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1.
Rev Cardiovasc Med ; 22(4): 1143-1155, 2021 12 22.
Article in English | MEDLINE | ID: covidwho-1598363

ABSTRACT

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. Increased rates of morbidity and mortality have led to the increased need for the implementation of secondary prevention interventions. Exercise-based cardiac rehabilitation (CR) represents a multifactorial intervention, including elements of physical exercise and activity, education regarding healthy lifestyle habits (smoking cessation, nutritional habits), to improve the physical capacity and psychological status of cardiac patients. However, participation rates in CR programs remain low due to socioeconomic, geographical and personal barriers. Recently the COVID-19 pandemic restrictions have added another barrier to CR programs. Therefore there is an emerging need to further improve the types and methods of implementing CR. Cardiac telerehabilitation, integrating advanced technology for both monitoring and communicating with the cardiac population, appears to be an innovative CR alternative that can overcome some of the barriers preventing CR participation. This review paper aims to describe the background and core components of center-based CR and cardiac telerehabilitation, and discuss their implications for present day clinical practice and their future perspectives.


Subject(s)
COVID-19 , Cardiac Rehabilitation , Telerehabilitation , Humans , Pandemics , SARS-CoV-2
2.
BMC Health Serv Res ; 21(1): 1363, 2021 Dec 24.
Article in English | MEDLINE | ID: covidwho-1582070

ABSTRACT

BACKGROUND: Restrictions on face-to-face contact, due to COVID-19, led to a rapid adoption of technology to remotely deliver cardiac rehabilitation (CR). Some technologies, including Active+me, were used without knowing their benefits. We assessed changes in patient activation measure (PAM) in patients participating in routine CR, using Active+me. We also investigated changes in PAM among low, moderate, and high risk patients, changes in cardiovascular risk factors, and explored patient and healthcare professional experiences of using Active+me. METHODS: Patients received standard CR education and an exercise prescription. Active+me was used to monitor patient health, progress towards goals, and provide additional lifestyle support. Patients accessed Active+me through a smart-device application which synchronised to telemetry enabled scales, blood pressure monitors, pulse oximeter, and activity trackers. Changes in PAM score following CR were calculated. Sub-group analysis was conducted on patients at high, moderate, and low risk of exercise induced cardiovascular events. Qualitative interviews explored the acceptability of Active+me. RESULTS: Forty-six patients were recruited (Age: 60.4 ± 10.9 years; BMI: 27.9 ± 5.0 kg.m2; 78.3% male). PAM scores increased from 65.5 (range: 51.0 to 100.0) to 70.2 (range: 40.7 to 100.0; P = 0.039). PAM scores of high risk patients increased from 61.9 (range: 53.0 to 91.0) to 75.0 (range: 58.1 to 100.0; P = 0.044). The PAM scores of moderate and low risk patients did not change. Resting systolic blood pressure decreased from 125 mmHg (95% CI: 120 to 130 mmHg) to 119 mmHg (95% CI: 115 to 122 mmHg; P = 0.023) and waist circumference measurements decreased from 92.8 cm (95% CI: 82.6 to 102.9 cm) to 85.3 cm (95% CI 79.1 to 96.2 cm; P = 0.026). Self-reported physical activity levels increased from 1557.5 MET-minutes (range: 245.0 to 5355.0 MET-minutes) to 3363.2 MET-minutes (range: 105.0 to 12,360.0 MET-minutes; P < 0.001). Active+me was acceptable to patients and healthcare professionals. CONCLUSION: Participation in standard CR, with Active+me, is associated with increased patient skill, knowledge, and confidence to manage their condition. Active+me may be an appropriate platform to support CR delivery when patients cannot be seen face-to-face. TRIAL REGISTRATION: As this was not a clinical trial, the study was not registered in a trial registry.


Subject(s)
COVID-19 , Cardiac Rehabilitation , Aged , Female , Humans , Male , Middle Aged , Pandemics , Patient Participation , SARS-CoV-2
3.
Rev Port Cardiol (Engl Ed) ; 40(12): 957-964, 2021 12.
Article in English | MEDLINE | ID: covidwho-1586735

ABSTRACT

INTRODUCTION AND OBJECTIVES: During the COVID-19 pandemic, among the safety measures adopted, use of facemasks during exercise training sessions in cardiac rehabilitation programs raised concerns regarding possible detrimental effects on exercise capacity. Our study examined the cardiorespiratory impact of wearing two types of the most common facemasks during treadmill aerobic training. METHODS: Twelve healthy health professionals completed three trials of a symptom-limited Bruce treadmill protocol: Without a mask, with a surgical mask and with a respirator. Perceived exertion and dyspnea were evaluated with the Borg Scale of Perceived Exertion and the Borg Dyspnea Scale, respectively. Blood pressure, heart rate and arterial oxygen saturation (SpO2) were measured at each 3-minute stage. RESULTS: Using a surgical mask or a respirator resulted in a shorter duration of exercise testing. At peak capacity, using a respirator resulted in higher levels of dyspnea and perceived exertion compared to not wearing a facemask. A significant drop in SpO2 was present at the end of exercise testing only when using a respirator. There were no differences in either chronotropic or blood pressure responses between testing conditions. CONCLUSIONS: Professionals involved in cardiac rehabilitation should be aware of the cardiorespiratory impact of facemasks. Future studies should assess whether exposure to these conditions may impact on the overall results of contemporary cardiac rehabilitation programs.


Subject(s)
COVID-19 , Cardiac Rehabilitation , Exercise , Humans , Masks , Pandemics , SARS-CoV-2
4.
Int J Environ Res Public Health ; 18(24)2021 12 12.
Article in English | MEDLINE | ID: covidwho-1572468

ABSTRACT

Cardiovascular rehabilitation (CR) is an effective secondary preventive model of care. However, the use of CR is insufficient, and the reasons for this are not well-characterized in East-Central Europe. This prospective observational study psychometrically validated the recently translated Cardiac Rehabilitation Barriers Scale for the Czech language (CRBS-CZE) and identified the main CR barriers. Consecutive cardiac in/out-patients were approached from January 2020 for 18 months, of whom 186 (89.9%) consented. In addition to sociodemographic characteristics, participants completed the 21-item CRBS-CZE (response options 1-5, with higher scores representing greater barriers), and their CR utilization was tracked. Forty-five (24.2%) participants enrolled in CR, of whom 42 completed the CRBS a second time thereafter. Factor analysis revealed four factors, consistent with other CRBS translations. Internal reliability was acceptable for all but one factor (Cronbach's alpha range = 0.44-0.77). Mean total barrier scores were significantly higher in non-enrollers (p < 0.001), decreased from first and second administration in these enrollers (p < 0.001), and were lower in CR completers (p < 0.001), supporting criterion validity. There were also significant differences in barrier scores by education, geography, tobacco use, among other variables, further supporting validity. The biggest barriers to enrolment were distance, work responsibilities, lack of time, transportation problems, and comorbidities; and the greatest barriers to adherence were distance and travel. Several items were considered irrelevant at first and second administration. Other barriers included wearing a mask during the COVID-19 pandemic. The study demonstrated sufficient validity and reliability of CRBS-CZE, which supports its use in future research.


Subject(s)
COVID-19 , Cardiac Rehabilitation , Czech Republic , Europe , Humans , Pandemics , Psychometrics , Reproducibility of Results , SARS-CoV-2 , Surveys and Questionnaires
5.
Gac Med Mex ; 156(6): 559-569, 2020.
Article in English | MEDLINE | ID: covidwho-1503050

ABSTRACT

INTRODUCTION: Mexico has the highest 30-day mortality due to acute myocardial infarction (AMI), which constitutes one of the main causes of mortality in the country: 28 % versus 7.5 % on average for the Organization for Economic Co-operation and Development member countries. OBJECTIVE: To establish critical pathways and essential interinstitutional pharmacological strategies for the care of patients with AMI in Mexico, regardless of their socioeconomic status. METHOD: A group of experts in AMI diagnosis and treatment, representatives of the main public health institutions in Mexico, as well as the Mexican cardiology societies, the Mexican Red Cross and representatives of the Spanish Society of Cardiology, were brought together in order to optimize strategies based on the best existing evidence. RESULTS: An interinstitutional clinical practice guideline was designed for early diagnosis and timely treatment of AMI with ST-segment elevation, following the clinical horizon of the disease, with the proposal of algorithms that improve the prognosis of patients who attend the emergency services due to an AMI. CONCLUSION: With these clinical practice guidelines, the group of experts proposes to universalize AMI diagnosis and treatment, regardless of patient socioeconomic status. INTRODUCCIÓN: México tiene la mortalidad más alta a 30 días por infarto agudo de miocardio (IAM), el cual constituye una de las principales causas de mortalidad en el país: 28 % versus 7.5 % del promedio de los países de la Organización para la Cooperación y el Desarrollo Económicos. OBJETIVO: Establecer las rutas críticas y las estrategias farmacológicas esenciales interinstitucionales para la atención de los pacientes con IAM en México, independientemente de su condición socioeconómica. MÉTODO: Se reunió a un grupo de expertos en diagnóstico y tratamiento de IAM, representantes de las principales instituciones públicas de salud de México, así como las sociedades cardiológicas mexicanas, Cruz Roja Mexicana y representantes de la Sociedad Española de Cardiología con la finalidad de optimizar las estrategias con base en la mejor evidencia existente. RESULTADOS: Se diseñó una guía de práctica clínica interinstitucional para el diagnóstico temprano y tratamiento oportuno del IAM con elevación del segmento ST, siguiendo el horizonte clínico de la enfermedad, con la propuesta de algoritmos que mejoren el pronóstico de los pacientes que acuden por IAM a los servicios de urgencias. CONCLUSIÓN: Con la presente guía práctica, el grupo de expertos propone universalizar el diagnóstico y tratamiento en el IAM, independientemente de la condición socioeconómica del paciente.


Subject(s)
Consensus , ST Elevation Myocardial Infarction/diagnosis , Biomarkers/blood , COVID-19/prevention & control , Cardiac Rehabilitation , Cause of Death , Electrocardiography , Humans , Mexico , Myocardial Reperfusion/methods , Percutaneous Coronary Intervention/methods , ST Elevation Myocardial Infarction/blood , ST Elevation Myocardial Infarction/rehabilitation , Societies, Medical , Spain , Thrombolytic Therapy/methods
7.
Eur Heart J ; 42(15): 1451-1453, 2021 04 14.
Article in English | MEDLINE | ID: covidwho-1467313
8.
BMJ Open ; 11(4): e047134, 2021 04 13.
Article in English | MEDLINE | ID: covidwho-1455715

ABSTRACT

BACKGROUND: Cardiac rehabilitation (CR) decreases the morbidity and mortality risk among patients with cardiac diseases; however, the impact of CR on patients with diabetes remains underexplored. This is a protocol for a systematic review and meta-analysis methodology to explore if the effect of CR on mortality and morbidity is the same in patients with type 2 diabetes compared with patients without diabetes. METHODS AND ANALYSIS: Interventional and non-interventional studies comparing the effect of CR, for at least 1 month, on all-cause mortality and cardiovascular outcomes including fatal and non-fatal myocardial infarction, revascularisation and rehospitalisation in adults with cardiac diseases will be deemed eligible for inclusion. Studies published between 1990 and 2020 will be searched in PubMed, Embase, Cochrane, CINAHL, Scopus and in registries for randomised controlled trials. Eligible studies will be selected using the Covidence software, and their salient details regarding the design, population, tested interventions and outcomes of interest will be gathered. The quality of studies to be deemed eligible and reviewed will be assessed using the Cochrane Collaboration and National Heart, Lung, and Blood Institute's tools. The appraisal process will be based on the study design (interventional and non-interventional). In the meta-analysis step, the pooled effect of CR on the outcomes will be estimated. All meta-analyses will be done using the random-effects model approach (inverse-variance method). I 2 and p value of χ2 statistics will guide the heterogeneity assessment. Subgroup analyses will also be performed. The small study effect will be investigated by generating the funnel plots. The symmetry of the latter will be tested by performing Egger's test. ETHICS AND DISSEMINATION: The systematic review will use data from published literature; hence, no ethical approval will be required. Findings of the systematic review and meta-analysis will be published in peer-reviewed international journals and will be disseminated in local and international scientific meetings. PROSPERO REGISTRATION NUMBER: CRD42020148832.


Subject(s)
Cardiac Rehabilitation , Diabetes Mellitus, Type 2 , Myocardial Infarction , Adult , Humans , Meta-Analysis as Topic , Morbidity , Research Design , Systematic Reviews as Topic
9.
Circ Cardiovasc Qual Outcomes ; 14(10): e008215, 2021 10.
Article in English | MEDLINE | ID: covidwho-1443688

ABSTRACT

This article describes the October 2020 proceedings of the Million Hearts Cardiac Rehabilitation Think Tank: Accelerating New Care Models, convened with representatives from professional organizations, cardiac rehabilitation (CR) programs, academic institutions, federal agencies, payers, and patient representative groups. As CR delivery evolves, terminology is evolving to reflect not where activities occur (eg, center, home) but how CR is delivered: in-person synchronous, synchronous with real-time audiovisual communication (virtual), or asynchronous (remote). Patients and CR staff may interact through ≥1 delivery modes. Though new models may change how CR is delivered and who can access CR, new models should not change what is delivered-a multidisciplinary program addressing CR core components. During the coronavirus disease 2019 (COVID-19) public health emergency, Medicare issued waivers to allow virtual CR; it is unclear whether these waivers will become permanent policy post-public health emergency. Given CR underuse and disparities in delivery, new models must equitably address patient and health system contributors to disparities. Strategies for implementing new CR care models address safety, exercise prescription, monitoring, and education. The available evidence supports the efficacy and safety of new CR care models. Still, additional research should study diverse populations, impact on patient-centered outcomes, effect on long-term outcomes and health care utilization, and implementation in diverse settings. CR is evolving to include in-person synchronous, virtual, and remote modes of delivery; there is significant enthusiasm for implementing new care models and learning how new care models can broaden access to CR, improve patient outcomes, and address health inequities.


Subject(s)
COVID-19 , Cardiac Rehabilitation , Aged , Exercise Therapy , Humans , Medicare , SARS-CoV-2 , United States
10.
11.
J Cardiopulm Rehabil Prev ; 41(2): 88-92, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1406511

ABSTRACT

The unprecedented nature of the COVID-19 pandemic has challenged how and whether patients with heart disease are able to safely access center-based exercise training and cardiac rehabilitation (CR). This commentary provides an experience-based overview of how one health system quickly developed and applied inclusive policies to allow patients to have safe and effective access to exercise-based CR.


Subject(s)
COVID-19/epidemiology , Cardiac Rehabilitation/methods , Exercise Therapy/methods , Heart Failure/rehabilitation , Home Care Services/organization & administration , Pandemics , Comorbidity , Heart Failure/epidemiology , Humans , SARS-CoV-2
12.
Phys Med Rehabil Clin N Am ; 32(2): 263-276, 2021 05.
Article in English | MEDLINE | ID: covidwho-1392486

ABSTRACT

Cardiopulmonary telerehabilitation is a safe and effective alternative to traditional center-based rehabilitation. It offers a sustainable solution to more conveniently meet the needs of patients with acute or chronic, preexisting or newly acquired, cardiopulmonary diseases. To maximize success, programs should prioritize basic, safe, and timely care options over comprehensive or complex approaches. The future should incorporate new strategies learned during a global pandemic and harness the power of information and communication technology to provide evidence-based patient-centered care. This review highlights clinical considerations, current evidence, recommendations, and future directions of cardiopulmonary telerehabilitation.


Subject(s)
Cardiac Rehabilitation/methods , Health Services Accessibility , Respiratory Therapy/methods , Telerehabilitation/methods , COVID-19/epidemiology , Cardiac Rehabilitation/economics , Humans , Pandemics , Respiratory Therapy/economics , SARS-CoV-2 , Telerehabilitation/economics , United States/epidemiology
13.
J Cardiopulm Rehabil Prev ; 41(5): 308-314, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1377990

ABSTRACT

PURPOSE: Provision of phase 2 cardiac rehabilitation (CR) has been directly impacted by coronavirus disease-19 (COVID-19). Economic analyses to date have not identified the financial implications of pandemic-related changes to CR. The aim of this study was to compare the costs and reimbursements of CR between two periods: (1) pre-COVID-19 and (2) during the COVID-19 pandemic. METHODS: Health care costs of providing CR were calculated using a microcosting approach. Unit costs of CR were based on staff time, consumables, and overhead costs. Reimbursement rates were derived from commercial and public health insurance. The mean cost and reimbursement/participant were calculated. Staff and participant COVID-19 infections were also examined. RESULTS: The mean number of CR participants enrolled/mo declined during the pandemic (-10%; 33.8 ± 2.0 vs 30.5 ± 3.2, P = .39), the mean cost/participant increased marginally (+13%; $2897 ± $131 vs $3265 ± $149, P = .09), and the mean reimbursement/participant decreased slightly (-4%; $2959 ± $224 vs $2844 ± $181, P = .70). However, these differences did not reach statistical significance. The pre-COVID mean operating surplus/participant ($62 ± $140) eroded into a deficit of -$421 ± $170/participant during the pandemic. No known COVID-19 infections occurred among the 183 participants and 14 on-site staff members during the pandemic period. CONCLUSIONS: COVID-19-related safety protocols required CR programs to modify service delivery. Results demonstrate that it was possible to safely maintain this critically important service; however, CR program costs exceeded revenues. The challenge going forward is to optimize CR service delivery to increase participation and achieve financial solvency.


Subject(s)
COVID-19 , Cardiac Rehabilitation , Health Care Costs , Aged , Cardiac Rehabilitation/economics , Female , Humans , Male , Middle Aged , Pandemics , Patient Safety , SARS-CoV-2
14.
Int J Environ Res Public Health ; 18(16)2021 08 14.
Article in English | MEDLINE | ID: covidwho-1376820

ABSTRACT

Cardiac rehabilitation (CR) remains underutilised, despite its established clinical benefit. A personality traits assessment may help promote CR implementation, as they are determinants of health-related behaviour. This study aimed to examine the association between the Big Five personality traits and outpatient CR participation in patients with cardiovascular disease (CVD) after discharge. This retrospective cohort study included 163 patients aged <80 years, who underwent inpatient CR when hospitalised for CVD. The Big Five personality traits (conscientiousness, neuroticism, openness, extraversion, and agreeableness) of each patient were evaluated at discharge, using the Japanese version of the Ten-Item Personality Inventory. We examined the relationship of each personality trait with non-participation in outpatient CR and dropout within three months, using logistic regression analysis. Out of 61 patients who initiated the outpatient CR, 29 patients dropped out, leaving us with 32 subjects. The logistic regression analysis results showed that high conscientiousness was associated with non-participation in CR. The primary reason for this was a lack of motivation. Conversely, low conscientiousness and high openness were predictors of dropout. This study suggests that the assessment of the Big Five personality traits, especially conscientiousness and openness, can help improve health communication with patients to promote outpatient CR participation after discharge.


Subject(s)
Cardiac Rehabilitation , Cardiovascular Diseases , Cardiovascular Diseases/epidemiology , Humans , Japan , Personality , Personality Inventory , Retrospective Studies
15.
Z Evid Fortbild Qual Gesundhwes ; 164: 11-14, 2021 Aug.
Article in German | MEDLINE | ID: covidwho-1371549

ABSTRACT

BACKGROUND: In Germany, the COVID-19 pandemic has significantly changed cardiological care in both the outpatient and inpatient setting, including the cancellation of elective interventions. The investigation presented here was carried out in order to obtain information on the extent to which this also applies to cardiac rehabilitation facilities. METHODS: In August 2020, all 107 member institutions of the DGPR were contacted and asked to take part in an online survey containing 12 sets of questions on the topic. RESULTS: At the end of August, data were available from 45 institutions. 31.1 % of the institutions provided rehabilitation services for patients with cardiac complications/manifestations of COVID-19 disease, mainly after acute coronary syndrome (29.6 %) and pulmonary artery embolism (25.9 %). More than 40 % of the facilities were required to close down partially or completely, and 14 % feared a partial or complete closure by the end of 2020. The costs for testing, if SARS-CoV-2 infection was suspected (72.1 %), were mainly borne by the rehabilitation facilities. CONCLUSIONS: Despite the limitations of a short-term data collection and a response rate of approx. 45 %, the present study gives indications of the challenging situation of the COVID-19 pandemic for cardiological rehabilitation facilities in Germany.


Subject(s)
COVID-19 , Cardiac Rehabilitation , Germany , Humans , Pandemics/prevention & control , SARS-CoV-2
17.
Glob Heart ; 16(1): 43, 2021 06 10.
Article in English | MEDLINE | ID: covidwho-1285506

ABSTRACT

Background: We investigated impacts of COVID-19 on cardiac rehabilitation (CR) delivery around the globe, including virtual delivery, as well as effects on providers and patients. Methods: In this cross-sectional study, a piloted survey was administered to CR programs globally via REDCap from April to June 2020. The 50 members of the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) and personal contacts facilitated program identification. Results: Overall, 1062 (18.3% program response rate) responses were received from 70/111 (63.1% country response rate) countries in the world with existent CR programs. Of these, 367 (49.1%) programs reported they had stopped CR delivery, and 203 (27.1%) stopped temporarily (mean = 8.3 ± 2.8 weeks). Alternative models were delivered in 322 (39.7%) programs, primarily through low-tech modes (n = 226,19.3%). Furthermore, 353 (30.2%) respondents were re-deployed, and 276 (37.3%) felt the need to work due to fear of losing their job, despite the perceived risk of contracting COVID-19 (mean = 30.0% ± 27.4/100). Also, 266 (22.5%) reported anxiety, 241(20.4%) were concerned about exposing their family, 113 (9.7%) reported increased workload to transition to remote delivery, and 105 (9.0%) were juggling caregiving responsibilities during business hours. Patients were often contacting staff regarding grocery shopping for heart-healthy foods (n = 333, 28.4%), how to use technology to interact with the program (n = 329, 27.9%), having to stop their exercise because they have no place to exercise (n = 303, 25.7%), and their risk of death from COVID-19 due to pre-existing cardiovascular disease (n = 249, 21.2%). Respondents perceived staff (n = 488, 41.3%) and patient (n = 453, 38.6%) personal protective equipment, as well as COVID-19 screening (n = 414, 35.2%), and testing (n = 411, 35.0%) as paramount to in-person service resumption. Conclusion: Given the estimated number of CR programs globally, these results suggest approximately 4400 CR programs globally have ceased or temporarily stopped service delivery. Those that remain open are implementing new technologies to ensure their patients receive CR safely, despite the challenges. Highlights: - COVID-19 has impacted cardiac rehabilitation (CR) delivery around the globe.- In this cross-sectional study, a survey was completed by 1062 (18.3%) CR programs from 70 (63.1%) countries.- The pandemic has resulted in at least temporary cessation of ~75% of CR programs, with others ceasing initiation of new patients, reducing components delivered, and/or changing of mode delivery with little opportunity for planning and training.- There is also significant psychosocial and economic impact on CR providers.- Alternative CR model (e.g., home-based, virtual) reimbursement advocacy is needed, to ensure safe, accessible secondary prevention delivery.


Subject(s)
Attitude of Health Personnel , COVID-19 , Cardiac Rehabilitation/methods , Delivery of Health Care/methods , Cross-Sectional Studies , Duration of Therapy , Global Health , Humans , Reimbursement Mechanisms , SARS-CoV-2 , Surveys and Questionnaires , Telerehabilitation/methods
18.
Open Heart ; 8(1)2021 06.
Article in English | MEDLINE | ID: covidwho-1263930

ABSTRACT

OBJECTIVES: This meta-analysis aims to (1) evaluate the efficacy of physical activity interventions in heart failure and (2) to identify intervention characteristics significantly associated with the interventions' efficacy. METHODS: Randomised controlled trials reporting intervention effects on physical activity in heart failure were combined in a meta-analysis using a random-effect model. Exploratory meta-analysis was performed by specifying the general approach (eg, cardiac rehabilitation), strategies used (eg, action planning), setting (eg, centre based), mode of delivery (eg, face to face or online), facilitator (eg, nurse), contact time and behavioural change theory use as predictors in the random-effect model. RESULTS: Interventions (n=21) had a significant overall effect (SMD=0.54, 95% CI (0.13 to 0.95), p<0.0005). Combining an exercise programme with behavioural change intervention was found efficacious (SMD=1.26, 95% CI (0.26 to 2.26), p<0.05). Centre-based (SMD=0.98, 95% CI (0.35 to 1.62), and group-based (SMD=0.89, 95% CI (0.29 to 1.50),) delivery by a physiotherapist (SMD=0.84, 95% CI (0.03 to 1.65),) were significantly associated with efficacy. The following strategies were identified efficacious: prompts/cues (SMD=3.29, 95% CI (1.97 to 4.62)), credible source (standardised mean difference, SMD=2.08, 95% CI (0.95;3.22)), adding objects to the environment (SMD=1.47, 95% CI (0.41 to 2.53)), generalisation of the target behaviour SMD=1.32, 95% CI (0.22 to 2.41)), monitoring of behaviour by others without feedback (SMD=1.02, 95% CI (0.05 to 1.98)), self-monitoring of outcome(s) of behaviour (SMD=0.79, 95% CI (0.06 to 1.52), graded tasks (SMD=0.73, 95% CI (0.22 to 1.24)), behavioural practice/rehearsal (SMD=0.72, 95% CI (0.26 to 1.18)), action planning (SMD=0.62, 95% CI (0.03 to 1.21)) and goal setting (behaviour) (SMD=0.56, 95% CI (0.03 to 1.08)). CONCLUSION: The meta-analysis suggests intervention characteristics that may be suitable for promoting physical activity in heart failure. There is moderate evidence in support of an exercise programme combined with a behavioural change intervention delivered by a physiotherapist in a group-based and centre-based settings. PROSPERO REGISTERATION: CRD42015015280.


Subject(s)
Behavior Therapy/methods , Cardiac Rehabilitation/methods , Exercise/physiology , Heart Failure/rehabilitation , Heart Failure/physiopathology , Humans , Treatment Outcome
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