Background Exercise is safe and provides considerable benefits for patients with heart failure (HF) including improved function, quality of life, and symptoms. However, patients with HF have difficulty initiating and adhering to an exercise regimen. To improve adherence, our team developed Heart Failure Exercise and Resistance Training (HEART) Camp, a multicomponent, theory-driven intervention that was efficacious in a randomized controlled trial of long-term adherence to exercise in patients with HF. Identifying active components of efficacious interventions is a priority. Purpose The purpose of this study is to use mediation analysis to determine which interventional components accounted for long-term adherence to exercise in patients with HF. Methods This study included 204 patients with HF enrolled in a randomized controlled trial. Instruments measuring interventional components were completed at baseline, 6, 12, and 18 months. Hierarchical linear models generated slope estimates to be used as predictors in logistic regression models. Significant variables were tested for indirect effects using path analyses with 1,000 bootstrapped estimates. Results Significant mediation effects were observed for the interventional components of negative attitudes (β NA = 0.368, s.e. = 0.062, p < .001), self-efficacy (β SE = 0.190, s.e. = 0.047, p < .001), and relapse management (β RM = 0.243, s.e. = 0.076, p = .001). Conclusions These findings highlight improving attitudes, self-efficacy, and managing relapse as key interventional components to improve long-term adherence to exercise in patients with HF. Future interventions targeting adherence to exercise in patients with HF and other chronic illnesses should consider the incorporation of these active components.

中文翻译：

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消极态度、自我效能感和复发管理介导心力衰竭患者长期坚持锻炼

背景 运动是安全的，并且为心力衰竭 (HF) 患者提供了相当大的益处，包括改善功能、生活质量和症状。然而，心衰患者难以开始和坚持锻炼方案。为了提高依从性，我们的团队开发了心力衰竭运动和阻力训练 (HEART) 训练营，这是一种多成分、理论驱动的干预措施，在心衰患者长期坚持运动的随机对照试验中非常有效。确定有效干预措施的有效成分是当务之急。目的 本研究的目的是使用中介分析来确定哪些干预成分导致心衰患者长期坚持锻炼。方法 本研究纳入随机对照试验的 204 名 HF 患者。测量介入组件的仪器在基线、6、12 和 18 个月完成。分层线性模型生成斜率估计值，用作逻辑回归模型中的预测变量。使用具有 1,000 个自举估计的路径分析来测试显着变量的间接影响。结果 消极态度的干预成分（β NA = 0.368，se = 0.062，p < .001）、自我效能感（β SE = 0.190，se = 0.047，p < .001）、和复发管理（β RM = 0.243，se = 0.076，p = .001）。结论 这些发现强调了改善态度、自我效能感和管理复发是提高心衰患者长期坚持锻炼的关键干预措施。