Effects of exercise training on motivation in patients with heart failure with preserved ejection fraction: Results from the randomized controlled Ex-DHF trial

BACKGROUND: Heart failure (HF) is a global public health issue. Over 50 % of symptomatic HF patients have HF with preserved ejection fraction (HFpEF), but to date, few pharmacotherapy treatments have been shown to improve morbidity and mortality in patients with HFpEF. Exercise training (ET) is an important component in the management of HFpEF since it improves exercise capacity, quality of life, and reduces HF hospitalizations. However, low motivation is a common barrier to adherence to ET. METHODS: In this secondary analysis of the Ex-DHF trial, we investigated whether a 12-month, structured, supervised ET intervention in HFpEF patients increases overall motivation, self-determined (intrinsic and identified) motivation, and non-self-determined (extrinsic and introjected) motivation, measured using the German Scale for Self-concordance of Sport- and Exercise-related Goals (SSK), compared to usual care (UC). RESULTS: We enrolled 322 participants (mean age 69.6 ± 7.3 years; 59.6 % women). ET was associated with significant improvements in overall motivation at 12 months (B = 0.78, 95 % CI 0.14-1.42, p = 0.017) compared with UC. Furthermore, ET led to significant increases in intrinsic (B = 0.57; 95 % CI 0.29-0.85, p < 0.001) and identified motivation (B = 0.47, 95 % CI 0.21-0.73, p < 0.001) at 12 months compared with UC, with no between-group differences in extrinsic or introjected motivation. CONCLUSIONS: A 12-month ET intervention led to a significant increase in motivation in patients with HFpEF, with specific increases in self-determined motivation (intrinsic and identified). Given the key role of motivation in health behaviors, especially self-determined motivation types, supervised ET may have the potential to impact long-term adherence to ET in patients with HFpEF. TRIAL REGISTRATION: Ethics approval for this study was obtained from the Regional Committees for Medical Research Ethics of the Charité Medical Center Berlin, University Medical Center Göttingen, University of Würzburg, University of Leipzig Medical Center, and Technical University München. The study was registered after approval by the ethics committee at http://www.isrctn.com, on August 23, 2011. The registration number is ISRCTN86879094.