BACKGROUND: Exercise is safe and provides considerable benefits for patients with heart failure (HF) including improved function, quality of life, and symptoms. However, patients with HF have difficulty initiating and adhering to an exercise regimen. To improve adherence, our team developed Heart Failure Exercise and Resistance Training (HEART) Camp, a multicomponent, theory-driven intervention that was efficacious in a randomized controlled trial of long-term adherence to exercise in patients with HF. Identifying active components of efficacious interventions is a priority. PURPOSE: The purpose of this study is to use mediation analysis to determine which interventional components accounted for long-term adherence to exercise in patients with HF. METHODS: This study included 204 patients with HF enrolled in a randomized controlled trial. Instruments measuring interventional components were completed at baseline, 6, 12, and 18 months. Hierarchical linear models generated slope estimates to be used as predictors in logistic regression models. Significant variables were tested for indirect effects using path analyses with 1,000 bootstrapped estimates. RESULTS: Significant mediation effects were observed for the interventional components of negative attitudes (beta[NA] = 0.368, SE = 0.062, p < 0.001), self-efficacy (beta[SE] = 0.190, SE = 0.047, p < 0.001), and relapse management (beta[RM] = 0.243, SE = 0.076, p = 0.001). CONCLUSIONS: These findings highlight improving attitudes, self-efficacy, and managing relapse as key interventional components to improve long-term adherence to exercise in patients with HF. Future interventions targeting adherence to exercise in patients with HF and other chronic illnesses should consider the incorporation of these active components.

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