# What are the exercise barriers, facilitators and preferences of community-dwelling older adults with heart failure with preserved ejection fraction? A qualitative best fit framework analysis

## TL;DR

This study explores what helps and hinders older adults with heart failure to exercise, using insights from patient and public involvement events.

## Contribution

The study identifies specific capability, opportunity, and motivation factors influencing exercise behavior change in heart failure patients.

## Key findings

- Exercise barriers include negative symptoms and lack of self-efficacy in HFpEF patients.
- Facilitators include appealing components and adequate support for exercise engagement.
- Motivation factors like well-being and goal achievement are crucial for behavior change.

## Abstract

To establish, through patient and public involvement (PPI) events, the exercise barriers, facilitators and preferences of people with heart failure with preserved ejection fraction (HFpEF).

Qualitative ‘best fit’ framework analysis was used to analyse field notes and transcripts collected during three patient and public involvement meetings and three workshops. The best fit framework was based on the COM-B model of behaviour change, which has identified that Capability, Opportunity and Motivation components are essential for Behaviour change. The Consolidated criteria for Reporting Qualitative research checklist was used to structure the report.

Setting and participants: Community dwelling older adults with HFpEF.

24 people with HFpEF (n=16 female, 66%), 2 spouses and 2 people with chronic conditions participated in the PPI meetings and workshops. Multiple exercise-related capability (negative symptoms, functional ability, resilience and self-efficacy and knowledge and skill); opportunity (appealing components, optimal conditions, adequate support); and motivation factors (well-being, physical gains, goal achievement, sense of enjoyment) were identified as essential to facilitating change in exercise behaviours in people with HFpEF.

This study provides insight into capability, opportunity and motivation conditions that people with HFpEF feel are necessary to enable them to engage in exercise-related behaviour change. This work extends previous post hoc work by moving beyond identification of broad influencers that may enable or impede exercise intervention engagement, to identify intervention conditions necessary to affect change.