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CompletedNCT03402490Ex-DHFadd-onUpdated Jan 18, 2018

Enhancement of Physical Activity in Elderly Patients With Diastolic Heart Failure by a Motivational Intervention

An interventional study of Motivational interviewing in Diastolic Heart Failure, sponsored by University of Göttingen. Completed. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2018-01-18.

Sponsored by University of Göttingen · Not applicable, Interventional, and Supportive care

Phase
Not applicable
Study type
Interventional
Enrollment
39
Allocation
Non-randomized
Ages
18 Years and older
Sex
All
01

Study summary

The aim of our pilot study is to evaluate the feasibility, acceptance and efficacy of motivational interviewing (MI) to support elderly patients with heart failure with preserved ejection fraction (HFpEF) in maintaining or starting physical activity (PA).

Read the detailed description

Patients discharged from the Ex-DHF trial were recruited from June 2013 to December 2015 and offered participation in a controlled add-on pilot study. The treatment group (n=19) received 5 sessions of MI, each lasting 15-30 min over 6 months to enhance physical activity.

For the first two and the last sessions participants met with the psychologist-counsellor face-to-face for about 45 minutes. The remaining three sessions could be conducted via telephone or face-to-face, depending on participants' preferences, and typically lasted 15-30 minutes. Per study protocol, counsellors (physicians and psychologists trained in motivational interviewing) assisted the participants in: (1) Setting goals for their physical activity; (2) developing a plan to increase physical activities; (3) setting specific plans for the implementation of the plan; and (4) overcoming possible barriers. Participants were also asked to keep track of their daily physical activity in a diary, which counsellors then discussed with them during the sessions.

After patients had given their written informed consent, counsellors assessed all participants via structured interview and self-rating scales. At baseline only, sociodemographic information was recorded.

At baseline and at the final 6-month visit participants' motivation to be physically active in the upcoming weeks was assessed using the SSK-scale ("Sportbezogene Selbstkonkord" = sports-related self-concordance, Seelig and Fuchs 2006) to assess the self concordance of sport- and exercise-related goals.

The kind and extent of patients' daily physical activity was recorded using patient diaries. At baseline and 6 months we also conducted a symptom-limited cardiopulmonary exercise test on a bicycle ergometer, in order to assess changes in maximum rate of oxygen consumption during the last 30 seconds before the termination of the exercise (peak oxygen consumption (VO2 [ml/min/kg])) as measure of maximal exercise capacity. Participants also completed the 6-minute walk test on flat surface (6-MWT) as an additional parameter to assess submaximal exercise capacity.

Additionally, at the 6-month assessment, intervention participants filled out a questionnaire about their subjective evaluation of the counseling program.

The control group (n=20) received usual care.

02

Conditions studied

  • Diastolic Heart Failure

Keywords

  • Motivational interviewing
  • physical activity
  • feasibility
  • HFpEF
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • preserved left ventricular systolic function (left ventricular ejection fraction >= 50%),
  • echocardiographically determined diastolic dysfunction (grade ≥ 1),
  • New York Heart association functional classes I, II or III,
  • at least one cardiovascular risk-factor (overweight, diabetes, hypertension, smoking or hyperlipidemia)
  • participation in Ex-DHF main study
  • written informed consent

Exclusion criteria

Exclusion Criteria:

  • Non-cardiac causes for heart failure-like symptoms
  • Chronic obstructive pulmonary disease GOLD stages ≥II
  • Anaemia (haemoglobin \<11 mg/dL)
  • Significant renal dysfunction (eGFR \<30 mL/min/1.73 m**2 indexed to BSA)
  • Significant peripheral artery disease (Fontaine ≥IIb)
  • Musculoskeletal disease that contributes to reduced exercise performance
  • Specific cardiomyopathy (e.g. amyloidosis)
  • Haemodynamically significant valvular disorders
  • Significant coronary artery disease (current angina pectoris Canadian Cardiovascular Society Class ≥II or positive stress test, myocardial infarction or coronary artery bypass graft within the last 3 months)
  • Any inability or contraindication to participate in cardiopulmonary exercise testing or in an exercise programme (e.g. physiological, mental) or to supply essential information (e.g. questionnaire, diary)
  • Ineffective control of resting blood pressure (≥140/90 mmHg or ≥160/100 mmHg with ≥3 antihypertensive drugs) or of resting heart rate (≥100 b.p.m.)
  • Expected low adherence (e.g. by travel distance to trial site; planned absences longer than 4 weeks during follow-up) or ongoing drug abuse
  • Pregnant or nursing women
  • Concomitant participation in other interventional clinical trials
04

Study design

Phase
Not applicable
Primary purpose
Supportive care
Allocation
Non-randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
39 participants (actual)

Study arms

  • Experimental
    Motivational interviewing

    Over a time span of 6 months, participants in the intervention group received up to 7 sessions of motivational counseling, lasting 15-30 minutes each, to enhance physical activity.

    Behavioral: Motivational interviewing

  • No intervention
    Usual care

    Participants who served as controls received usual care.

Interventions

  • BehavioralMotivational interviewing
05

What researchers measure

Primary outcomes

  1. Adherence to intervention

    To evaluate the feasibility of motivational counseling to enhance physical activity patients´ adherence to appointments is assessed as number / percentage of sessions attended

    Time frame: Over 6 month intervention period

  2. Patient acceptance of intervention

    To assess how patients evaluate the Intervention, i.e. receiving motivational counseling, they were asked to fill in evaluation sheets

    Time frame: At 6-month assessment

  3. Effectiveness (peak VO2)

    Changes in the maximal exercise capacity (peak VO2) during a symptom-limited cardiopulmonary exercise test on a bicycle ergometer.

    Time frame: Change from baseline to 6-month assessment

  4. Effectiveness (6-minute walk distance)

    Six-minutes walking distance

    Time frame: Change from baseline to 6-month assessment

Other outcomes

  1. Motivation

    Participants' motivation to be physically active was registered using the SSK (Sports-related self-concordance) scale. The self-concordance score is computed by subtracting the sum of the introjected and extrinsic motivation from the sum of the intrinsic and identified motivation subscales, with resulting scores ranging from -10 to +10 (higher value = higher self-concordance)

    Time frame: Change from baseline to 6-month assessment.

  2. Physical activity

    The kind and extent of patients' daily physical activity was recorded using patient diaries

    Time frame: Change from baseline to 6-month assessment.

06

Study locations

No study locations are listed for this record.

07

Registry details

Key details

Study ID
NCT03402490
Lead sponsor
University of Göttingen
Collaborators
Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK)
Responsible party
Christoph Herrmann-Lingen (Prof. Dr., University of Göttingen) — Principal investigator
First posted
Jan 18, 2018
Start date
Jun 18, 2013
Primary completion
Dec 8, 2015
Completion
Dec 8, 2015
Last update
Jan 18, 2018

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
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