Margaret McCarthy

Abstract

Background: Physical inactivity continues to be amajor risk factor for cardiovascular disease, and only one half of adults in the United States meet physical activity (PA) goals. PA data are often collected for surveillance or for measuring change after an intervention. One of the challenges in PA research is quantifying exactly how much and what type of PA is taking place-especially because self-report instruments have inconsistent validity. Objective: The purpose is to review the elements to consider when collecting PA data via motion sensors, including the difference between PA and exercise, type of data to collect, choosing the device, length of time to monitor PA, instructions to the participants, and interpretation of the data. Methods: The current literature on motion sensor research was reviewed and synthesized to summarize relevant considerations when using a motion sensor to collect PA data. Results: Exercise is a division of PA that is structured, planned, and repetitive. Pedometer data include steps taken and calculated distance and energy expenditure. Accelerometer data include activity counts and intensity. The device chosen depends on desired data, cost, validity, and ease of use. Reactivity to the device may influence the duration of data collection. Instructions to participantsmay vary depending on the purpose of the study. Experts suggest pedometer data be reported as steps-because that is the direct output-and distance traveled and energy expenditure are estimated values. Accelerometer count data may be analyzed to provide information on time spent in moderate or vigorous activity. Discussion: Thoughtful decision making about PA data collection using motion sensor devices is needed to advance nursing science.

Abstract

Aim: To describe the results of the process evaluation of an exercise counseling intervention using motivational interviewing (MI). Background: Exercise can safely be incorporated into heart failure self-care, but many lack access to cardiac rehabilitation. One alternative is to provide exercise counseling in the clinical setting. Methods: This process evaluation was conducted according to previously established guidelines for health promotion programs. This includes an assessment of recruitment and retention, implementation, and reach. Results: Desired number of subjects were recruited, but 25% dropped out during study. Good fidelity to the intervention was achieved; the use of MI was evaluated with improvement in adherence over time. Dose included initial session plus 12 weekly phone calls. Subjects varied in participation of daily diary usage. Setting was conducive to recruitment and data collection. Conclusions: Evaluating the process of an intervention provides valuable feedback on content, delivery and fidelity.

Abstract

Physical activity and cardiac rehabilitation (CR) are components of heart failure (HF) self-care. The aims of this study were to describe patterns of physical activity in African Americans (n = 30) with HF and to explore experience in CR. This was a mixed method, concurrent nested, predominantly qualitative study. Qualitative data were collected via interviews exploring typical physical activity, and CR experience. It was augmented by quantitative data measuring HF severity, self-care, functional capacity and depressive symptoms. Mean age was 60 ± 15 years; 65% were New York Heart Association (NYHA) class III HF. Forty-three percent reported that they did less than 30 min of exercise in the past week; 23% were told “nothing” about exercise by their provider, and 53% were told to do “minimal exercise”. A measure of functional capacity indicated the ability to do moderate activity. Two related themes stemmed from the narratives describing current physical activity: “given up” and “still trying”. Six participants recalled referral to CR with one person participating. There was high concordance between qualitative and quantitative data, and evidence that depression may play a role in low levels of physical activity. Findings highlight the need for strategies to increase adherence to current physical activity guidelines in this older minority population with HF.

Abstract

Purpose The purpose of this secondary analysis was to determine changes in physical inactivity from baseline to 5 years and to identify factors associated with and predictive of physical inactivity among individuals with type 2 diabetes enrolled in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study. DIAD was a prospective randomized screening trial that assessed the prevalence of silent ischemia in asymptomatic patients with type 2 diabetes. Subjects were recruited from diabetes and primary care practices at 14 centers throughout the United States and Canada. This is a secondary data analysis of the physical activity data (type and hours/week) collected. No intervention was conducted. In all subjects, physical inactivity rose from 24% at baseline to 33% at 5 years (S = 28.93; P <.0001). This change was significant in both men (S = 11.44; P <.0001), increasing from 23% to 31%, and women (S = 18.05; P <.0001), increasing from 25% to 36%. Gender differences were noted in several factors associated with baseline physical inactivity as well as in factors predictive of physical inactivity at 5 years. Important factors associated at both time points included lower level of education, current employment, presence of peripheral and autonomic neuropathy, and indicators of overweight/obesity. Baseline physical inactivity was strongly predictive of physical inactivity at 5 years (odds ratio, 3.27; 95% confidence interval, 2.36-4.54; P <.0001). Gender-related differences were noted in factors associated with and predictive of physical inactivity.

Abstract

Objectives: Depression is very common in patients with heart failure (HF). However, little is known about how depression influences self-care (ie, adherence to diet, medication and symptom management behaviors) in ethnic minority patients with HF. The purpose of this study was to explore the meaning of depression and how depressive symptoms affect self-care in an ethnic minority Black population with HF. Design: In this mixed methods study, 30 Black patients (mean age 59.63 SD 615 years; 60% male) participated in in-depth interviews about HF self-care and mood; and completed standardized instruments measuring self-care, depression, and physical functioning. Thematic content analysis was used to explore the meaning of depression and elicit themes about how depressive symptoms affect daily self-care practices. Qualitative and quantitative data were integrated in the final analytic phase. Results: Self-care was very poor in the sample. Forty percent of the sample had evidence of depressive symptoms (PHQ-9≥10; mean 7.59 ± 6 5.29, range 0 to 22). Individuals with depressive symptoms had poorer self-care (P=.029). In the qualitative data, individuals described depressive mood as "feeling blue⋯ like I failed." "Overwhelming" sadness and fatigue influenced self-care and resulted in treatment delays. For many, spirituality was central to coping with sadness. Few discussed depressive feelings with health care providers. Conclusions: Depression in ethnic minority patients with HF may be difficult to assess. Research to develop and test culturally sensitive interventions is critically needed, since depression influences self-care and minority populations continue to experience poorer outcomes.

Abstract

BACKGROUND:: Heart failure (HF) places a disproportionate burden on ethnic minority populations, including blacks, who have the highest risk of developing HF and experience poorer outcomes. Self-care, which encompasses adherence to diet, medication, and symptom management, can significantly improve outcomes. However, HF self-care is notoriously poor in ethnic minority black populations. OBJECTIVES:: Because culture is central to the development of self-care, we sought to describe the self-care practices and sociocultural influences of self-care in an ethnic minority black population with HF. METHODS:: In this mixed-methods study, 30 black patients with HF (mean [SD] age, 59.63 [15] years; 67% New York Heart Association class III) participated in interviews about self-care, cultural beliefs, and social support and completed standardized instruments measuring self-care and social support. Thematic content analysis revealed themes about sociocultural influences of self-care. Qualitative and quantitative data were integrated in the final analytic phase. RESULTS:: Self-care was very poor (standardized mean [SD] Self-care of Heart Failure Index [SCHFI] maintenance, 60.05 [18.12]; SCHFI management, 51.19 [18.98]; SCHFI confidence, 62.64 [8.16]). The overarching qualitative theme was that self-care is influenced by cultural beliefs, including the meaning ascribed to HF, and by social norms. The common belief that HF was inevitable ("all my people have bad hearts") or attributed to "stress" influenced daily self-care. Spirituality was also linked to self-care ("the doctor may order it but I pray on it"). Cultural beliefs supported some self-care behaviors like medication adherence. Difficulty reconciling cultural preferences (favorite foods) with the salt-restricted diet was evident. The significant relationship of social support and self-care (r = 0.451, P = .01) was explicated by the qualitative data. Social norms interfered with willingness to access social support, and "selectivity" in whom individuals confided led to social isolation and confounded self-care practices. CONCLUSIONS:: Research to develop and test culturally sensitive interventions is needed. Community-based interventions that provide culturally acceptable resources to facilitate self-care should be explored.

Abstract

Objective: The study objective was to describe the self-care behaviors of adherence to medication, diet, exercise, and symptom monitoring of older workers with cardiovascular disease (CVD) and explore the relationship among job characteristics (job demands, job control, and workplace support), self-care, and quality of life. More than 3.5 million workers have CVD with significant work limitations and increased disability. Workers must meet the challenges of today's work processes that include increased stress and intense production demands while managing the complexities of their CVD. Methods: A total of 129 workers (aged ≥ 45 years) with CVD completed standardized instruments about self-care (Specific Adherence Scale α = .74), job characteristics (Job Content Questionnaire α = .71), and quality of life (MacNew health-related quality of life α = .84). Regression analyses were used to examine relationships between variables. Results: The sample had a mean age of 59.16 ± 8.83 years, 56.3% were female, and 36.5% were African-American. Self-care behaviors varied. Most workers (71.4%) reported medication adherence, and few adhered to diet (27%), exercise (18%), or symptom monitoring (31.3%). Psychologic job demands were negatively correlated to self-care (r = -217, P = .02). Better adherence was reported by those with workplace support (r = .313, P = .001). Job characteristics explained 22% of variance in self-care adherence behaviors. Adherence was a significant determinant of general quality of life. Conclusion: Because job characteristics may interfere with self-care, clinicians should assess job demands and discuss stress management with employed patients. Interventions that foster worksite programs and facilitate self-care among workers with CVD are needed.

Abstract

Although death rates from cardiovascular disease (CVD) have declined in recent years, it continues to be the leading cause of death for women in the United States. The risk factors for CVD are well established and include physical inactivity. According to the Centers for Disease Control, in 2008, 38% of women reported no physical activity. For many women who experience a cardiac event, their first opportunity to become physically active is through a formal cardiac rehabilitation (CR) program. Unfortunately, women often underutilize CR programs. The purpose of this integrative review was to examine the barriers to participation in a CR program among women with CVD.