When Philip Hester was diagnosed with heart failure seven years ago, the doctor asked him how he was still standing.
“Stubborn Irishman, I guess,” Hester said.
A few months later, when his heart was stronger, doctors recommended exercise. But Hester was wary of working out with a weakened heart.
A Lincoln nurse practitioner believes that having a coach might help to ease such fears. Bunny Pozehl of the University of Nebraska Medical Center College of Nursing in Lincoln is studying exercise adherence in heart failure patients.
All participants attended initial educational meetings and have free access to a gym. One group meets weekly with an exercise specialist who has expertise in cardiac patients. The specialist answers questions about exercising with a heart condition and helps the patients set goals, among other things.
The other group doesn't work weekly with a specialist.
At the end of the study, researchers will interview patients about what helped them stick with the exercise program, what didn't and what might have.
Pozehl said the study could serve as a model for future programs for heart failure patients.
“While this might seem like a 'duh' kind of thing,” she said, researchers might find that working with a coach still isn't enough to establish exercise habits.
For healthy people who work out, Pozehl said, “the literature does show that the presence of a coach is helpful, support from others is helpful and removing barriers to exercise is helpful.”
But no one has measured what might help those with heart failure, a progressive chronic condition that weakens the heart's ability to pump blood.
“They're afraid,” Pozehl said of people with heart failure. “(They say), 'I'm already tired, I'm already short of breath, and you want me to do something that is going to make that worse?'”
Nearly 5 million people in the United States have heart failure, according to the Heart Failure Society of America. Symptoms are often mistaken for normal signs of aging, such as shortness of breath during even mild activity, general fatigue and weight gain.
Many people with heart failure are able to exercise, but plans require “tremendous individualization,” said Dr. Mark Williams, director of Cardiovascular Disease Prevention and Rehabilitation at Alegent Creighton Health. “If we talk about a 10-minute walk, that might be difficult for some patients. There will be a wide variety of exercise tolerance.”
Alegent Creighton Health offers a maintenance program for heart failure patients at four hospitals in Omaha and Council Bluffs. Patients who pay a fee to exercise at the facilities have access to nurses the same way that traditional gym members have access to gym employees.
They do not, however, have regular meetings.
More than 200 patients will participate in the five-year study, which is funded through a $3.36 million grant from the National Institutes of Health. Participants are asked to exercise 150 minutes a week for 18 months.
Hester, who is participating in the study, said he worried about exercising without supervision after his diagnosis.
“I was nervous as heck,” he said. “I didn't know what you could do and what you couldn't do.”
Hester, of Lincoln, is among those in the study without a coach. Already, he said, he feels more comfortable working out alone.
“I'm moving things that haven't been moved in a while,” Hester said. “It's doing me good.”
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