Temporal Variation in Psychosocial Factors and Physical Activity Levels Among Patients With Heart Failure

BACKGROUND: Anecdotal evidence suggests that symptoms and physical activity levels in patients with heart failure (HF) fluctuate considerably, though empirical data to support this claim are sparse. We examined how stable psychosocial traits (eg, intrinsic motivation), situational psychosocial states (eg, vitality), and HF symptoms vary in stable patients with HF and their association with physical activity. METHODS: The MOVIN-HF study (Mobile Health Intervention to Increase Activity in Heart Failure) was a prospective, observational study of patients with symptomatic HF. We collected data on (1) psychosocial traits at baseline and (2) twice daily ecological momentary assessments for 28 days of participants' symptoms and current psychosocial states. Physical activity was measured by smartwatch step counts. We evaluated the association between baseline psychosocial states and mean daily step counts and between ecological momentary assessments of symptoms and psychosocial states and short-term step counts (12 hours after ecological momentary assessments). Mixed effects models quantified associations. RESULTS: Between February and June 2024, 30 participants enrolled in the study; the mean age was 59.7 (SD, 13.6) years, 53% were female, and most (63%) had New York Heart Association class 2 HF symptoms. Baseline psychosocial traits like motivational quality were significantly associated with daily step count. For example, each 1-point increase in intrinsic motivation was associated with 39% higher daily step count (95% CI, 3%-87%). There was also significant variability in ecological momentary assessment scores of symptoms and psychosocial states: 10 (33%) participants experienced a 50% or greater change in HF symptoms, and 18 (60%) a 50% or greater change in vitality. HF symptoms and psychosocial states (eg, vitality, competence) were significantly associated with 12-hour step count. CONCLUSIONS: Baseline psychosocial traits are associated with daily physical activity. In addition, symptoms and psychosocial states fluctuate frequently among patients with HF and are associated with short term physical activity. These findings suggest tailored interventions may improve physical activity levels.