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and women in that respect. In terms of their wanting
to do stuff and actually doing it.” (R12). A proposed
explanation for the lack of sex differences in the HF
population was described as the type of recommended
activity, being aerobic and of low intensity: “We are
talking about thirty minutes of walking! Everybody
can do it I think. I didn’t notice any differences.”
(R3). Apart from the type of activity, the HF itself was
proposed to be the foremost reason for the lack of or
reduced sex differences, both in terms of performance
and in terms of barriers and motivations.
“The effect of disease limitations on sex differences
in physical capacity” refers to the physical limitation
accompanying the disease, which some healthcare
providers argued overrules any prior sex differences
in physical capability: “I think that both genders are
equally debilitated by the disease” and “I don’t think
there are any gender differences in the amount of
improvement in the exercise capacity of patients with
heart failure. I guess it would depend on the severity
of the disease.” (R1).
“The disease’s effect on barriers to and motivations
for PA” refers to the motivations and barriers relating to
the disease. The barriers to PA mentioned as accompa-
nying HF included depression, fear, hospitalization, lack
of energy and physical limitations. However, in contrast
to the increase in barriers that comes with the disease,
it was also suggested to provide increased motivation
to PA. “Healthy people don’t feel the clock ticking…
In contrast to healthy people where every activity is
preventive – here, it’s the treatment! So, it’s like you say
“What is your motivation to take a pill?” – I mean, I
don’t have the motivation if I don’t have any [disease].
But they have. So, they have to do it. It’s their pill.”
(R9). Table III sums up the motivations and barriers
that were mentioned as being common for both sexes,
among which the main ones were related to the disease.
Tailoring activity advice for heart failure patients
based on sex
Some healthcare providers said they did not adapt
their care based on the sex of the patient. When asked,
Table III. Common motivations and barriers of patients with
heart failure as described by healthcare providers
Common motivations Common barriers
Weight and shape Lack of time
Increasing functionality Fear
Feeling better Laziness
Know the importance Physical limitations
Improving quality of life Depression
Meeting with people Lack of energy
Noticing that they improve Weather barriers
Health reasons Barriers due to holidays
Hospitalization
www.medicaljournals.se/jrm
one of the healthcare providers said: “No, because
that strategy is unisex. It doesn’t favour one over the
other.” (R7). Based on not noting any sex differences
regarding physical capacity and activity in the HF
population, some also argued that adapting care ba-
sed on sex was unnecessary, saying “I don’t think it’s
something that is essential in terms of planning future
healthcare or rehabilitation for men or women.” (R12).
However, based on observed sex differences, others
argued that there is a value in adapting care based on
the sex of the patients. Three categories make up this
theme, including “Adaptions in care based on gender”,
“Difficulties in adapting care based on gender” and
“Factors to consider when giving PA advice”.
“Adapting HF care based on gender” refers to adap-
tation being done or proposals for things that can be
done. These included having different attitudes, using
different motivations, recommending different activi-
ties, addressing gender-specific barriers and offering
gender-specific rehabilitation groups/programmes. For
example, one respondent said: “I might approach it a
little bit differently… I will recommend, for a woman,
to go walking with a friend in the evening.” (R8). They
also argued that adapting care according to the indivi-
dual is essential, with gender being part of the equation:
“You have to take gender into account. And you have to
know the differences and to know your patient. To know
the motivations and the barriers.” (R2). When asked
if they tailor care to men and women, one interviewee
answered: “Obviously. Not because we recommend
something else. The attitude is different.” (R2).
“Difficulties in adjusting HF care based on sex”
refers to an identified fear among healthcare provi-
ders of discriminating and to the lack of knowledge
and research on the subject. One healthcare provider
said: “It’s problematic because if you make the wrong
decision, the family thinks as you say that it is discri-
mination. But I think it’s the lack of evidence-based
medicine. If you have research to back you up, you can
tell the family why this decision was made because it’s
for the benefit of the patient, it’s better for the patient
to treat her like this. It’s not discrimination.” (R9).
“Factors to consider when giving PA advice to HF
patients.” In addition to the sex of the patients, a few
other factors were mentioned as being important to
consider when giving advice about PA. These included
preference for activities, prior level of activity, disease
state, physical capacity, and religion.
DISCUSSION
Healthcare providers identified several differences
between male and female patients with HF with regard
to PA and motivations for and barriers to PA. Sex dif-