate activities (minutes)	20 (0–270)	0 (0–240)	43 (0–292)	0.16
Walking (minutes)	120 (35–120)	90 (20–315)	120 (40–315)	0.44
Sitting on a chair (minutes)	1,689 (1,260–2,520)	2,100 (1,260–3,150)	1,680 (1,260–3,150)	0.69

Notes:

a Median and quartiles were calculated for continuous data, and absolute numbers and percentages were computed for nominal variables.

b The MET, or simply metabolic equivalent, is a physiological measure expressing the energy cost of physical activities, and is defined as the ratio of metabolic rate (and therefore the rate of energy consumption) during a specific physical activity to a reference metabolic rate.

Abbreviations: HF, heart failure; MET, metabolic equivalent of task.

Table 3 Differences between heart failure patients with a low weekly physical activity level (<600 METs) and patients with a high weekly physical activity (≥3,000 METs)a

	Low physical activity, N=53	High physical activity, N=35	Significance
Age (years)	71 (±9)	72 (±11)	0.71
Female	20 (38%)	11 (31%)	0.54
Education			0.04
Primary school	29 (55%)	9 (26%)
Secondary school	12 (23%)	9 (26%)
Higher than secondary school	6 (11%)	8 (23%)
Marital status			0.79
Married/in a relationship	25 (66%)	25 (71%)
NYHA class			0.13
NYHA I/II	14 (30%)	14 (52%)
NYHA III/IV	18 (38%)	8 (30%)
Time after diagnosis (months)	26 (±19)	24 (±21)	0.74
Smoking	6 (11%)	2 (6%)	0.82
Alcohol consumption			0.19
Nothing	15 (28%)	6 (18%)
One glass or less a week	15 (28%)	14 (41%)
2–7 glasses a week	19 (36%)	14 (41%)
More than 7 glasses a week	4 (11%)	0 (0%)
Comorbidity	37 (79%)	23 (70%)	0.26
Exercise self-efficacy	3 (±2)	4 (±2)	0.00
Exercise motivation	1 (±1)	2 (±1)	0.00
Physical motivation	2 (±1)	2 (±1)	0.00
Psychological motivation	1 (±1)	2 (±1)	0.00
Social motivation	1 (±1)	1 (±1)	0.01

Note:

a Means and standard deviations were calculated for continuous data, and absolute numbers and percentages were computed for nominal variables.

Abbreviations: MET, metabolic equivalent of task; NYHA, New York Heart Association.

Table 4 Potential barriers to exercise in heart failure patients and sex differences in potential barriers to exercise

Potential barriers to exercise	Total group, N=154	Women, N=49	Men, N=105	Significance
Total self-efficacy	3.6 (±2.2)	3.6 (±2.0)	3.5 (±2.4)	0.76
Suffering from minor injuries	115 (85%)	35 (71%)	80 (76%)	0.49
Need to spend time on other things	114 (83%)	37 (76%)	77 (73%)	0.85
Need to spend time on family responsibilities	112 (82%)	39 (80%)	73 (70%)	0.19
Feeling physically tired	115 (82%)	35 (71%)	80 (76%)	0.68
Experience symptoms	109 (81%)	35 (71%)	74 (71%)	0.90
Working long hours	104 (80%)	33 (67%)	71 (68%)	0.39
Feeling bored with exercising	106 (76%)	29 (59%)	77 (73%)	0.07
Experience side effects of the medication	98 (75%)	35 (71%)	63 (60%)	0.27
The weather is bad	96 (73%)	25 (51%)	71 (68%)	0.07
Hard to get to the gym	95 (71%)	31 (63%)	64 (61%)	0.68
Exercise is expensive	91 (70%)	29 (59%)	62 (59%)	0.09
Family is not interested in exercise	93 (69%)	27 (55%)	66 (63%)	0.30
Afraid of getting hurt through exercise	86 (68%)	23 (47%)	63 (60%)	0.09

Notes: The response alternatives 1 (not confident)–5 were combined into a potential barrier, the response alternatives 6–10 (very confident) were combined into no potential barrier. Absolute numbers and percentages were computed for nominal variables.

Table 5 Motivations to exercise in heart failure patients and sex differences in motivations to exercisea

Motivations to exercise	Total, N=154	Women, N=49	Men, N=105	Significance
Total motivation	1.8 (±1.0)	2.1 (±2.4)	1.7 (±2.0)	<0.01
Physical motivation	1.4 (±1.2)	1.7 (1.0)	1.2 (±0.9)	0.02
I want to be healthier and perhaps live longer	97 (66%)	35 (71%)	56 (53%)	0.05
I want to develop stamina and feel strong	62 (42%)	23 (47%)	39 (37%)	0.20
I want to be in good shape and for my clothes to fit better	57 (39%)	22 (45%)	35 (33%)	0.11
I want to look good	23 (16%)	10 (20%)	13 (12%)	0.19
Social motivation	2.2 (±1.0)	2.5 (±1.0)	2.1 (±1.0)	0.04
I want to be as active as my friends and family	37 (25%)	25 (31%)	22 (21%)	0.18
I want to belong to groups of fit people	35 (24%)	12 (25%)	23 (22%)	0.61
It is fun to exercise in a group or with other people	31 (21%)	14 (29%)	17 (16%)	0.05
Everyone else exercises, I want to do that too	25 (17%)	6 (12%)	19 (18%)	0.39
Psychological motivation	2.9 (±1.1)	2.2 (±1.0)	1.8 (±1.1)	0.02
I want a slower aging process and feel younger	84 (57%)	28 (57%)	19 (40%)	0.64
Exercise increases my general feeling of well-being	64 (44%)	25 (51%)	39 (37%)	0.08
I am proud of myself when I take regular exercise	58 (39%)	26 (53%)	32 (31%)	<0.01
I feel more in control of my life when I exercise	52 (36%)	18 (37%)	34 (32%)	0.46
I want to feel less physically exposed	49 (33%)	20 (41%)	29 (28%)	0.10
I feel more successful when I am in good shape	44 (30%)	19 (39%)	25 (24%)	<0.05
People who are fit are admired, I want to be admired too	19 (13%)	7 (14%)	12 (11%)	0.61

Notes: The response alternatives of the Exercise Motivation Index were dichotomized, the response alternatives 0 (not at all important)-2 (important) were combined into no or little motivation, and the response alternatives 3 (very important) and 4 (enormously important) were combined into a motivation.

a Means and standard deviations were calculated for continuous data, and absolute numbers and percentages were computed for nominal variables.