Researchers wanted to understand why people with heart failure struggle to stick with their self-care routines. They tracked 63 heart patients for a week, asking them twice daily about their plans and actual behaviors like taking medicine, watching their diet, weighing themselves, and exercising. The study found that patients were very consistent about taking medications but had much more trouble sticking with exercise. Interestingly, what people planned to do in the morning sometimes predicted what they’d actually do by evening—but not always. The research shows that motivation comes in different types, and understanding these differences could help doctors better support their patients in managing their heart health.

The Quick Take

  • What they studied: How well heart failure patients stick to their daily self-care routines and whether their morning intentions actually match what they do by evening
  • Who participated: 63 adults with heart failure (about half men, half women), averaging 62 years old, who used a mobile app to report their behaviors twice per day for one week
  • Key finding: Taking medicine was extremely consistent day-to-day, but exercise varied a lot. Morning plans to weigh themselves or exercise predicted evening behavior, but diet plans didn’t always lead to action
  • What it means for you: If you have heart failure, knowing that your morning intentions matter for some activities (like weighing yourself) but not others (like diet) can help you plan better. You might need extra support for exercise specifically, since it’s the hardest behavior to maintain consistently

The Research Details

This study used a special research method called ecological momentary assessment, which means researchers asked people about their real-life behaviors as they happened, rather than asking them to remember later. Sixty-three heart failure patients used a mobile app on their phones to answer two quick surveys every day for seven days. The surveys asked about their intentions (what they planned to do) in the morning and their actual behaviors (what they really did) in the evening. The researchers tracked four main self-care activities: taking medications, following a heart-healthy diet, weighing themselves daily, and exercising. This approach captures real daily life instead of relying on memory, which makes the results more accurate and honest.

Most research about patient behavior relies on people remembering what they did weeks or months ago, which is often inaccurate. By asking patients twice daily through their phones, this study captures the true ups and downs of daily life. This method also allows researchers to see which behaviors are stable habits and which ones change day-to-day, which is crucial information for helping doctors know where to focus their support efforts.

This study has several strengths: it used a real-time tracking method that reduces memory bias, it tracked actual daily behaviors rather than just asking about general habits, and it examined multiple self-care behaviors. However, the study was relatively small (63 patients) and only lasted one week, so results may not apply to all heart failure patients or show long-term patterns. The study also relied on patient self-reporting, which could be influenced by what people think researchers want to hear.

What the Results Show

The research revealed striking differences in how consistent patients were with different self-care behaviors. Taking medications was extremely stable—patients did it almost identically every single day (99% consistency). Weighing themselves and following diet rules were also fairly consistent (80% and 79% consistency). However, exercise was much more variable, changing significantly from day to day (only 46% consistency). This tells us that some self-care behaviors become automatic habits, while others require constant decision-making and motivation. The study also found that when patients intended to weigh themselves or exercise in the morning, they were significantly more likely to actually do those activities by evening. However, morning intentions about diet didn’t reliably predict evening diet behavior, suggesting that diet choices might be influenced by other factors like social situations or food availability that happen throughout the day.

The research identified different types of motivation that drive self-care behaviors. The most powerful motivations were ‘identified motivation’ (doing something because you understand why it’s important) and ‘integrated motivation’ (doing something because it fits with your personal values). These types of motivation were more common than ’external motivation’ (doing something just because someone told you to) across all self-care behaviors. This suggests that patients who understand the personal importance of their self-care and have made it part of their identity are more likely to stick with it. The study also showed that motivation types varied depending on the specific behavior—patients might have strong identified motivation for taking medicine but weaker motivation for exercise.

This study builds on self-determination theory, a well-established framework that explains how different types of motivation affect behavior. Previous research has shown that internal motivation (doing something because you want to) works better than external motivation (doing something because you have to) for long-term behavior change. This study confirms that pattern in heart failure patients and adds new information by showing that different self-care behaviors may require different types of motivation support. The finding that medication adherence is highly stable aligns with other research showing that when patients understand the life-or-death importance of medications, they tend to prioritize them.

The study only included 63 patients and lasted just one week, so we can’t be sure these patterns continue over months or years. The participants were mostly from one location and may not represent all heart failure patients, especially those from different cultures or socioeconomic backgrounds. The study relied entirely on patients self-reporting their behaviors through an app, which means some people might have reported what they thought researchers wanted to hear rather than the truth. Additionally, the study didn’t explore why exercise was so much harder to maintain than other behaviors—it just showed that it was. Finally, the research doesn’t tell us whether improving morning intentions would actually help patients do better with their self-care over the long term.

The Bottom Line

If you have heart failure: (1) Recognize that taking your medications is likely your strongest habit—keep that going. (2) Use morning planning for activities like weighing yourself and exercise, since your morning intentions predict evening success for these behaviors. (3) Understand that diet management may need different strategies than intention-setting alone, such as meal planning or social support. (4) If exercise is your struggle, you’re not alone—this study shows it’s the hardest behavior for most heart failure patients to maintain, so consider asking your doctor for extra support like cardiac rehabilitation programs or exercise coaching. Confidence level: Moderate—this is based on one week of data from a small group, so results may vary for different patients.

This research is most relevant to people living with heart failure and their healthcare providers. If you have heart failure, these findings can help you understand why some parts of your routine feel automatic while others require constant effort. Healthcare providers should use this information to stop assuming that all self-care behaviors are equally easy to maintain and instead provide targeted support for the behaviors patients struggle with most (especially exercise). Family members and caregivers of heart failure patients may also find this helpful for understanding where to offer support. This research is less relevant to people without heart failure, though some principles about motivation and behavior change might apply to other health conditions.

The study only tracked behaviors for one week, so we don’t know how long it takes to see real improvements. However, based on general behavior change research, if you implement these strategies (like using morning intentions for exercise and weighing), you might notice improvements in consistency within 2-4 weeks. Building lasting habits typically takes 2-3 months of consistent practice. You should discuss realistic timelines with your healthcare provider, as individual results vary significantly.

Want to Apply This Research?

  • Set up daily reminders at the same time each morning to log your self-care intentions for that day (medication, diet, weighing, exercise). Then log your actual behaviors in the evening. Track the percentage of days your evening behaviors matched your morning intentions. Aim to improve this match rate by 10% each week, starting with exercise and weighing since those showed the strongest connection between intention and action.
  • Use your app’s planning feature to set specific morning intentions for exercise and weighing yourself. For example: ‘Tomorrow morning I intend to weigh myself at 7am and exercise for 20 minutes at 5pm.’ Research shows that specific, time-bound intentions are more likely to become reality. For diet, instead of relying on morning intentions, use the app to plan meals the night before or track food choices in real-time as you make them throughout the day.
  • Create a weekly dashboard in your app showing consistency scores for each self-care behavior (similar to how the study measured stability). Watch for patterns—do certain days of the week show lower consistency? Do specific times of day work better for your intentions? Share these patterns with your healthcare provider to identify which behaviors need extra support. Over time, you should see medication consistency stay very high (95%+), while exercise and diet consistency gradually improve as you practice the intention-setting strategies.

This research provides insights into how heart failure patients manage their self-care, but it should not replace personalized medical advice from your healthcare provider. Every person’s heart failure is different, and what works for one patient may not work for another. Before making changes to your self-care routine, medication schedule, diet, or exercise program, always consult with your cardiologist or heart failure specialist. If you experience chest pain, shortness of breath, or other concerning symptoms, seek immediate medical attention. This study was conducted over one week with a small group of patients, so results may not apply to everyone with heart failure.