A Combined Aerobic and Resistance Exercise Program Improves Physical Functional Performance in Patients With Heart Failure: A Pilot Study Effect of resistance training on physical disability in chronic heart failure. Impact of a home-based walking and resistance training program on quality of life in patients with heart failure. Effects of an exercise adherence intervention on outcomes in patients with heart failure. Combined aerobic and resistance exercise program improves task performance in patients with heart failure. Exercise Training for Heart Failure Patients with and without Systolic Dysfunction: An Evidence-Based Analysis of How Patients Benefit Quality of life in patients with chronic heart failure: a randomized controlled trial of changes induced by a regular exercise program. A randomized trial of the addition of home-based exercise to specialist heart failure nurse care: the Birmingham Rehabilitation Uptake Maximisation study for patients with Congestive Heart Failure (BRUM-CHF) study. Heart failure and a controlled trial investigating outcomes of exercise training (HF-ACTION): design and rationale. Physical Exercise Improves The Functional Capacity and Quality of Life in Patients With Heart Failure Study of adherence to exercise in heart failure: the HEART camp trial protocol A group-based exercise program did not improve physical activity in patients with chronic heart failure and comorbidity: a randomized controlled trial. A Novel Rehabilitation Intervention for Older Patients With Acute Decompensated Heart Failure: The REHAB-HF Pilot Study. Effect of exercise training on quality of life in patients with chronic heart failure. Maintaining physical fitness of patients with chronic heart failure: a randomized controlled trial High intensity, interval exercise improves quality of life of patients with chronic heart failure: a randomized controlled trial. Cognitive Function and Treatment Adherence in Older Adults With Heart Failure
Background : Recent guidelines for exercise in patients with heart failure ( HF ) recommended aerobic and resistance exercise as being safe and effective ; however , the clinical and functional significance of these combined training modalities has not been established . In this pilot study , combined aerobic and resistance training was hypothesized to improve physical function , muscle strength , and health-related quality of life ( HRQOL ) compared with an attention control wait list ( ACWL ) . Methods : The 10-item Continuous Scale Physical Functional Performance Test ( CS-PFP10 ) , which simulates common household chores ; muscle strength ( h and grip and knee extension ) ; and HRQOL ( Kansas City Cardiomyopathy Question naire ) were evaluated at baseline ( T1 ) and at 12 weeks ( T2 ) . The home-based moderate-intensity walking and resistance training program was performed 5 days a week . Results : Twenty-four New York Heart Association class II to III HF patients ( mean [ SD ] age , 60 [ 10 ] years ; mean [ SD ] left ventricular ejection fraction , 25 % [ 9 % ] ) were r and omized to a combined aerobic and resistance exercise program or to an ACWL group . Of the total group , 58 % were New York Heart Association class III HF patients , 50 % were white , and 50 % were female . The CS-PFP10 total scores were significantly increased in the exercise group , from 45 ( 18 ) to 56 ( 16 ) . The Kansas City Cardiomyopathy Question naire overall summary score was significantly improved ( P < .001 ) at T2 in the exercise intervention group compared with the ACWL group . Conclusions : Participants provided the home-based , combined aerobic and resistance exercise program had significantly improved physical function , muscle strength , symptom severity , and HRQOL compared with the ACWL group . The findings of this study must be interpreted cautiously owing to the limitations of a small sample , data collection from a single center , and differences between control and interventions groups at baseline . A combined aerobic and resistance exercise approach may improve physical function in stable HF patients , but further study in a larger , more diverse population is recommended . However , in this study , the CS-PFP10 instrument demonstrated its ability to identify functional health status in HF patients and thus warrants further testing in a larger sample for possible use in clinical practice PURPOSE Patients with chronic heart failure ( CHF ) report difficulty performing activities of daily living . To our knowledge , however , no study has directly measured performance in activities of daily living in these patients to systematic ally assess their level of physical disability . Moreover , the contribution of skeletal muscle weakness to physical disability in CHF remains unclear . Thus , we measured performance in activities of daily living in CHF patients and controls , its relationship to aerobic capacity and muscle strength , and the effect of resistance exercise training to improve muscle strength and physical disability . METHODS Patients and controls were assessed for performance in activities of daily living , self-reported physical function , peak aerobic capacity , body composition , and muscle strength before and after an 18-wk resistance training program . To remove the confounding effects of several disease-related factors ( muscle disuse , hospitalization , acute illness ) , we recruited controls with similar activity levels as CHF patients and tested patients > 6 months after any disease exacerbation/hospitalization . RESULTS Performance in activities of daily living was 30 % lower ( P < 0.05 ) in CHF patients versus controls and was related to both reduced aerobic capacity ( P < 0.001 ) and muscle strength ( P < 0.01 ) . Moreover , resistance training improved ( P < 0.05 to P < 0.001 ) physical function and muscle strength in patients and controls similarly , without altering aerobic capacity . CONCLUSIONS CHF patients are characterized by marked physical disability compared with age- and physical activity-matched controls , which is related to reduced aerobic capacity and muscle strength . CHF patients respond to resistance training with normal strength/functional adaptations . Our results support muscle weakness as a determinant of physical disability in CHF and show that interventions that increase muscle strength  ( resistance training ) reduce physical disability Patients with heart failure ( HF ) often have profound activity limitations and diminished quality of life ( QOL ) due to symptoms of dyspnea and fatigue . Although recent studies demonstrate positive physiologic and psychological benefits of low to moderate intensity , supervised , aerobic exercise training performed 3 to 5 days/ week for 20 to 40 minutes ' duration , in a monitored setting , the efficacy of a home-based exercise program combining endurance and resistance exercise on symptoms and QOL , are unknown . This r and omized controlled study examined the efficacy , safety , and adherence rates of a 3-month home-based combined walking and resistance exercise program on symptoms and QOL in 40 women and men aged 30 to 76 years with New York Heart Association class II to III HF . Baseline and 3-month evaluations consisted of a chronic HF question naire to assess symptoms and QOL and exercise capacity by symptom-limited treadmill exercise test with respiratory gas analysis . The exercise intervention improved fatigue ( p = 0.02 ) , emotional function ( p = 0.01 ) , and mastery ( p = 0.04 ) . Overall exercise adherence was excellent ( 90 % ) and there were no reported adverse events . A moderate intensity home-based combined walking and resistance program for patients with class II to III HF is safe and effective in reducing symptoms and improving QOL The purpose of this study was to determine how an exercise adherence intervention affects the physiological , functional , and quality of life outcomes of patients with heart failure ( HF ) . Sixteen HF patients were r and omly assigned to an  exercise-only group  ( n = 8) or to an  exercise-with-adherence group ( n = 8) . Two of the 16 people  died from nonexercise related causes during the study and were not included in the analysis . The intervention was tested over a 24-week period in which patients participated in a 12-week supervised exercise program ( Phase 1 ) followed by 12 weeks of unsupervised home exercise ( Phase 2 ) . The intervention format was one of individualized graphic feedback on exercise goals and participation and problem-solving support by nurses . Results indicate that patients who received the intervention exercised more frequently and experienced improved outcomes during both phases . The adherence intervention may encourage HF patients to continue to exercise and thereby maintain the health benefits gained in both phases of an exercise program OBJECTIVES To assess the effects of a home-based aerobic and resistance training program on the physical function of adults with New York Heart Association ( NYHA ) class II and III patients and systolic heart failure ( HF ) . DESIGN R and omized controlled trial . SETTING Home based . PARTICIPANTS Stable patients ( N=24 ; mean age , 60 ± 10 y ; left ventricular ejection fraction , 25 % ± 9 % ; 50 % white ; 50 % women ) with New York Heart Association ( NYHA ) classes II and III ( NYHA class III , 58 % ) systolic heart failure ( HF ) . INTERVENTION A 12-week progressive home-based program of moderate-intensity aerobic and resistance exercise . Attention control wait list participants performed light stretching and flexibility exercises . MAIN OUTCOME MEASURES A 10-item performance-based physical function measure , the Continuous Scale Physical Functional Performance test ( CS-PFP10 ) , was the major outcome variable and included specific physical activities measured in time to complete a task , weight carried during a task , and distance walked . Other measures included muscle strength , HRQOL ( Minnesota Living With Heart Failure Question naire , Epworth Sleepiness Scale ) , functional capacity ( Duke Activity Status Index ) , and disease severity ( brain natriuretic peptide ) levels . RESULTS After the exercise intervention , 9 of 10 specific task activities were performed more rapidly , with increased weight carried by exercise participants compared with the attention control wait list group . Exercise participants also showed significant improvements in CS-PFP10 total score ( P<.025 ) , upper and lower muscle strength , and HRQOL ( P<.001 ) compared with the attention control wait list group . Adherence rates were 83 % and 99 % for the aerobic and resistance training , respectively . CONCLUSIONS Patients with stable HF who participate in a moderate-intensity combined aerobic and resistance exercise program may improve performance of routine physical activities of daily living by using a home-based exercise approach . Performance-based measures such as the CS-PFP10 may provide additional insights into physical function in patients with HF that more commonly used exercise tests may not identify . Early detection of subtle changes that may signal declining physical function that are amenable to intervention potentially may slow further loss of function in this patient population Significant benefits can be derived by heart failure patients from exercise training . This paper provides an evidence -based assessment of expected clinical benefits of exercise training for heart failure patients . Meta-analyses and r and omized , controlled trials of exercise training in heart failure patients were review ed from a search of PubMed , Cochrane Controlled Trial Registry ( CCTR ) , CINAHL , and EMBASE . Exercise training improves functional capacity , quality of life , hospitalization , and systolic and diastolic function in heart failure patients . Heart failure patients with preserved systolic function ( HFnEF ) participating in exercise training studies are more likely to be women and are 5–7 years older than their systolic heart failure ( CHF ) counterparts . All patients exhibit low functional capacities , although in HFnEF patients this may be age related , therefore subtle differences in exercise prescriptions are required . Published works report that exercise training is beneficial for heart failure patients with and without systolic dysfunction The aim of this study was to evaluate the impact of a three-month exercise program on the perception of quality of life in patients with severe chronic heart failure . In a r and omized controlled setting , 27 patients with a left ventricular ejection fraction of 18.1 + /- 8.0 % were entered into the study . The training group performed aerobic exercises for three hours/week while the control group continued their usual activities of daily living .  Quality of life was measured using the German version of the MOS SF-36 . Two patients required a change in their drug regimen and were therefore withdrawn from the study . Twenty-five patients completed the study . In the exercise group the perception of quality of life improved significantly in the domains of vitality ( p = 0.0001 ) , physical role fulfillment ( p = 0.001 ) , physical ( p = 0.02 ) and social ( p = 0.0002 ) functioning . Exercise was effective in increasing peak oxygen uptake and exercise time ( p < 0.01 ) . Only weak correlations were registered between parameters of physical performance and quality of life domains . The results of the study indicate that aerobic exercise can improve the perception of quality of life in patients with severe chronic heart failure AIMS Supervised exercise can benefit selected patients with heart failure , however the effectiveness of home-based exercise remains uncertain . We aim ed to assess the effectiveness of a home-based exercise programme in addition to specialist heart failure nurse care . METHODS AND RESULTS This was a r and omized controlled trial of a home-based walking and resistance exercise programme plus specialist nurse care ( n=84 ) compared with  specialist nurse care alone ( n=85 ) in a heart failure population in the West Midl and s , UK . PRIMARY OUTCOME Minnesota Living with Heart Failure Question naire ( MLwHFQ ) at 6 and 12 months . SECONDARY OUTCOMES composite of death , hospital admission with heart failure or myocardial infa rct ion ; psychological well-being ; generic quality of life ( EQ-5D ) ; exercise capacity . There was no statistically significant difference between groups in the MLwHFQ at 6 month ( mean , 95 % CI ) ( -2.53 , -7.87 to 2.80 ) and 12 month ( -0.55 , -5.87 to 4.76 ) follow-up or secondary outcomes with the exception of a higher EQ-5D score ( 0.11 , 0.04 to 0.18 ) at 6 months and lower Hospital Anxiety and Depression Scale score ( -1.07 , -2.00 to -0.14 ) at 12 months , in favour of the exercise group . At 6 months , the control group showed deterioration in physical activity , exercise capacity , and generic quality of life . CONCLUSION Home-based exercise training programmes may not be appropriate for community-based heart failure patients BACKGROUND Although there are limited clinical data to support the use of exercise training as a means to reduce mortality and morbidity in patients with heart failure , current guidelines state that exercise is beneficial . TRIAL DESIGN The objective of this trial is to determine whether exercise training reduces all-cause mortality or all-cause hospitalization for patients with left ventricular systolic dysfunction and heart failure symptoms . After undergoing baseline assessment s to determine whether they can safely exercise , patients are r and omized to either usual care or exercise training . Patients in the exercise training arm attend 36 supervised facility-based exercise training sessions . Exercise modalities are cycling or walking . After completing 18 sessions , patients initiate home-based exercise and then transition to solely home-based exercise after completing all 36 sessions . Patients return for facility-based training every 3 months to reinforce their exercise training program . Patients are followed for up to 4 years . Physiologic , quality -of-life , and economic end points that characterize the effect of exercise training in this patient population will be measured at baseline and at intervals throughout the trial . Blood sample s will be collected to examine biomarkers such as brain natriuretic peptide , tumor necrosis factor , and C-reactive protein . CONCLUSIONS Because of its relatively low cost , high availability , and ease of use , exercise training is an intervention that could be accessible to most patients with heart failure . The HF-ACTION trial is design ed to definitively assess the effect of exercise training on the clinical ly relevant end points of mortality , hospitalization , and quality of life in patients with heart failure OBJECTIVE The purpose of this study was to investigate the effects of physical exercise on the functional capacity and quality of life in heart failure patients . METHODS Forty-two patients of both sexes with heart failure of NYHA class II and III with different etiologies were r and omly divided into  untrained or trained groups . The six-month exercise program consisted of aerobic training , muscle strength training , agility and joint flexibility activities . Physical fitness was evaluated by testing the performance on these trained components . Quality of life was evaluated by scored answers to a st and ardized question naire involving multiple domains . RESULTS Baseline values did not differ between groups . Improvement in the trained group was identified in all components of functional capacity when compared to the untrained group ( p < 0.001 ) . Quality of life improved in the trained patients concerning physical , psychological , social and environmental domains ( p < 0.001 ) , whereas no significant change was found in the untrained patients . CONCLUSIONS Guided and monitored physical exercise is safe and has the potential to improve functional capacity and quality of life in heart failure patients with multiple etiologies Background Adherence to the Heart Failure Society of America ( HFSA ) 2010 guidelines recommending 30 minutes of supervised moderate intensity exercise five days per week is difficult for patients with heart failure ( HF ) . Innovative programs are needed to assist HF patients to adhere to long-term exercise . The objective of this prospect i ve r and omized two-group repeated measures experimental design is to determine the efficacy of a behavioral exercise training intervention on long-term adherence to exercise at 18 months in patients with heart failure . Methods / Design A sample size of 246 subjects with heart failure will be recruited over a 3 year period . All subjects receive a cardiopulmonary exercise test and 9 supervised exercise training sessions during a 3 week run-in period prior to r and omization . Subjects completing at least 6 of 9 training sessions are r and omized to the HEART Camp Intervention group ( HC ) or to a st and ard care ( SC ) exercise group . The HC intervention group receives cognitive-behavioral strategies that address the intervention components of knowledge , attitudes , self-efficacy , behavioral self-management skills and social support . The SC group is provided access to the exercise facility and regular facility staff for the 18 month study period . The primary aim is to evaluate the effect of HEART Camp on adherence to exercise , with our central hypothesis that the HC group will have significantly better adherence to exercise at 18 months . Secondary aims include evaluating which components of the  HEART Camp intervention mediate the effects of the intervention on adherence ; evaluating the effect of HEART Camp on specific health outcomes ; exploring selected demographic variables ( race , gender , age ) as potential moderators of the effect of the HEART Camp  intervention on adherence ; and exploring the perceptions and experiences that context ualize exercise adherence . Discussion The HEART Camp intervention is the first to test a multi-component intervention design ed to improve long-term adherence to exercise behavior in patients with HF . Improving long-term adherence to exercise is the logical first step to ensure the required dose of exercise that is necessary to realize beneficial health outcomes and reduce costs in this burdensome chronic illness . Trial registration Clincaltrials.gov NCT01658670 OBJECTIVE To investigate how group-based exercise affects the levels of physical activity , physical fitness and health- related quality of life ( HRQoL ) in patients with chronic heart failure and comorbidities . DESIGN R and omized controlled trial . PATIENTS A total of 48 patients ( 10 women , 38 men ) , mean age 71 years ( st and ard deviation 8 years ) , ejection fraction 27 % ( st and ard deviation 10 % ) , and New York Heart Association functional class II-III . METHODS A bicycle test , 6-min walk test ( 6MWT ) and muscle endurance tests were performed . Physical activity was assessed with a pedometer and the International Physical Activity Question naire ( IPAQ ) , HRQoL was evaluated with the Short Form-36 ( SF-36 ) . Patients were r and omized to control or intervention groups . Intervention consisted of an individually design ed group-based exercise programme twice a week , for a period of 3 months . Subjects in the control group were asked to continue with their usual lives . RESULTS A total of 42 patients completed the study , and 6 dropped-out .  Steps/day did not increase significantly after intervention ( p = 0.351 ) , but IPAQ score did ( p = 0.008 ) . Exercise tolerance ( p = 0.001 ) , 6MWT ( p = 0.014 ) , shoulder abduction ( p = 0.028 ) , heel lift ( p < 0.0001 ) and HRQoL ( p = 0.018 ) improved significantly in the intervention group compared with the control group . CONCLUSION Group-based exercise did not improve the level of physical activity in patients with chronic heart failure and comorbidity ; however , physical fitness and HRQoL were significantly improved OBJECTIVES This study sought to assess a novel physical rehabilitation intervention in older patients hospitalized for acute decompensated heart failure ( ADHF ) . BACKGROUND After ADHF , older patients , who are frequently frail with multiple comorbidities , have prolonged and incomplete recovery of physical function and remain at high risk for poor outcomes . METHODS The REHAB-HF ( Rehabilitation Therapy in Older Acute Heart Failure Patients ) pilot study was a 3-site , r and omized , attention-controlled pilot study of a tailored , progressive , multidomain physical rehabilitation intervention beginning in the hospital and continuing for 12 weeks post-discharge in patients ≥60 years hospitalized with ADHF . The primary purpose was to assess the feasibility and reasonableness of the hypothesis that the novel rehabilitation intervention would improve physical function ( Short Physical Performance Battery [ SPPB ] ) over 3 months and reduce all-cause rehospitalizations over 6 months . RESULTS The study enrolled 27 patients with ADHF ( ages 60 to 98 years ; 59 % women ; 56 % African American ; 41 % with preserved ejection fraction [ ≥45 % ] ) . At baseline , participants had marked impairments in physical function , multiple comorbidities , and frailty . Study retention ( 89 % ) and intervention adherence ( 93 % ) were excellent . At 3 months , an intervention effect size was measured for the SPPB score of + 1.1 U ( 7.4 ± 0.5 U vs. 6.3 ± 0.5 U ) , and at 6 months an effect size was observed for an all-cause rehospitalization rate of -0.48 ( 1.16 ± 0.35 vs. 1.64 ± 0.39 ) . The change in SPPB score was strongly related to all-cause rehospitalizations , explaining 91 % of change . CONCLUSIONS These findings support the feasibility and rationale for a recently launched , National Institutes of Health-funded trial to test the safety and efficacy of this novel multidomain physical rehabilitation intervention to improve physical function and reduce rehospitalizations in older , frail patients with ADHF with multiple comorbidities . ( Rehabilitation and Exercise Training After Hospitalization [ REHAB-HF ] ; NCT01508650 ; A Trial of Rehabilitation Therapy in Older Acute Heart Failure Patients [ REHAB-HF ] ; NCT02196038 ) The effect of exercise training on quality of life and exercise capacity was studied in 67 patients with mild to moderate chronic heart failure ( CHF ; age : 65.6+/-8.3 years ; left ventricular ejection fraction : 26.5+/-9.6 % ) . Patients were r and omly allocated to either a training group or to a control group . After intervention a significantly larger decrease in Feelings of Being Disabled ( a subscale of the Heart Patients Psychological Question naire ) and a significantly larger increase in the Self- Assessment of General Well-Being ( SAGWB ) were observed in the training group . Exercise time and anaerobic threshold were increased in the training group only . The increase in exercise time was related to both Feelings of Being Disabled and SAGWB . We conclude that supervised exercise training improves both quality of life and exercise capacity and can be safely performed by chronic heart failure patients Background We aim ed to compare the effects of three different training advices , after 1 year , following a 6 months supervised cardiac rehabilitation period in patients with chronic heart failure ( CHF ) . Methods Sixty-nine CHF patients were r and omized , at the end of their rehabilitation period , either to usual care ( UC ) or to UC and controlled home training ( HT ) , prolonged supervised training ( ST ) or preferred training ( PT ) . Treadmill cardiopulmonary exercise testing was performed before rehabilitation , postrehabilitation and thereafter at 3-month intervals during the 1-year follow-up . submaximal exercise capacity [ Oxygen consumption and workload at the respiratory compensation point ( VO2RCP , WattRCP ) and submaximal workload ( SMW ) efficiency ( SMW/HR ) at 70 % of the initial maximal workload ] was chosen as a primary endpoint , because health status in CHF patients depends largely on their ability to perform activities at a submaximal level . Results After 6 months of rehabilitation , the four groups ( UC , HT , ST and PT ) were comparable with regard to cardiac rehabilitation-derived benefit , both at the submaximal and maximal level . Although exercise capacity during follow-up declined in both UC and HT patients , ST and especially PT patients maintained and even improved VO2peak and VO2RCP . However , only PT patients managed to maintain or even increase submaximal ( WattRCP and SMW/HR ratio ) workload ( P= 0.045 and < 0.0001 for interaction , respectively ) . Ventilatory-derived prognostic markers during treadmill cardio pulmonary exercise testing evolved similarly in the four subgroups . Conclusion This study suggests that engagement in physical training of their own choice ( PT ) , might be the optimal training modality for maintaining physical capacity in CHF patients BACKGROUND The aim of this study was to evaluate the effect of high intensity , interval exercise on quality of life ( QoL ) and depression status , in chronic heart failure ( CHF ) patients . METHODS A r and omized controlled trial ( phase III ) . Of the 100 consecutive CHF patients ( NYHA classes II-IV , ejection fraction ≤ 50 % ) that were r and omly allocated to exercise intervention ( n = 50 , high-intensity intermittent endurance training 30 s at 100 % of max workload , 30 s at rest , for 45 min/day-by-12 weeks ) or no exercise advice ( n = 50 ) , 72 ( exercise group , n = 33 , 63 ± 9 years , 88 % men , 70 % ischemic CHF and control group , n = 39 , 56 ± 11 years , 82 % men , 70 % ischemic CHF ) completed the study . QoL was assessed using the vali date d and translated Minnesota Living with Heart Failure question naire . Depressive symptomatology was evaluated using the vali date d and translated Zung Depression Rating Scale ( ZDRS ) . Maximal oxygen uptake ( VO(2max ) ) and carbon dioxide production ( VCO(2max ) ) were also measured breath-by-breath . RESULTS Data analysis demonstrated that in the intervention group MLHFQ score was reduced by 66 % ( P = 0.003 ) ; 6-min-walk distance increased by 13 % ( P < 0.05 ) , VO(2max ) level increased by 31 % ( P = 0.001 ) , VCO(2max ) level increased by 28 % ( P = 0.001 ) and peak power output increased by 25 % ( P = 0.001 ) , as compared with the control group . CONCLUSION High intensity , systematic aerobic training , could be strongly encouraged in CHF patients , since it improves QoL , by favorably modifying their fitness level Objective Treatment recommendation and guidelines for patients with heart failure ( HF ) can be complex , and past work has shown that patients with HF demonstrate low rates of adherence to recommended health behaviors . Although previous work has identified several medical , demographic , and psychosocial predictors of the capacity to adhere to treatment recommendations of persons with HF , little is known about the contribution of cognitive impairment to reported treatment adherence in this population . Methods A total of 149 persons with HF ( mean [ st and ard deviation ] = 68.08 [ 10.74 ] years ) completed a brief fitness assessment and neuropsychological testing . Treatment adherence was assessed using the  Heart Failure Compliance Question naire , a brief measure that asks participants to report their adherence to a variety of recommended health behaviors ( i.e. , medication management , diet , and exercise , among others ) . Results The percentage of participants who reported poor overall adherence was 16.1 % , with particularly high rates of nonadherence to dietary and exercise recommendations . Hierarchical regression analyses adjusting for possible confounds revealed that reduced performance on attention ( & bgr ; = .26 , p = .01 ) , executive function ( & bgr ; = .18 , p = .04 ) , and language ( & bgr ; = .22 , p = .01 ) was associated with poorer overall adherence . Follow-up analyses showed that these cognitive domains were associated with behaviors such as keeping doctor appointments , medication management , and dietary recommendations ( p < .05 for all ) . Conclusions The current findings demonstrate that cognitive function is an independent contributor to adherence in older adults with HF . Prospect i ve studies that objective ly measure treatment adherence are needed to clarify these findings and identify possible strategies to improve outcomes in this population . Trial Registration : clinical trials.gov Identifier : NCT00871897
Positive outcomes occurred in the short-term from interventions using approaches such as  exercise prescriptions , goal setting , feedback and problem-solving .
However , longer-term maintenance of exercise  was less successful .
Physical activity is recommended for people with stable heart failure ( HF ) , because it is known to improve quality of life and health outcomes .
However , adherence to this recommendation has been poor in many studies .
A systematic review was conducted to examine the effectiveness of strategies used to promote exercise adherence in those with HF .