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Table I. Themes and categories from the interviews with healthcare professionals
Themes Categories
Men and women prefer and perform different PA regardless of health status Sex differences in PA and capacity in healthy people
Sex differences in PA and capacity in patients with HF
Barriers to and motivations for PA in male patients with HF
Barriers to and motivations for PA in female patients with HF
Factors influencing PA and physical capacity
Factors influencing barriers and sex differences in barriers to PA
Impact of healthcare provider on sex differences in PA
Impact of the disease severity on sex differences in physical capacity
Impact of the disease severity on barriers to and motivations for PA
Adapting HF care based on sex
Difficulties in adjusting HF care based on sex
Factors to consider when giving PA advice to patients with HF
Male and female patients with HF have different motivations for and barriers to being
active
Factors related to differences in PA and physical capacity between male and female
patients with HF
The HF has more impact on PA and physical capacity than patient’s sex
Tailoring activity advice for patients with HF based on sex
PA: physical activity; HF: heart failure.
• To validate the units of analysis, a summary of the interview
was sent to all respondents, who were requested to confirm
what had been said, and to correct or add anything, if needed.
Likewise, discussions were held with a second researcher
throughout the process of collecting and analysing the qua-
litative data.
• Quotations from the interviews are used to illustrate the
themes and categories, further strengthening the creditability
of the results.
• Finally, the content of the analysis was discussed with 2 ex-
perienced HF healthcare providers who commented on the
final interpretation (TBG and JMW).
RESULTS
The study revealed 5 themes with associated categories
(Table I), as follows:
Men and women prefer and perform different
physical activity regardless of health status
The healthcare providers identified multiple differen-
ces between men and women in terms of performing
PA. Sex differences were described regardless of health
status, although observations were more ambivalent
when comparing patients with HF.
“Sex differences in physical activity and capacity
in healthy people” reflects the view among healthcare
providers that healthy men are stronger and more ac-
tive than healthy women. Men and women were also
believed to have different preferences for activities.
The healthcare providers expected women to carry out
less intense activities than men, such as yoga, Pilates,
dancing and walking, whereas men were expected to
do sports, running and weight-lifting. One respondent
suggested that the reason for this discrepancy in PA
could be multifactorial, saying: “Maybe, for a number
of reasons, maybe because it is a bit sort of a male thing
to do exercise, but also in general women are maybe
more preoccupied with sort of other things like the
house and kids and stuff like that.” (R12).
In the second category “Sex differences in physical
activity and capacity in HF patients”, the healthcare
providers described a similar sex discrepancy in prefe-
rence for activities among patients with HF. However,
in terms of level of PA and physical capacity, the ob-
servations were inconsistent. While some stated that
female patients were more active and performed better
physically than their male counterparts, others reported
higher male attendance in cardiac rehabilitation. One
respondent said: “They [female patients] are less ac-
tive. They will do maybe less rehabilitation. They will
do less physical activity which is recommended. They
are very, very, very limited.” (R2).
Male and female heart failure patients have different
motivations for, and barriers to, being active
The healthcare providers described that male and
female patients differ in terms of barriers and moti-
vations (Table II).
In the category “Barriers to and motivations for PA
in female HF patients”, family, external appearance
and exercising in groups were mentioned as being
particularly important motivations for female patients.
Some healthcare providers experienced female patients
as being more motivated than male patients, while they
felt that men had a stronger tendency to give up. One
Table II. Barriers and motivations for physical activity of male and female patients as perceived by healthcare providers
Female motivations Male motivations Female barriers Male barriers
Family Wanting to be stronger Physical inactivity prior to heart failure Work
Exercising in a group Health reasons Lack of time Ashamed of showing weakness
Appearance Competition Lack of self-esteem Laziness
Wanting to get back to work Fear
Appearance
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