The influence of outcome expectations on adherence to exercise in adults with heart failure enrolled in an exercise study: A convergent mixed methods study.

BACKGROUND: Exercise improves outcomes in adults with heart failure (HF); however, adherence is difficult and may be influenced by individuals' exercise outcome expectations. OBJECTIVES: To examine relationships between exercise outcome expectations and exercise adherence in adults with HF. METHODS: We used a convergent mixed methods approach to integrate qualitative (exercise outcome expectations) and quantitative (exercise adherence) data from a randomized controlled trial. Exercise outcome expectations were recorded from baseline surveys, analyzed using content analysis, and transformed for integration. Data were integrated with Chi-square tests to evaluate relationships between qualitative themes and 6- and 12-month exercise adherence. RESULTS: Of the 204 adults with HF in the parent study, 134 completed baseline surveys. These participants were 47% female, 56.7% Caucasian, and had a mean age 60.2 years. Five themes emerged: Physical and Mental Health, Symptom Control, Global Health, Quality of Life with HF, and Exercise Routines. Exercise adherence at 6- and 12-months was 43/126 (34.1%) and 46/134 (33.8%), respectively. At 6 months, exercise adherence was less likely in participants who reported expecting improved Physical and Mental Health (n = 110; Χ2=5.37, p=.02) and more likely in those expecting improved Quality of Life with Heart Failure (n = 67; Χ2=6.62, p=.01). No significant relationships were identified at 12 months. CONCLUSION: In adults with HF, the influence of baseline expectations of exercise on long-term adherence is unclear. Future studies could expand this work by examining expectations of exercise over time and relationships between expectations and other social cognitive constructs that drive exercise adherence behavior.