Tailored exercise support for people with heart failure

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In 2018 in the UK, the number of people diagnosed with heart failure (HF) was measured at 920,000 and it is thought that a further 270,000 people are living with the condition without knowing they have it. Individuals with heart failure have a harder time pumping blood around their body because their heart has either become too weak or too stiff. This leads to breathlessness, exhaustion, feeling faint and having swollen ankles and legs. While HF cannot usually be cured, the symptoms can be managed and quality of life improved through different treatments – one being physical exercise.

It is recommended that people with HF should aim for 150-300 minutes of exercise each week, however research indicates that most do less than a third of what is required, with activity levels decreasing with increasing age. To address this, Professor Avery and her team have designed a new intervention based on current research and evidence, aimed at increasing the physical activity levels of people with HF called ‘BeActive-HF’. The intervention was designed to be of no fixed length and was intended to become a key part of ongoing care.

BeActive-HF began with training healthcare professionals (HCPs) who are involved in the care of patients with HF, with the necessary knowledge, skills, and confidence to deliver the programme to the patients that need it and refer patients who require further support to cardiac rehabilitation services. 26 HCPs were recruited from three NHS trusts and included a range of job roles including HF nurses, ward nurses, healthcare assistants and pharmacists. These professionals were then tasked with recruiting suitable patients to deliver the programme to. Once recruited, the patients had their physical activity and quality of life levels measured at the beginning, after 6 months and then after 12 months. It was found that after 12 months, physical activity levels increased in terms of steps per day and light intensity activity, furthermore, the average physical, emotional, and social quality of life scores were increased after six months and maintained after 12 months. Over the course of the programme being delivered, the team measured both physical fitness and wellbeing and conducted interviews to see how patients and HCPs felt about the programme. In terms of the physical measures, there was no significant improvement, however the interviews revealed that both patients and HCPs enjoyed the programme.

Patients reported improvements to confidence and understanding of how to safely exercise, as well as increases in their quality of life. These reported improvements ranged from increased independence and daily range in movement:

“Yes, they’ve helped [materials]. Because I used to have my newspaper delivered, it’s only a small thing, but now I walk down to the paper shop” (P17, Male, aged 82)

To increased participation in social exercise:

“The girls [friends] were saying, there’s this new class on the Friday, I thought, well, I might as well go there” (P18, Female, aged 74)

The HCPs also reported that the programme was easy to understand and implement and improved their own confidence in providing exercise guidance for patients, as this kind of support is often otherwise lacking. Their comments also highlight the acute need for programmes such as Be-Active HF with some trusts not having any home-based options for heart failure patients:

“We have a huge group of patients, we don’t offer any home-based rehab from [the trust] and it’s an area that we’re very aware that we’re lacking in, so it’s another option. It sounded like it would really bridge that gap for us, that we don’t have that in place with those patients” (P11, Trust 2)

Even where there are rehabilitation options for heart failure patients, uptake is often low. This feedback suggests that BeActive-HF could be instrumental in providing the confidence for patients to participate in rehab:

“There are some patients that say, ‘Well, I can’t even get up out of the chair’ and you might have excluded them. Whereas I think [BeActive-HF] changed my thinking…One of the patients who I did it with would not have entertained cardiac rehab in the slightest. She would have said no. But actually, by starting with the BeActive she started to get a bit of confidence, and it built her up to then she was like, ‘Actually maybe I might like cardiac rehab’, and she went, and she did. (P5, Trust 3)

Based on the positive feedback from this project, the team are now planning a larger scale trial to evaluate BeActive-HF. In order to ensure that this future trial is representative of the heart failure community, Professor Leah Avery and her team conducted a workshop in collaboration with Heart Research UK and Pumping Marvellous to talk to patients about the project and gather their views on any future work.