City Research Online

Abstract

Heart failure (HF) is a complex clinical syndrome of symptoms and signs that suggest reduced efficiency with which the heart pumps blood around the body. HF is a prevalent condition worldwide and in the United Kingdom. The clinical outcomes of HF include mortality, morbidity, and reduced quality of life. Physical activity is beneficial to individuals with HF as it improves quality of life and reduces hospitalisation. However, its levels are exceptionally low in this population group. This suggests a need for supporting and encouraging behaviour change. The overall aim of this research is to extend understanding of how to promote physical activity among people with HF through systematic reviews and empirical research. Following the Medical Research Council guidance for developing complex interventions, first a meta-analysis of 16 randomised controlled trials evaluating physical activity was performed. The review identified a lack of understanding how best to increase physical activity in HF in older adults (>70 years old) who constitute the majority of the HF population. In Bayesian meta-analysis of 28 observational studies the existing evidence on the relevant clinical, demographic, and psychosocial barriers and enablers to physical activity in HF was summarised. The review identified contextual factors that need to be considered when conducting research and developing behaviour change interventions. These were age, depression, and comorbidity. However, less is known about the modifiable factors that can be addressed in an intervention. A qualitative study using semi-structured interviews (N = 16) based on the Theoretical Domains Framework formulated 78 belief statements describing the barriers and enablers. Theoretical domains containing these beliefs and corresponding constructs that were both pervasive and common were deemed most relevant. These were: concerns about physical activity (Beliefs about Consequences), self-efficacy (Beliefs about Capabilities), social support (Social Influences), major health event (Environmental Context and Resources), goal behavioural (Goal), action planning (Behavioural Regulation) and (Optimism). A scale assessing these constructs was developed. Finally, computational modelling helped in assessing plausibility and providing grounds for model comparison. A power analysis and feasibility assessment are reported based on the model and the obtained N=3 sample.

Publication Type:	Thesis (Doctoral)
Subjects:	Q Science > QP Physiology
Departments:	Doctoral Theses School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses School of Health & Psychological Sciences > Healthcare Services Research & Management

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