| BackgroundHeart failure,which is one of the most important cardiovascular diseases with high incidence,is the serious and terminal stage of various heart diseases today.In recent years,despite the new drug and therapy aims to achieve better results,the prognosis is still not ideal.Exercise rehabilitation is an effective way to improve the prognosis of heart failure.2013 American Heart Association Foundation/American Heart Association Heart Failure Management Guide ranked exercise rehabilitation for heart failure as class I A recommendation.The effectiveness of exercise in patients with heart failure has been confirmed.However,if the patient does not adhere to exercise,the effect will no longer continue.Foreign research shows that despite well-organized and well-funded resources,trying to optimize exercise compliance,only about 40%patients in the intervention group achieved the exercise target in the short term.2014 the Chinese expert consensus about chronic stable heart failure exercise rehabilitation recommend that stable New York Heart Association(NYHA)class I-III HF patients should consider taking exercise rehabilitation.However,most patients with heart failure lost contact with hospital staff after discharge.Few patients achieve the target in China.How to improve the exercise behavior of patients with heart failure has become an urgent problem to be solved.Objectives1.The aim of this study is to explore the effect of exercise behavior on the patients with heart failure.To know the status of family exercise behavior in those patients,we investigated the exercise behavior of the patients with heart failure in four aspects,which are form,frequency,time and intensity.2.Based on the influencing factors of exercise behavior in this research,combined with the domestic and foreign research in patients with heart failure,we formulated nursing measures and discussed the intervention effects to promote the exercise behavior,quality of life and psychological status of patients with heart failure.MethodsDescriptive study in the first phase:137 HF patients in total who were treated in Cardiology in total,First Affiliated Hospital of Nanjing Medical University,from November 2015 to April 2016 were investigated by convenience sampling method.Demographics,characteristics of disease,self-efficacy for exercise,social support and exercise behaviors at home were collected.The form,frequency,time and intensity of the exercise behavior respectively as the dependent variable,variables which were statistically significant in univariate analysis and correlation analysis as the independent variable,influencing factors of family behaviors in patients with heart failure were analyzed by SPSS 19.0.Quasi-experiment in the second phase:Forty patients who were hospitalized from June to July in 2016 were included as control group,and 38 patients from September to October were treated as intervention group.Patients in the intervention group received health education and self-efficacy intervention,including individualized self-efficacy interventions during hospitalization and follow-up after discharge,while patients in the control group received health education only.All of these patients were told to record the exercise logs(including the form,frequency,duration and intensity of exercise).All patients were assessed using self-efficacy for exercise,Hospital anxiety and depression scale,and Minnesota living with heart failure questionnaire at baseline and 4 months after discharge.The data of 71 patients(37 cases in the control group and 34 cases in the intervention group)were analyzed by SPSS 19.0 to evaluate the effect of exercise self-efficacy intervention on family behavior,quality of life and psychological status of patients with heart failure.Results1.Self-efficacy for exercise and family exercise behavior status:The total score of self-efficacy for exercise was 32.80 ± 9.33 points.118(86.1%)patients did aerobic exercises.19(13.9%)patients did aerobic combined with resistance exercises.The exercise frequency was 3.23±0.80 times a week.The time spent in exercise was(24.22±36.18)minutes a day.The exercise intensity was at the intensity of Rating of Perceived Exertion(RPE)11.38±1.30.2.The influencing factors of family exercise behavior:The results of x2 analysis showed that there were significant differences in the exercise form of patients with different age,educational level and complications(P<0.05).The t-test and variance analysis indicated that there were significant differences in the frequency of exercise among patients with different marriage,cardiac function and complications(P<0.05).There were statistically significant differences in exercise time among patients with different educational levels,cardiac function,and complications(P<0.05).There were significant differences in exercise intensity between different sexes,marriage,cardiac function and complications(P<0.05).The correlation analysis showed that the correlation between exercise frequency(times per week),time(minutes per time),intensity(RPE)and SEE were positively significant(r was 0.539,0.607 and 0.539,respectively).The correlation between exercise frequency,time,intensity and age were significant(r was-0.350?-0.229 and-0.377,respectively).The correlation between exercise frequency,time,intensity and social support were significant(r was 0.281?0.562 and 0.221,respectively).Multiple Linear regression analysis showed that SEE,New York Heart Association and co-morbidity were the influencing factors of exercise frequency.SEE,social support,New York Heart Association age and co-morbidity were influencing factors of exercise time.The influencing factor of exercise intensity was SEE and co-morbidity.3.Effect of exercise self-efficacy intervention:After exercise self-efficacy intervention of 4 months,the frequency,duration and intensity of exercise and the scores of SEE increased more significantly in the intervention group than in the control group(P<0.05),the hospital depression and quality of life scores were significantly different between the two groups.Conclusions1.The SEE of HF patients at home were relatively poor.The exercise behaviors of HF patients at home need to be improved.In the design and implementation of the rehabilitation and nursing intervention,patients' SEE should be strengthened.Meanwhile,Medical staff should take into consideration various factors of exercise behavior compliance such as social support,age,cardiac function and co-morbidities.2.Exercise self-efficacy intervention can effectively improve SEE and home exercise behavior in patients with heart failure.Exercise could improve the patient's psychological health and quality of life. |
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