Patients' experiences of physical limitations in daily life activities when suffering from chronic heart failure; a phenomenographic analysis The aim of the study was to describe how patients suffering from chronic heart failure conceived their physical limitations in daily life activities. An explorative and qualitative design with a phenomenographic approach was chosen, a total of 15 patients were interviewed. The findings indicate that participants perceived a variety of structural aspects pertaining to physical limitations in activities of daily life which resulted in four referential aspects. Need of finding practical solutions in daily life focused on how life had to be changed and other ways of performing activities of daily life had to be invented. Having realistic expectations about the future was characterised by belief that the future itself would be marked by change in physical functioning, but an incentive to maintain functions and activities ensured good quality of or even increased capacity in daily life. Not believing in one's own ability included the perception of having no opportunity to improve ability to perform activities of daily life. There were perceptions of undesired passivity, undefined fear of straining themselves or performing activities that could endanger their health in addition to uncertainty about the future. In Losing one's social role in daily life, participants described losing their social network and their position in society and family because of limited physical capacity. A lack of important issues, mental and physical, occurred when physical capacity was lost. In conclusion, patients suffering from chronic heart failure found new solutions to manage activities in daily life, including willingness to change focus and identify other ways of doing important things. Patients had an incentive to maintain functions and activities to ensure a good quality of and strengthen their physical capacity in daily life. Inability to trust in their physical capacity in combination with experienced limitations in daily life prevented patients from attempting to increase activities.

BACKGROUND: Physical limitation is a great burden for patients with heart failure, but little is known about how that affects spouses. Beneficial effects of support on the prognosis for the patient with chronic heart failure may come at a psychological and physical cost to the person providing the support.

PURPOSE: The aim of this study was to explore and describe how spouses conceive the physical limitations in patients with heart failure and the impact these limitations have on the daily life of the spouse.

DESIGN: A qualitative design with a phenomenographic approach was chosen for the study.

FINDINGS: The informants were 15 spouses of heart failure patients. The spouses perceived a variety of aspects pertaining to how they conceive the physical limitations in the loved one with heart failure and the implication this had on their daily life. The referential aspects were: Losing self-containment, Missing communality, Accommodating to the situation and Finding satisfaction in life.

IMPLICATIONS AND CONCLUSIONS: Awareness must be raised among health care professionals about the profound impact heart failure in loved ones has on the spouses and explore how the spouses' needs can be appropriately met. Since spouses have an important role to play in the management of heart failure, it is of great importance that nurses identify and support spouses to manage daily life activities. Taking care of the good days in order to have a rich life and to help spouses see possibilities is necessary since it is difficult to predict the future.

INTRODUCTION: Chronic heart failure (CHF) limits exercise capacity which influences physical fitness and health-related quality of life (HRQoL).

AIM: The aim was to determine the effects on physical capacity and HRQoL of an exercise programme in elderly patients with CHF in primary care.

METHODS: An exercise intervention was conducted as a prospective, longitudinal and controlled clinical study in primary care in elderly patients with CHF. Endurance exercise and resistance training were conducted as group-training at the primary care centre and as home training. Follow-up on physical capacity and HRQoL was done at 3, 6 and 12months.

RESULTS: Exercise significantly improved muscle endurance in the intervention group (n=29, mean age 76.2years) compared to the control group (n=31, mean age 74.4years) at all follow-ups except for shoulder flexion right at 12months (shoulder abduction p=0.006, p=0.048, p=0.029; shoulder flexion right p=0.002, p=0.032, p=0.585; shoulder flexion left p=0.000, p=0.046, p=0.004). Six minute walk test improved in the intervention group at 3months (p=0.013) compared to the control group. HRQoL measured by EQ5D-VAS significantly improved in the intervention group at 3 and 12months (p=0.016 and p=0.034) and SF-36, general health (p=0.048) and physical component scale (p=0.026) significantly improved at 3months compared to the control group.

CONCLUSION: This study shows that exercise conducted in groups in primary care and in the patients' homes could be used in elderly patients with CHF. The combination of endurance exercise and resistance training has positive effects on physical capacity. However, the minor effects in HRQoL need further verification in a study with a larger study population.