Development and implementation of a HAPA-based exercise rehabilitation program for patients with chronic heart failure

Objective To develop a Health Action Process Approach (HAPA) based exercise rehabilitation program for chronic heart failure (CHF) patients and evaluate its effectiveness. Methods A randomized controlled trial was carried out in which 100 patients with CHF admitted to the Department of Cardiology between April 2024 and April 2025 were recruited. Participants were randomly allocated to either the control group ( n = 50) receiving routine care or the intervention group ( n = 50) receiving the HAPA-based exercise rehabilitation program for three months. Primary outcomes were exercise adherence, exercise self-efficacy and quality of life (QoL), which were compared between the two groups. Results During the study, three and two patients in the intervention and control groups, respectively, withdrew, leaving 95 people for final analysis. Exercise adherence scores showed significant time and group effects (both P < 0.001), but the time by group interaction was not statistically significant ( P = 0.141). No substantial between-group variances were found at baseline ( P = 0.070), however, the intervention group had significantly higher exercise adherence scores at 1, 3 and 6 months post-intervention (all P < 0.001). At three months, exercise self-efficacy was significantly greater in the intervention group (MD = 7.57, 95% CI: 3.98–11.17; Cohen's d = 0.86; P < 0.001). Additionally, total QoL scores as well as scores in the physical, emotional, and other domains were substantially lower in the intervention group relative to the control group (all P < 0.001), suggesting improved QoL. Conclusion Exercise rehabilitation program based on HAPA may improve exercise adherence, exercise self-efficacy and QoL in patients with chronic heart failure. Nevertheless, additional studies are needed to verify its efficacy and its broader clinical usefulness.