Effects of exercise training on motivation in patients with heart failure with preserved ejection fraction: Results from the randomized controlled Ex-DHF trial

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research Pub Date : 2025-08-06 DOI:10.1016/j.jpsychores.2025.112344

Monika Sadlonova , Christopher M. Celano , Jeff Huffman , Malte Jetzke , Carlotta Derad , Daniel Broschmann , Anna Feuerstein , Gerd Hasenfuss , Kathleen Nolte , Burkert Pieske , Stephan Mueller , Martin Halle , Frank Edelmann , Rolf Wachter , Christoph Herrmann-Lingen

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Abstract

Background

Heart failure (HF) is a global public health issue. Over 50 % of symptomatic HF patients have HF with preserved ejection fraction (HFpEF), but to date, few pharmacotherapy treatments have been shown to improve morbidity and mortality in patients with HFpEF. Exercise training (ET) is an important component in the management of HFpEF since it improves exercise capacity, quality of life, and reduces HF hospitalizations. However, low motivation is a common barrier to adherence to ET.

Methods

In this secondary analysis of the Ex-DHF trial, we investigated whether a 12-month, structured, supervised ET intervention in HFpEF patients increases overall motivation, self-determined (intrinsic and identified) motivation, and non-self-determined (extrinsic and introjected) motivation, measured using the German Scale for Self-concordance of Sport- and Exercise-related Goals (SSK), compared to usual care (UC).

Results

We enrolled 322 participants (mean age 69.6 ± 7.3 years; 59.6 % women). ET was associated with significant improvements in overall motivation at 12 months (B = 0.78, 95 % CI 0.14–1.42, p = 0.017) compared with UC. Furthermore, ET led to significant increases in intrinsic (B = 0.57; 95 % CI 0.29–0.85, p < 0.001) and identified motivation (B = 0.47, 95 % CI 0.21–0.73, p < 0.001) at 12 months compared with UC, with no between-group differences in extrinsic or introjected motivation.

Conclusions

A 12-month ET intervention led to a significant increase in motivation in patients with HFpEF, with specific increases in self-determined motivation (intrinsic and identified). Given the key role of motivation in health behaviors, especially self-determined motivation types, supervised ET may have the potential to impact long-term adherence to ET in patients with HFpEF.

Trial registration

Ethics approval for this study was obtained from the Regional Committees for Medical Research Ethics of the Charité Medical Center Berlin, University Medical Center Göttingen, University of Würzburg, University of Leipzig Medical Center, and Technical University München. The study was registered after approval by the ethics committee at http://www.isrctn.com, on August 23, 2011. The registration number is ISRCTN86879094.

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运动训练对保留射血分数的心力衰竭患者动机的影响：来自随机对照Ex-DHF试验的结果

心衰（HF）是一个全球性的公共卫生问题。超过50%的症状性HF患者有保留射血分数（HFpEF）的HF，但迄今为止，很少有药物治疗被证明可以改善HFpEF患者的发病率和死亡率。运动训练（ET）是HFpEF管理的重要组成部分，因为它可以提高运动能力，提高生活质量，减少HF住院治疗。方法在对Ex-DHF试验的二次分析中，我们调查了在HFpEF患者中进行为期12个月的结构化、监督的ET干预是否增加了总体动机、自我决定（内在的和确定的）动机和非自我决定（外在的和内源性的）动机，使用德国运动和运动相关目标自我一致性量表（SSK）测量，与常规护理（UC）相比。结果共入组322例，平均年龄69.6±7.3岁；女性占59.6%)。与UC相比，ET与12个月时整体动机的显著改善相关（B = 0.78, 95% CI 0.14-1.42, p = 0.017）。此外，ET显著增加了内蕴(B = 0.57；95% CI 0.29-0.85, p <；0.001)和确定的动机(B = 0.47, 95% CI 0.21-0.73, p <；0.001)，与UC相比，在12个月时，外在或内在动机没有组间差异。结论：12个月的ET干预导致HFpEF患者的动机显著增加，特别是自我决定的动机（内在的和识别的）增加。鉴于动机在健康行为中的关键作用，尤其是自我决定的动机类型，有监督的ET可能会影响HFpEF患者对ET的长期依从性。试验注册本研究获得了柏林慈善医学中心、大学医学中心Göttingen、维尔茨堡大学、莱比锡大学医学中心和慕尼黑工业大学医学研究伦理区域委员会的伦理批准。该研究经伦理委员会批准，于2011年8月23日在http://www.isrctn.com上注册。注册号为ISRCTN86879094。

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来源期刊

Journal of Psychosomatic Research 医学-精神病学

CiteScore

7.40

自引率

6.40%

发文量

314

审稿时长

6.2 weeks

期刊介绍： The Journal of Psychosomatic Research is a multidisciplinary research journal covering all aspects of the relationships between psychology and medicine. The scope is broad and ranges from basic human biological and psychological research to evaluations of treatment and services. Papers will normally be concerned with illness or patients rather than studies of healthy populations. Studies concerning special populations, such as the elderly and children and adolescents, are welcome. In addition to peer-reviewed original papers, the journal publishes editorials, reviews, and other papers related to the journal''s aims.