What are the experiences of people with heart failure regarding participation in physical activity? A systematic review, meta-aggregation and development of a logic model.

Objectives
To (1) synthesise the experiences of people with heart failure and those who care for them concerning participation in physical activity (2) develop a logic model for a future intervention which will support people with heart failure to feel confident and safe in being physically active.

Design
A systematic review and meta-aggregation using Joanna Briggs Institute (JBI) methodology.

Data sources
MEDLINE, Emcare and PsycINFO databases were searched through until June 2024 inclusively.

Eligibility criteria
Studies with a qualitative design, including qualitative components of mixed-methods studies, which describe experiences of participation in physical activity by adults with chronic heart failure.

Data extraction and synthesis
Two independent reviewers used standardised methods to search and screen studies. Data extraction included the PROGRESS-Plus items. The JBI checklist for qualitative studies was applied. Meta-aggregation guided by JBI methods was used to synthesise the data. This evidence, along with input from a patient and public involvement group, healthcare professionals and charity organisations, was used to develop a logic model.

Results
We included 28 papers (25 studies) comprising 14 qualitative studies and 11 mixed-method studies describing the perspectives of 483 people with heart failure, 64 carers and 12 healthcare professionals.

The meta-aggregation produced seven synthesised findings describing the impact of physical symptoms, emotional factors, extrinsic factors, access to knowledge, self-motivation and peer/professional motivation and the positive impact of physical activity. The PROGRESS-PLUS tool identified significant inclusivity issues within the studies. The meta-aggregation with relevant contributor input informed behavioural determinants and potential intervention components of a logic model.

Conclusions
This study identifies behavioural determinants that underlie the actions of people with heart failure in their relationship with physical activity and potential intervention components for a novel intervention design to support this population. There is a lack of studies exploring health professionals’ and carers’ perspectives on this topic.