Objective Improvement in Daily Physical Activity in Heart Failure Remains Elusive: A Systematic Review

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Purpose:The purpose was to comprehensively review the literature for exercise- and psychosocial-based rehabilitation interventions for improving daily physical activity (PA) in patients with heart failure (HF).Methods:A search of the PubMed/MEDLINE, CINAHL, ProQuest Medical, PsycINFO, and Web of Science databases was conducted. Articles were included if they (1) were written in English, (2) included subjects with HF, (3) assessed physical or psychosocial rehabilitation interventions to improve daily PA, and (4) measured daily PA qualitatively or quantitatively. Case reports, non–peer-reviewed research, and articles without full text available were excluded. Two authors completed the screening independently, and conflicts were resolved by a third author.Results:One thousand four hundred sixty-two unique records were identified, and of these, 47 were selected for full-text review. Ultimately 15 were included: 13 randomized controlled trials and 2 case series, published from 1999 to 2016. No studies using only exercise interventions resulted in objective increases in daily PA. All 3 studies using only psychosocial interventions resulted in an increase, but only 1 of these used an objective measure and that study was a case series. One study using a combination of exercise and psychosocial interventions showed an objective increase in daily PA, but that result was not replicated later in a similar study.Conclusions:Exercise interventions alone do not result in improvement in daily PA in patients with HF. Further investigation concerning psychosocial interventions, with objective outcome measurement, is warranted.

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