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See detailWhat strategies are effective for exercise adherence in heart failure? A systematic review of controlled studies.
Tierney, Stephanie; Mamas, Mamas; Woods, Stephen et al

in Heart failure reviews (2012), 17(1), 107-15

Physical activity is recommended for people with stable heart failure (HF), because it is known to improve quality of life and health outcomes. However, adherence to this recommendation has been poor in ... [more ▼]

Physical activity is recommended for people with stable heart failure (HF), because it is known to improve quality of life and health outcomes. However, adherence to this recommendation has been poor in many studies. A systematic review was conducted to examine the effectiveness of strategies used to promote exercise adherence in those with HF. The following databases were searched for relevant literature published between January 1980 and December 2010: British Nursing Index; CINAHL; Cochrane Library; Embase; Medline and PsycINFO. Papers with a control group focused on adults with HF that measured exercise or physical activity adherence were included. Nine randomised controlled trials were identified, involving a total of 3,231 patients (range 16-2,331). Six of these studies were informed by specific psychological theories. Positive outcomes occurred in the short-term from interventions using approaches such as exercise prescriptions, goal setting, feedback and problem-solving. However, longer-term maintenance of exercise was less successful. There was some support for interventions underpinned by theoretical frameworks, but more research is required to make clearer recommendations. Addressing self-efficacy in relation to exercise may be a particularly useful area to consider in this respect. [less ▲]

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See detailWhat can we learn from patients with heart failure about exercise adherence? A systematic review of qualitative papers.
Tierney, Stephanie; Mamas, Mamas; Skelton, Dawn et al

in Health psychology : official journal of the Division of Health Psychology, American Psychological Association (2011), 30(4), 401-10

OBJECTIVES: Keeping physically active has been shown to bring positive outcomes for patients diagnosed with heart failure (HF). However, a number of individuals with this health problem do not undertake ... [more ▼]

OBJECTIVES: Keeping physically active has been shown to bring positive outcomes for patients diagnosed with heart failure (HF). However, a number of individuals with this health problem do not undertake regular exercise. A review of extant qualitative research was conducted to explore what it can tell us about barriers and enablers to physical activity among people with HF. METHODS: A systematic search, involving electronic databases and endeavors to locate gray literature, was carried out to identify relevant qualitative studies published from 1980 onward. Data from retrieved papers were combined using framework analysis. Papers read in full numbered 32, and 20 were included in the review. RESULTS: Synthesis of results from the 20 studies resulted in 4 main themes: Changing soma, negative emotional response, adjusting to altered status, and interpersonal influences. How individuals responded to their diagnosis and their altered physical status related to their activity levels, as did the degree of encouragement to exercise coming from family, friends, and professionals. These findings can be connected to the theory of behavioral change developed by Bandura, known as social cognitive theory (SCT). CONCLUSIONS: SCT may be a useful framework for developing interventions to support patients with HF in undertaking and maintaining regular exercise patterns. Specific components of SCT that practitioners may wish to consider include self-efficacy and outcome expectancies. These were issues referred to in papers for the systematic review that appear to be particularly related to exercise adherence. [less ▲]

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See detailWhat influences physical activity in people with heart failure?: a qualitative study.
Tierney, Stephanie; Elwers, Heather; Sange, Chandbi et al

in International journal of nursing studies (2011), 48(10), 1234-43

BACKGROUND: Research has highlighted the benefits of physical activity for people with stable heart failure in improving morbidity and quality of life. However, adherence to exercise among this patient ... [more ▼]

BACKGROUND: Research has highlighted the benefits of physical activity for people with stable heart failure in improving morbidity and quality of life. However, adherence to exercise among this patient group is low. Barriers and enablers to sustained physical activity for individuals with heart failure have been little investigated. OBJECTIVES: To explore reasons why people with heart failure do and do not engage in regular physical activity. DESIGN: A qualitative, interview-based investigation. SETTINGS: Three heart failure clinics held at hospitals in the UK. PARTICIPANTS: Purposive sampling was adopted to provide maximum variation in terms of gender, age, heart failure duration and severity, and current activity levels. Twenty two patients (7=female) were interviewed, aged between 53 and 82 years. METHODS: Semi-structured interviews were conducted via telephone. These were recorded and transcribed verbatim. Framework analysis was applied to collected data. RESULTS: Interviewees' narratives suggested that adopting positive health behaviours was complex, affected by internal and external factors. This was reflected in the four themes identified during analysis: fluctuating health; mental outlook; others' expectations; environmental influences. Failure to exercise arose because of symptoms, co-morbidities, poor sense of self as active and/or lack of perceived benefit. Likewise, encouragement from others and inclement weather affected exercising. CONCLUSIONS: Areas identified during interviews as influencing activity levels relate to those commonly found in behavioural change theories, namely perceived costs and benefits, self-efficacy and social support. These are concepts that practitioners may consider when devising interventions to assist patients with heart failure in undertaking and maintaining regular exercise patterns. [less ▲]

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