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J Rehabil Med 2019; 51: 532–538 ORIGINAL REPORT PHYSICAL ACTIVITY RECOMMENDATIONS FOR PATIENTS WITH HEART FAILURE BASED ON SEX: A QUALITATIVE INTERVIEW STUDY Emilie CEWERS 1 , Adam JOENSSON 1 , Jean Marc WEINSTEIN, MB, BS, FRCP 2 , Tuvia BEN GAL, MD 3 and Tiny JAARSMA, RN, PHD 4 From the 1 Faculty of Medical and Health Sciences, Linkoping University, Linköping, Sweden, 2 Cardiology Department, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel, 3 Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva, affiliated to the Sacker Faculty of Medicine, Tel Aviv University, Israel and 4 Department of Nursing, Faculty of Medical and Health Sciences, Linkoping University, Norrköping, Sweden Objective: Physical activity is an essential part of managing heart failure. However, adherence to ac- tivity recommendations is low, especially in female patients. The aim of this study was to investigate the perceptions of healthcare providers regarding sex differences in physical activity, motivation, barriers, and whether adaptations in care based on sex might be meaningful. Methods: This is a qualitative study; data were col- lected in semi-structured interviews with healthcare providers. The data were analysed using qualitative content analysis. Results: The major overarching theme was that healthcare providers feel that “Men and women are equal, but different”. This theme was explained in terms of 7 sub-themes with associated categories, as follows: “Men and women prefer and perform dif- ferent physical activity regardless of health status”, “Male and female heart failure patients have diffe- rent motivations for, and barriers to, being active”, “Factors related to differences in physical activity and physical capacity between male and female heart failure patients”, “Heart failure has more impact on physical activity and physical capacity than patient’s sex”, and “Tailoring activity advice for heart failure patients based on sex.” Discussion: Healthcare providers had clear opini- ons regarding the existence of sex differences that might affect patients’ care. Several differences were identified in male and female heart failure patients in terms of physical activity. There seems to be a conflict between fear of discriminating and the value of personalizing care. Key words: exercise; women; heart failure; qualitative. Accepted May 16, 2019; Epub ahead of print Jun 4, 2019 J Rehabil Med 2019; 51: 532–538 Correspondence address: Tiny Jaarsma, Nursing, Linköping University, 60174 Norrköping, Sweden. E-mail: [email protected] H eart failure (HF) is a highly prevalent and severe syndrome that affects 26 million people world- wide and 1-2 % in many countries, including Sweden (1). HF severely compromises the lives of patients through symptom burden (e.g. breathlessness, fatigue and ankle swelling), reduction in quality of life and LAY ABSTRACT Physical activity is an essential part of managing heart failure. However, not all patients are active, especial- ly women. This study investigated the perceptions of healthcare providers regarding sex differences in phy- sical activity, motivations and barriers, and whether adaptations in care based on sex might be meaningful. This is a qualitative study and data were collected in in- terviews with healthcare providers. Data were analysed using qualitative content analysis. The major theme was that healthcare providers feel that “Men and women are equal, but they are different”. They described that men and women have different reasons and barriers to being active and that they perform different activities. They felt that different care might be needed for patients with heart failure, but that disease burden often has a greater impact on physical activity than patient’s sex. Healthcare providers had clear opinions regarding the existence of sex differences that might affect patients’ care. Several differences were identified in male and female heart failure patients in terms of physical acti- vity. There seems to be a conflict between fear of discri- minating and the value of personalizing care. physical capacity, and high rates of hospitalization, morbidity and mortality (2–4). Moreover, the patients are at risk of developing several HF-related complica- tions, contributing to an overall poor prognosis (5, 6). Routine physical activity (PA) has been shown to be beneficial for health-related quality of life in patients with HF and has a negative correlation with future HF-specific hospitalization (7). Although no significant difference in mortality rates in patients with HF has been seen with routine PA in the short term, current evidence indicates a potential reduction in mortality in the longer term (7). Despite the benefits of PA, overall adherence to ad- vice about PA in patients with HF is poor (8–10). This is in accordance with the mean general non-adherence with long-term therapies of 50% (11), and can be explained by a combination of healthcare providers’ non-compliance with guidelines and by patients failing to follow recommended therapy. Healthcare providers play an important part in promoting PA and have been viewed as a vital source of support for increasing levels of PA. The importance of healthcare providers’ This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2569 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977