Adherence of Heart Failure Patients to Exercise
Adherence of Heart Failure Patients to Exercise
Exercise training is ideally prescribed according to the FITT acronym, which stands for frequency, intensity, time, and type. Frequency refers to the number of physical training sessions during a specific time period; intensity refers to the physiological effort associated with participation in a special type of exercise training; time refers to the duration of execution of a single exercise training session; and type indicates the exercise modality. Three different modalities are generally prescribed in HF patients, i.e. aerobic endurance (continuous and interval), strength/resistance training, and respiratory muscle. Therefore, assessment of adherence should include all the above-mentioned components (Table 1).
The assessment of patients' adherence differs depending on whether the exercise training programme is hospital (in- or outpatient setting) or home based.
Adherence can be assessed by subjective and/or objective methods. The subjective methods include physical activity questionnaires and diaries filled in by patients. Objective methods include the recording of data from pedometers, accelerometers, pulsometers (heart rate monitoring), and electrocardiogram (ECG) telemonitoring. The advantages and disadvantages of these different methods are presented in Table 2. In order to rule out definitely whether exercise training has a benefit on morbidity and mortality, adherence to prescribed exercise regimens, as well as physical activity performed in addition to the prescribed regimen (whether it concerns a training or a control group, where some form of physical activity is always advised as part of good medical practice in the follow-up of a cardiac patient) should be taken into account. Nevertheless, it is likely that adherence to exercise in daily practice is even more problematic compared with pharmacological therapy, where it is known to be quite poor, especially in a home-based, non-monitored setting. In the hospital-based setting, adherence can be directly monitored by the caring staff. Instead, in a home-based setting, different options have been envisaged: regular home visits by nurses, planned controls in a rehabilitation or specialized centre, or remote monitoring performed via the telephone, web, or by transmission of a report to a monitoring centre, can be considered.
How to Assess Adherence to Exercise
Exercise training is ideally prescribed according to the FITT acronym, which stands for frequency, intensity, time, and type. Frequency refers to the number of physical training sessions during a specific time period; intensity refers to the physiological effort associated with participation in a special type of exercise training; time refers to the duration of execution of a single exercise training session; and type indicates the exercise modality. Three different modalities are generally prescribed in HF patients, i.e. aerobic endurance (continuous and interval), strength/resistance training, and respiratory muscle. Therefore, assessment of adherence should include all the above-mentioned components (Table 1).
The assessment of patients' adherence differs depending on whether the exercise training programme is hospital (in- or outpatient setting) or home based.
Adherence can be assessed by subjective and/or objective methods. The subjective methods include physical activity questionnaires and diaries filled in by patients. Objective methods include the recording of data from pedometers, accelerometers, pulsometers (heart rate monitoring), and electrocardiogram (ECG) telemonitoring. The advantages and disadvantages of these different methods are presented in Table 2. In order to rule out definitely whether exercise training has a benefit on morbidity and mortality, adherence to prescribed exercise regimens, as well as physical activity performed in addition to the prescribed regimen (whether it concerns a training or a control group, where some form of physical activity is always advised as part of good medical practice in the follow-up of a cardiac patient) should be taken into account. Nevertheless, it is likely that adherence to exercise in daily practice is even more problematic compared with pharmacological therapy, where it is known to be quite poor, especially in a home-based, non-monitored setting. In the hospital-based setting, adherence can be directly monitored by the caring staff. Instead, in a home-based setting, different options have been envisaged: regular home visits by nurses, planned controls in a rehabilitation or specialized centre, or remote monitoring performed via the telephone, web, or by transmission of a report to a monitoring centre, can be considered.