Congestive heart failure (CHF) is the end stage of many diseases of the heart and a major cause of morbidity and mortality. The incidence of CHF is increasing steadily as treatment for its coronary antecedents, such as myocardial infarction, advances. Treatment of CHF generally relies on a battery of pharmacological interventions, alongside exercise and diet regimens. It is only in recent years that the psychological impact of heart failure has been explored, which is reflected by the absence of standardized psychological assessment for patients with CHF. In this article, we review studies that have addressed the effects of depression, anxiety, coping style, and level of social support in CHF. From the available evidence, it appears that patients generally experience moderate levels of depression, but not greatly heightened anxiety. Level of social support and style of coping with the disease are, however, important prognostic factors. It is difficult to draw definitive conclusions owing to the paucity of literature. Further work examining this issue is needed if the psychological issues of heart failure are not to be neglected.

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Psychological Factors in Heart Failure: A Review of the Literature

The purpose of this investigation was to test the effectiveness of an adherence facilitation intervention consisting of goal setting, graphic feedback, and provider guidance to support adherence to home exercise in a sample of patients with heart failure who had completed a supervised exercise program. The sample consisted of 13 patients with an ejection fraction of 40% or less who were randomly assigned to either the exercise only group (n=6) or the exercise with adherence facilitation group (n=7). The format of the intervention was graphic depiction of each patient's exercise goals in comparison to each patient's exercise participation. Graphs were mailed at 3-week intervals for 12 weeks. Results indicate that patients who received the intervention demonstrated higher exercise adherence and greater confidence in continuing to exercise in the future. The adherence facilitation intervention may be helpful to heart failure patients in adapting to a program of home exercise. (c)2002 CHF, Inc.

Staying on course: the effects of an adherence facilitation intervention on home exercise participation.

Background: Self-efficacy is a person's confidence in being able to successfully perform a specific activity or behavior. Self-efficacy has been shown to influence exercise capacity in patients pos...

Effect of treadmill testing and exercise training on self-efficacy in patients with heart failure.

Aim. To explore the conceptual underpinnings of self-efficacy to address the barriers to participating in physical activity and propose a model of intervention.

Background.  The benefits of physical activity in reducing cardiovascular risk have led to evidence-based recommendations for patients with heart disease, including those with chronic heart failure. However, adherence to best practice recommendations is often suboptimal, particularly in those individuals who experience high symptom burden and feel less confident to undertake physical activity. Self-efficacy is the degree of confidence an individual has in his/her ability to perform behaviour under several specific circumstances. Four factors influence an individual’s level of self-efficacy: (1) past performance, (2) vicarious experience, (3) verbal persuasion and (4) physiological arousal.

Design.  Discursive.

Methods.  Using the method of a discursive paper, this article seeks to explore the conceptual underpinnings of self-efficacy to address the barriers to participating in physical activity and proposes a model of intervention, the Home-Heart-Walk, to promote physical activity and monitor functional status.

Conclusions.  Implementing effective interventions to promote physical activities require appreciation of factors impacting on behaviour change. Addressing concepts relating to self-efficacy in physical activity interventions may promote participation and adherence in the longer term.

Relevance to clinical practice.  The increasing burden of chronic disease and the emphasis on self-management strategies underscore the importance of promoting adherence to recommendations, such as physical activity.

Self-efficacy: a useful construct to promote physical activity in people with stable chronic heart failure

It is widely accepted that physical activity is important for physical functioning and well-being, and as such the promotion of active lifestyles is becoming increasingly significant in public health policy both in the UK and worldwide. Sedentary lifestyles have been associated with increased risk of obesity and preventable disease including diabetes, coronary heart disease and some cancers. With regards cancer specifically, this chapter will provide a brief overview on current opinions on the link between physical activity and cancer prevention. 
The published evidence focuses both on primary and secondary prevention. More recent evidence has investigated the use of physical activity in secondary prevention for those who have been diagnosed with cancer and proposed a link between physical activity, morbidity and mortality in those with cancer. The evidence-base for secondary prevention is more limited. Nevertheless, studies to date have indicated that physical activity can improve both physical functioning and psychological outcomes in cancer survivors, and significantly improve quality of life. 
The exact nature of those interventions which confer the most positive effects is less well-established, and there is a current lack of consensus on the most appropriate type, intensity and duration of activity for people with cancer. It has not yet been well established as to which stage of the treatment programme physical activity should be encouraged (during or following treatment) or the most appropriate length of time during which structured physical activity interventions should be delivered to achieve beneficial results. 
These factors will be discussed in this chapter, and barriers to engaging in physical activity for those with a diagnosis of cancer will be considered. The chapter will conclude with a summary of key findings and the potential for further research.

Physical activity and cancer

Increasing self-efficacy is not a state that develops quickly. It is unrealistic to expect that the factors contributing to illness and disability will be modified easily. The home care nurse can positively influence self-efficacy expectations in the heart failure population by creating a supportive environment to perform physical activities (performance mastery), assisting with encouragement and support (verbal persuasion), providing anticipatory guidance and sharing how others perform (vicarious experience), and providing a realistic assessment of a person's abilities (physiologic state). By enhancing self-efficacy, the home care nurse can increase physical activity levels in this population, leading to decreased symptomatology and improved quality of life.

Judith M. Borsody

Papers

Using self-efficacy to increase physical activity in patients with heart failure.