This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. While benefits of exercise are well documented for individuals with heart failure (HF), rural dwelling adults (RDA) are often limited in ability or resources to participate in cardiac rehabilitation or home exercise programs. Long-term goal: The broad goal for this program of research is to enhance the quality of life (QOL) of adults with HF.
Specific aims : The Health Belief Model guides this study to 1) Explore relationships between perceptions, modifying factors, self-efficacy (SE), and likelihood of PA using a 3 month pedometer intervention among RDA with HF;2) To determine feasibility of a larger study;and, 3) To determine adequacy and appropriateness of study measures and design. The study will gather preliminary data to test the following hypothesis: After controlling for health status, rural dwelling adults living with heart failure who wear a pedometer for 3 months and receive Health Care Provider (HCP) prescriptive feedback will demonstrate a greater increase in the average number of steps taken / day, report a greater improvement in exercise self-efficacy and QOL, and demonstrate greater improvements in physical function (6MWT, BP, HR) compared to individuals who wear a pedometer and do not receive HCP feedback or individuals who receive usual care. Design: This prospective, randomized study will determine differences in steps/day, QOL, and physical function between three groups: PedPlus - receive usual care and a combination of a pedometer educational/motivational packet, pedometer feedback, and Health Care Provider prescriptive feedback;Ped - PedPlus intervention without Health Care Provider prescriptive feedback;and usual care (UC). Primary outcomes include steps/day (Ped, PedPlus), QOL and six minute walk distance. Secondary outcomes include BP, HR, and exercise SE. Setting: A tertiary care medical center will be the recruitment and testing site. Physical activity will occur in the patient's home environment. Sample: Fifty-one RDA, aged ? 18, with a confirmed diagnosis of HF (NYHA I-III) will be recruited. Instruments: Short Form 36 (SF-36v2), Kansas City Cardiomyopathy Questionnaire (KCCQ), Cardiac Exercise Self Efficacy Instrument (CESEI) (modified). Procedures: Patients with HF, who verbalize knowledge of their diagnosis and for whom the cardiology fellow/cardiologist believes it would be appropriate, will receive a brochure. The RN caring for the patient will inform the study nurse if the patient is interested in learning more about the study or potential participants can contact the study nurse directly to be screened for study participation. During the clinic visit, or within one week of the clinic visit, baseline data will be collected from all participants: demographics, SF-36v2, KCCQ, CESEI, activity survey, and 6MWT. Patients will then be randomized using block randomization. The UC group will receive no contact until follow-up. The two pedometer groups will receive pedometer and log recording instructions. Every two weeks the pedometer groups will be reminded by postcard to return logs. The Ped only group will not receive feedback;the PedPlus group will be contacted with an individualized steps/day prescription based on log data. At 12 weeks all data (except SF-36v2) will again be collected. Primary analysis methods: Data will be analyzed by linear-mixed effects ANCOVA models with the SF-36v2 as covariate.
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