Table 2 Intervention components, strategies and delivery

KNOWLEDGE

Knowledge of exercise training

• Aerobic exercise

9 exercise training sessions delivered by facility staff.

• Resistance exercise (bands, free weights or circuit equipment)

• Heart rate monitor to self-monitor

Weekly meetings with coach for training first 12 months.

• Rating of perceived exertion (RPE) to self-monitor

Camp topics on exercise in the daily life of a patient with HF

• HEART Camp Motto – “Choose to Move for Heart Improvement” – Discussion of expectations and feelings related to exercise

Weekly group sessions with the RN (30 minutes of content and 30 minutes of discussion).

• “Game Day: Firing up your Engine” – Pathophysiology of HF and benefits of exercise

• “Telling Your Story” – Sharing symptom experiences and understanding symptoms in relation to exercise

Schedule will repeat every 6 weeks. Subjects expected to attend each session at least once. Subjects encouraged to bring significant others/family to sessions.

• “Show & Tell” – Bring medications to group session and discuss actions and effects in relation to exercise

• “Pack-a-Lunch Day” – Dietary sodium and fluid restrictions (discuss fluid retention and effects on exercise)

• “Survival Guide” – How-to exercise safely during life’s ups and downs

ATTITUDES

Safety (Reducing fear)

• Cardiopulmonary Stress Test (CPX) at beginning of run-in

Facility staff and coach use individual exercise guidelines to adjust exercise

• Individual exercise guidelines determined from CPX (40%-80% HRR)

Perceived benefits and barriers

• Complete Barriers Self-Efficacy Scale (BARSE) at each data collection point

Weekly meetings with the coach to discuss barriers, strategies to overcome barriers, and reinforce exercise benefits

• Weekly discussion with coach to identify individual strategies for overcoming perceived barriers to exercise and reinforcement of benefits

SELF-EFFICACY

Enactive mastery experiences (performance accomplishment)

• Return demonstrate use of exercise equipment and heart rate monitor

Subject’s weekly meeting with coach

• Goal setting for weekly exercise & review of weekly graphs of goal accomplishment (total number of sessions, total number of minutes of moderate intensity exercise)

Vicarious experience

• Sharing successes during group session discussion

Weekly group sessions with RN allow 30 minutes for group discussion and sharing

• Sharing strategies to overcome barriers during group sessions

Verbal persuasion

• Education on benefits of exercise

Six weekly group sessions with camp counselor.

• Web-based educational material related to exercise (HFSA Module on Exercise)

Weekly meetings with coach to discuss goal-setting and feedback.

• Feedback related to individual progress toward goals

Physiological & affective States

• Symptom assessment education

Discussed in group sessions and as needed by coach

• Recognition of warning symptoms to moderate or stop exercise

• Symptom management strategies for exercise

BEHAVIORAL SELF-MANAGEMENT SKILLS

Goal setting

• Goals: number of sessions and number of minutes of moderate intensity exercise per week

Coach reviews with subject each week

Self-monitoring

• Return demonstration of self-monitoring techniques (heart rate, rating of perceived exertion, symptoms)

Facility staff and coach

• Entry/log in exercise diary

Coach reviews diary weekly

Problem-solving

• Subject notes problems in exercise diary

Coach reviews diary weekly

• Subject reviews problems with coach

Barriers management

• Coach reviews BARSE at data collection time points (Baseline, 6 and 12 months)

Coach discusses individual perceptions and strategies

Relapse management

• Phone call to subject if relapse for one week

Coach places phone call to set up face-to-face meeting

SOCIAL SUPPORT

Social relationships

• Six weeks with RN in camp group sessions

Group sessions

• Weekly interaction with coach during adoption and transition

Weekly coach interaction