比较有心力衰竭的黑人和白人老年患者的运动决定因素。

Comparing exercise determinants between Black and White older adults with heart failure.

机构信息

Department of Health Sciences, School of Health & Human Sciences, Indiana University, 901 W New York St., Indianapolis, IN, 46202, USA.

College of Nursing, Ohio State University, Columbus, OH, USA.

出版信息

BMC Geriatr. 2023 Sep 30;23(1):614. doi: 10.1186/s12877-023-04305-2.

DOI:10.1186/s12877-023-04305-2

PMID:37777727

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10543325/

Abstract

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.

摘要

背景

心力衰竭是老年人死亡的主要原因。有规律地进行中等至剧烈强度的运动已被证明可以提高生存率。建议采用理论指导的方法来促进运动，但在理解心力衰竭的老年人群体中的种族差异方面，理论框架的应用有限。本研究旨在使用健康信念模型比较诊断为心力衰竭的黑人和白人老年患者的运动行为决定因素。

方法

HF-ACTION 试验是一项多中心研究，旨在促进心力衰竭患者的运动，将参与者随机分配到实验组（三个月的小组运动课程，随后进行家庭训练）或对照组。本研究使用结构方程模型来检验健康信念模型结构在 12 个月内的变化以及老年人的运动行为。

结果

参与者（n=671）为年龄较大的成年人，年龄为 72.28（SD=5.41）岁（黑人：n=230；白人，n=441），被诊断为心力衰竭和射血分数降低。该模型发现，感知益处、自我效能、感知威胁和感知障碍可以预测黑人和白人老年患者的运动行为。然而，在这些结构中，只有感知益处和自我效能通过干预得到了促进，这两种种族都是如此。此外，干预措施仅对白种参与者的运动障碍有效果。最后，干预措施并没有改变两种种族的感知威胁。