Heart Failure (HF) is primarily a syndrome of aging and contributes to functional decline and disability. Evidence based strategies to help older adults with HF who are at risk for physical disability stay physically active and independent are greatly needed. The Joint Commission recently included Activity Assessment and Recommendations as a process measure for HF outpatient programs to gain Advanced Certification, highlighting the importance of physical activity in all patients with HF. Currently, there is little evidence to direct how to help older adults with HF increase their activity. The teaching materials provided by national organizations (American Heart Association and Heart Failure Society of America) are aimed at younger and more robust HF patients who can exercise at a greater intensity than older, frail adults with HF. Reframing exercise recommendations to instead concentrate on reducing sedentary behavior may be more achievable and sustainable for older adults with HF. We hypothesize that strategies that focus on decreasing sedentary behavior will be more effective then promoting a program of exercise. In this study, we will identify HF patients at risk for physical disability and randomize 72 patients to either a program to decrease sedentary behavior vs. a standard program to increase exercise. Using motivational interviewing techniques in both groups we will assist the patients in recognizing their potential and goal-setting. Patients will be monitored using the ActivPAL:monitor, a new technology that quantifies sedentary time and steps per day. Patients will be monitored for 12 weeks and receive 2 educational and goal setting sessions. Those in the intervention group will have sedentary behavior change emphasized and feedback from the ActivPAL monitor. The control group will focus on standard exercise recommendations and feedback from his/her exercise diary. Outcomes include change in sedentary time, steps/day, change in the HF specific health status measure, the Kansas City Cardiomyopathy Questionnaire and the Timed Get Up and Go. Anticipated results include a significant change in the intervention group vs the control: a decrease in sedentary time, an increase in steps/day, an increase in the Kansas City Cardiomyopathy Questionnaire scores and a decrease in the Timed Get Up and Go. The results of this study will provide the basis for designing a larger randomized controlled trial to investigate the effects of an intervention to reduce sedentary behavior and/or increase exercise on disability, falls and quality of life for older adults with HF. If the results from this study are positive, it has the potential to change the approach to promotion of physical activity and behavior change for older adults with HF.

Public Health Relevance

Physical activity is important to the health of older adults with heart failure. Presently, in clinical practice, older adults with heart failure are instructed to increase exercise which is often overwhelming for those with chronic illness. The purpose of this study is to compare two approaches to help older adults with heart failure increase their physical activity. The first group will concentrate on ways to decrease sedentary behavior and the second group will focus on increasing exercise. The aim of this study is to improve our approach in how we guide patients to become more physically active. The outcome of this study, if reducing sedentary behavior proves to be effective, will help to reframe the approach to focus on sedentary behavior rather then exercise.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Exploratory/Developmental Grants (R21)
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Social Psychology, Personality and Interpersonal Processes Study Section (SPIP)
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Zieman, Susan
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University of Colorado Denver
Internal Medicine/Medicine
Schools of Medicine
United States
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Beveridge, Louise A; Struthers, Allan D; Khan, Faisel et al. (2015) Effect of Vitamin D Supplementation on Blood Pressure: A Systematic Review and Meta-analysis Incorporating Individual Patient Data. JAMA Intern Med 175:745-54