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ARYA Atheroscler. 2014 Nov;10(6):319-33.

Self-efficacy strategies to improve exercise in patients with heart failure: A systematic review.

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Assistant Professor, Department of Public Health, School of of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Associate Professor, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Associate Professor, Department of Biostatistic, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.
Professor, Department of Public Health, School of Health, Qom University of Medical Sciences, Qom, Iran.
Department of Community Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
Assistant Professor, Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.



Despite exercise is recommended as an adjunct to medication therapy in patients with heart failure (HF), non-adherence to exercise is a major problem. While improving self-efficacy is an effective way to increase physical activity, the evidence concerning the relationship between strategies to enhance self-efficacy and exercise among HF has not been systematically reviewed. The objective of this systematic review is to assess the effect of interventions to change the self-efficacy on exercise in patients with HF.


A systematic database search was conducted for articles reporting exercise self-efficacy interventions. Databases such as PubMed, ProQuest, CINAHL, Scopus, and PsycINFO, and the Cochrane Library were searched with restrictions to the years 2000-June 2014. A search of relevant databases identified 10 studies. Published randomized controlled intervention studies focusing strategies to change self-efficacy to exercise adherence in HF were eligible for inclusion. In addition, studies that have applied self-efficacy-based interventions to improve exercise are discussed.


Limited published data exist evaluating the self-efficacy strategies to improve exercise in HF. Dominant strategies to improve patients' self-efficacy were performance accomplishments, vicarious experience, verbal persuasion, emotional arousal.


Evidence from some trials supports the view that incorporating the theory of self-efficacy into the design of an exercise intervention is beneficial. Moreover, exercise interventions aimed at integrating the four strategies of exercise self-efficacy can have positive effects on confidence and the ability to initiate exercise and recover HF symptoms. Findings of this study suggest that a positive relationship exists between self-efficacy and initiating and maintaining exercise in HF, especially in the short-term period.


Exercise; Heart Failure; Self-Efficacy


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