HEART Camp Connect—Promoting adherence to exercise in adults with heart failure with preserved ejection fraction

IF 3.7 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

ESC Heart Failure Pub Date : 2025-06-18 DOI:10.1002/ehf2.15341

Windy W. Alonso, Sara E. Bills, Scott W. Lundgren, Steven J. Keteyian, Joseph Norman, Alfred L. Fisher, Cheng Zheng, Kevin A. Kupzyk, Fernando A. Wilson, Tiffany J. Dudley, Bunny J. Pozehl

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Abstract

Aims

Most adults with stable heart failure are safe to exercise at a moderate intensity for 150 min/week. Regular participation in exercise may improve outcomes in adults with heart failure with preserved ejection fraction (HFpEF). Few adults with HFpEF initiate and sustain long-term exercise. To promote exercise adherence in adults with HFpEF, we developed the Heart Failure Exercise and Resistance Training (HEART) Camp Connect intervention that is tested in this clinical trial. This trial tests our central hypothesis that theory-informed coaching strategies delivered virtually will promote long-term adherence to exercise in adults with HFpEF and drive clinically meaningful, and cost-effective improvements in physiological and patient-reported outcomes. Our aims are to (a) evaluate the effects of virtual and in-person exercise and coaching on long-term adherence, (b) determine a benchmark of minutes of moderate intensity exercise associated with health status as related to key biobehavioural outcomes, (c) examine behaviour change theory-defined constructs as mediators of exercise adherence and (d) evaluate intervention costs.

Methods

This 18 month, three-group, repeated measures randomized controlled trial is enrolling 300 adults with HFpEF. Participants are randomized to enhanced usual care (EUC), virtual coaching, or in-person coaching. Our intervention applies coaching strategies, informed by behaviour change theories, in one-on-one and group settings weekly for 12 months. Our objective is to compare the effects of each delivery method to the other and EUC on exercise adherence (defined as ≥ 120 min of moderate intensity exercise/week) at 12 months (primary endpoint) and 18 months (sustainability endpoint). Secondary outcomes include minutes of moderate intensity exercise needed to drive minimal clinically important differences in health status, biomarkers, patient-reported symptoms and cost. Behaviour change theory-defined constructs (e.g., self-efficacy and outcome expectations) will be tested as mediators of exercise adherence.

Results

We expect that virtual coaching is equally as efficacious and more cost effective at promoting exercise adherence as in-person coaching. Effects on exercise adherence may be mediated by theory-defined constructs. We also expect to identify a threshold for minutes of moderate intensity exercise to potentially serve as an adherence benchmark in adults with HFpEF, one that may differ from the 120 min of exercise in our current definition.

Conclusions

These findings could shift the paradigm of exercise coaching in HF towards virtual delivery and increase the generalizability and reach of exercise training. This is especially important for adults with HFpEF as they are excluded from Medicare reimbursement for traditional cardiopulmonary rehabilitation.

Abstract Image

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心脏营连接-促进坚持运动的成人心力衰竭保留射血分数。

目的：大多数患有稳定性心力衰竭的成年人每周进行150分钟中等强度的运动是安全的。定期参加运动可以改善成人心力衰竭伴射血分数（HFpEF）的预后。很少有患有HFpEF的成年人开始并维持长期运动。为了促进成人HFpEF患者的运动依从性，我们开发了心力衰竭运动和阻力训练（Heart）训练营连接干预措施，并在本临床试验中进行了测试。该试验验证了我们的中心假设，即基于理论的指导策略将促进HFpEF成人患者长期坚持锻炼，并在生理和患者报告的结果方面推动具有临床意义和成本效益的改善。我们的目标是(a)评估虚拟和面对面锻炼和指导对长期坚持的影响，(b)确定与关键生物行为结果相关的健康状况相关的中等强度锻炼分钟的基准，(c)检查行为改变理论定义的结构作为运动坚持的中介，以及(d)评估干预成本。方法：这项为期18个月、三组、重复测量的随机对照试验招募了300名成人HFpEF患者。参与者被随机分配到增强常规护理（EUC）、虚拟教练或面对面教练组。我们的干预采用指导策略，以行为改变理论为依据，每周一对一和小组设置，持续12个月。我们的目标是比较每种给药方法与其他给药方法以及EUC在12个月（主要终点）和18个月（可持续性终点）时对运动依从性（定义为≥120分钟中等强度运动/周）的影响。次要结果包括中等强度运动所需的分钟数，以在健康状况、生物标志物、患者报告的症状和成本方面产生最小的临床重要差异。行为改变理论定义的构念（例如，自我效能和结果预期）将作为运动坚持的中介进行测试。结果：我们期望虚拟教练在促进运动坚持方面与面对面教练同样有效，更具成本效益。对运动坚持的影响可能由理论定义的构念介导。我们还希望确定一个中等强度运动分钟的阈值，可能作为HFpEF成人患者的坚持基准，这可能与我们目前定义的120分钟运动不同。结论：这些发现可以将心力衰竭运动指导的范式转向虚拟交付，并增加运动训练的普遍性和覆盖面。这对于患有HFpEF的成年人尤其重要，因为他们被排除在传统心肺康复的医疗保险报销之外。

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来源期刊

ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine

CiteScore

7.00

自引率

7.90%

发文量

461

审稿时长

12 weeks

期刊介绍： ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.