Key result
Exercise improves perceived benefits and self-efficacy across races but only reduces time barriers for White adults.
Why the study?
Limited application of theoretical frameworks has been conducted to understand racial disparities in exercise promotion among older adults with heart failure.
Does an exercise intervention improve Health Belief Model constructs and exercise behavior in Black and White older adults with heart failure?
RCT (n=671)
Randomized
Yes
Does an exercise intervention improve Health Belief Model constructs and exercise behavior in Black and White older adults with heart failure?
Standard exercise interventions for older adults with heart failure may fail to address perceived barriers to exercise among Black patients, highlighting the need for culturally tailored behavioral strategies.
Exercise interventions may overlook time barriers among Black HF patients; hypothesis-generating for race-specific tailoring in future trials.
BACKGROUND: Heart Failure is a leading cause of mortality among older adults. Engaging in regular exercise at moderate-to-vigorous intensity has been shown to improve survival rates. Theory-informed methodologies have been recommended to promote exercise, but limited application of theoretical framework has been conducted for understanding racial disparities among older adults with heart failure. This study aimed to use the Health Belief Model to compare exercise behavior determinants between Black and White older adults diagnosed with heart failure. METHODS: The HF-ACTION Trial is a multi-site study designed to promote exercise among individuals with heart failure that randomized participants to an experimental (three months of group exercise sessions followed by home-based training) or control arm. The present study used structural equation modeling to test the change in Health Belief Model constructs and exercise behavior across 12 months among older adults. RESULTS: Participants (n = 671) were older adults, 72.28 (SD = 5.41) years old, (Black: n = 230; White, n = 441) diagnosed with heart failure and reduced ejection fraction. The model found perceived benefits, self-efficacy, perceived threats, and perceived barriers to predict exercise behavior among Black and White older adults. However, among these constructs, only perceived benefits and self-efficacy were facilitated via intervention for both races. Additionally, the intervention was effective for addressing perceived barriers to exercise only among White participants. Finally, the intervention did not result in a change of perceived threats for both races. CONCLUSIONS: Among health belief model constructs, perceived threats and barriers were not facilitated for both races in the experimental arm, and the intervention did not resolve barriers among Black older adults. Racial differences need to be considered when designing interventions for clinical populations as future studies are warranted to address barriers to exercise among Black older adults with heart failure.
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Kaushal et al. (2023) conducted an RCT in Heart failure with reduced ejection fraction (n=671). Exercise training program vs. Usual care was evaluated on Change in Health Belief Model constructs (perceived benefits, self-efficacy, perceived threats, perceived barriers) and exercise behavior. The exercise intervention improved perceived benefits and self-efficacy for both races, but only addressed perceived time barriers among White (β=0.12) and not Black (β=0.07) older adults.
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