The Couples' Experiences of Patients' Physical Limitation in Daily Life Activities and Effects of Physical Exercise in Primary Care when having Chronic Heart Failure

The aim of this thesis was to explore and describe couples’ experiences of patients’ physical limitation in activities of daily life and evaluate the effects of an exercise programme in primary care when having chronic heart failure (CHF). In Study I, a comparison between patients with CHF and their spouses was made regarding health-related quality of life and depression. Inthe thesis a comparison was also made between patients, spouses and specific age and gender matched norms. There were statistically significant differences in health-related quality of life between patients and spouses as well as between patients and their norms as in SF-36 scores. The deteriorated health-related quality of life in patients was most present in the physical component but also in social function in the mental component. There were no differences between patients and spouses in depression symptoms. In Study II, patients with CHF described their conceptions of physical limitation in daily life activities. A phenomenographic approach made it possible to identify variations of the conceptions and the referential aspects that emerged were: need of finding practical solutions in daily life, having realistic expectations about the future, not believing in one’s own ability and losing one’s social role in daily life. In Study III, spouses’ conceptions about the physical limitation in daily life activities in a loved one with CHF andthe impact these limitations had on their daily life were examined. The phenomenographic approach resulted in different referential aspects. These were: losing self-containment, missing communality, accommodating to the situation and finding satisfaction in life. Study IV aimed at determining effects of an exercise programme in primary care in elderly patients with CHF. The intervention period was 12 months with continuous exercise in the primary care centre and in the patients’ homes. Tests of physical capacity showed significant consistent improvement in the exercise group in arms and shoulders during the intervention and in the 6 minute walk test at 3 months compared to the control group. The physical dimension of Minnesota living with heart failure was significantly improved at 3 months and Euroqol5DVAS was significantly improved at 3 and 12 months in the exercise group compared to the control group. The thesis shows that patients and spouses conceive a variety of issues of physical limitation in daily life and the physical component of health-related quality of life is the most affected. The physical capacity in patients is possible to affect with an exercise programme in primary care and patient homes. The exercise programme is beneficial interms of physical capacity in the upper body and walked distance in 6 minutes