Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Office of Research on Women’s Health and the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health Background It is difficult to quantify physical activity among adults with heart failure (HF) in the context of many disease-driven limitations. The Community Healthy Activities Model Program for Seniors (CHAMPS) Physical Activity Questionnaire, designed to measure physical activity among older adults, may be helpful in quantifying physical activity in HF. Purpose To quantify physical activity levels among adults with HF using the CHAMPS Physical Activity Questionnaire and to compare physical activity expenditure and frequency between adults ≥ 65 years vs. < 65 years, women and men, and those physically frail vs. non-physically frail. Methods This was an analysis of data collected from a cohort study of adults with New York Heart Association Functional Class I-IV HF. Using the CHAMPS Questionnaire, we calculated caloric expenditure (kcal) and frequency per week in all activities and moderate intensity activities. Physical frailty was measured with the Frailty Phenotype Criteria. Comparative statistics were used to compare physical activity between groups. Results The average age of the sample (n = 117) was 63.6±15.6 years, 48.7% were female, and most (76.9%) had non-ischemic HF etiology. Median caloric expenditure from all physical activities was 1827 kcal/week [Interquartile Range 735-3943] and moderate intensity activities was 397 kcal/week [Interquartile Range 0-1886]. For caloric expenditure from all physical activities, there was no significant difference between adults ≥ 65 years vs. < 65 years (p = 0.894), but women and those physically frail had significantly lower caloric expenditure (both p < 0.001). For caloric expenditure from moderate intensity physical activities, there was no significant difference between adults ≥ 65 years vs. < 65 years (p = 0.346), but women had significantly lower caloric expenditure (p < 0.001) as well as those physically frail (p < 0.001). Median frequency of all physical activities was 13 times per week [Interquartile Range 8-21] and of all moderate intensity activities was 3 times per week [Interquartile Range 0-8]. Conclusions Many adults with HF, regardless of age, report low physical activity using the CHAMPS Physical Activity Questionnaire; however, women and those physically frail report considerably lower physical activity than men and those non-physically frail, respectively. Capturing physical activity levels across multiple activities is necessary for the design and implementation of physical activity interventions in HF, and the CHAMPS measure may be one tool to do this.
Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): University of Akureyri Research Fund Landspitali University Hospital Science Fund. Background Self-care is an important part of secondary prevention for patients with coronary heart disease (CHD). But, we have limited knowledge about how self-care of CHD changes over time. The purpose of this prospective, longitudinal survey study was to determine if distinct trajectories of change in self-care behaviors could be identified following a hospitalization for CHD, and identify which characteristics are helpful in predicting trajectory membership. Methods Patients hospitalized acutely or electively for CHD were included in the study and completed questionnaires at hospital discharge and 6 months later. Self-care was measured with the Self-Care of Coronary Heart Disease Inventory, version 2.2 which consisted of 2 behavioral subscales (i.e., maintenance and management) that were standardized to range from 0-100 with higher scores indicating better self-care. Symptoms of anxiety and depression were assessed with the Hospital Anxiety and Depression Scale and health literacy with the Health Literacy Survey Questionnaire. Latent growth mixture modeling was used to identify distinct trajectories of CHD self-care behaviors over time. Results A total of 430 patients with CHD completed the study (mean age 64.3 ±8.9, 79% male). Overall, self-care was poor at enrollment (maintenance 61.6±15.4, management 53.5±18.5). Two trajectories of self-care behaviours were identified. The first "worse CHD self-care" trajectory (57.2% of the sample) had comparatively worse self-care maintenance and management at both enrollment and 6-month follow-up; self-care maintenance improved slightly (4.0±14.5-point improvement, p<0.001) but self-care management got worse (6.3±24.4-point worsening, p = 0.005) over time in this trajectory. The second "better CHD self-care" trajectory (42.8% of the sample) had comparatively better self-care maintenance and management at both enrollment and 6-month follow-up; self-care maintenance improved slightly (5.0±16.2-point improvement, p<0.001), and self-care management remained unchanged (0.8±21.9-point worsening, p = 0.713) in this trajectory (Figure 1). Predictors of fitting in the "worse CHD self-care" trajectory were older age, lower education, not having prior CHD hospitalizations, worse depression and anxiety symptoms, lower health literacy, and not participating in rehabilitation after hospitalization. Conclusion The determinants of change in CHD self-care overtime are complex and include multiple levels of potential intervention including health systems (e.g. rehabilitation) and individual care (e.g. red flags of poor literacy and affective symptoms). As such, care models which provide sufficient patient education, address mental health and focus on self-care management might help patients improve their self-care behaviour.Trajectories of self-care
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