Enhancement of Physical Activity in Elderly Patients With Diastolic Heart Failure by a Motivational Intervention

Patients discharged from the Ex-DHF trial were recruited from June 2013 to December 2015 and offered participation in a controlled add-on pilot study. The treatment group (n=19) received 5 sessions of MI, each lasting 15-30 min over 6 months to enhance physical activity.

For the first two and the last sessions participants met with the psychologist-counsellor face-to-face for about 45 minutes. The remaining three sessions could be conducted via telephone or face-to-face, depending on participants' preferences, and typically lasted 15-30 minutes. Per study protocol, counsellors (physicians and psychologists trained in motivational interviewing) assisted the participants in: (1) Setting goals for their physical activity; (2) developing a plan to increase physical activities; (3) setting specific plans for the implementation of the plan; and (4) overcoming possible barriers. Participants were also asked to keep track of their daily physical activity in a diary, which counsellors then discussed with them during the sessions.

After patients had given their written informed consent, counsellors assessed all participants via structured interview and self-rating scales. At baseline only, sociodemographic information was recorded.

At baseline and at the final 6-month visit participants' motivation to be physically active in the upcoming weeks was assessed using the SSK-scale ("Sportbezogene Selbstkonkord" = sports-related self-concordance, Seelig and Fuchs 2006) to assess the self concordance of sport- and exercise-related goals.

The kind and extent of patients' daily physical activity was recorded using patient diaries. At baseline and 6 months we also conducted a symptom-limited cardiopulmonary exercise test on a bicycle ergometer, in order to assess changes in maximum rate of oxygen consumption during the last 30 seconds before the termination of the exercise (peak oxygen consumption (VO2 [ml/min/kg])) as measure of maximal exercise capacity. Participants also completed the 6-minute walk test on flat surface (6-MWT) as an additional parameter to assess submaximal exercise capacity.

Additionally, at the 6-month assessment, intervention participants filled out a questionnaire about their subjective evaluation of the counseling program.

The control group (n=20) received usual care.

Inclusion criteria

• preserved left ventricular systolic function (left ventricular ejection fraction >= 50%),
• echocardiographically determined diastolic dysfunction (grade ≥ 1),
• New York Heart association functional classes I, II or III,
• at least one cardiovascular risk-factor (overweight, diabetes, hypertension, smoking or hyperlipidemia)
• participation in Ex-DHF main study
• written informed consent

Exclusion criteria

• Non-cardiac causes for heart failure-like symptoms
• Chronic obstructive pulmonary disease GOLD stages ≥II
• Anaemia (haemoglobin <11 mg/dL)
• Significant renal dysfunction (eGFR <30 mL/min/1.73 m**2 indexed to BSA)
• Significant peripheral artery disease (Fontaine ≥IIb)
• Musculoskeletal disease that contributes to reduced exercise performance
• Specific cardiomyopathy (e.g. amyloidosis)
• Haemodynamically significant valvular disorders
• Significant coronary artery disease (current angina pectoris Canadian Cardiovascular Society Class ≥II or positive stress test, myocardial infarction or coronary artery bypass graft within the last 3 months)
• Any inability or contraindication to participate in cardiopulmonary exercise testing or in an exercise programme (e.g. physiological, mental) or to supply essential information (e.g. questionnaire, diary)
• Ineffective control of resting blood pressure (≥140/90 mmHg or ≥160/100 mmHg with ≥3 antihypertensive drugs) or of resting heart rate (≥100 b.p.m.)
• Expected low adherence (e.g. by travel distance to trial site; planned absences longer than 4 weeks during follow-up) or ongoing drug abuse
• Pregnant or nursing women
• Concomitant participation in other interventional clinical trials