Factors limiting habitual exercise in patients with chronic heart failure: a multicenter prospective cohort study

Physical activity (PA) in the daily life is strongly related to prognosis in patients with or at high risk of heart failure (HF). However, factors limiting habitual exercise and their prognostic impacts remain unknown in HF patients. We sent questionnaires asking factors limiting habitual exercise in the daily life to 8370 patients with Stage A/B/C/D HF in our nationwide registry and received valid responses from 4935 patients (mean age 71.8 years, 71.0% male). Among the 5 components consisting of busyness, weak will, dislike, socioeconomic reasons and diseases in the questionnaires, busyness (34.5%) and diseases (34.7%) were the most frequently reported factors limiting habitual exercise, while socioeconomic reasons were the least (15.3%). Multiple Cox proportional hazard models indicated that busynessand diseases were associated with better (hazard ratio (HR) 0.53, 95% confidence interval (CI) 0.39-0.72, P < 0.001) and worse prognosis (HR 1.57, 95% CI 1.21-1.98, P < 0.001), respectively, while other components were not. Furthermore, it was noted that, while prognostic relevance of busyness limiting exercise did not differ by age or sex, negative impact of diseases was particularly evident in patients with age < 75 years (P for interaction < 0.01). Factors limiting habitual exercise were associated with busyness and diseases, but not with weak will, dislike, or socioeconomic reasons. While busyness was associated with better prognosis regardless of age and sex, diseases was associated with worse prognosis in younger populations. Thus, physicians may pay more attentions to the reasons that limit exercise in the daily lives of HF patients rather than the low amount of exercise itself.