Is the Theory of Planned Behavior a Useful Framework for Understanding Exercise Adherence During Phase II Cardiac Rehabilitation? (original) (raw)
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What Sustains Long-Term Adherence to Structured Physical Activity After a Cardiac Event
Purpose: Research addressing methods to sustain long-term adherence to physical activity among older adults is needed. This study investigated the motivations and supports deemed necessary to adhere to a community-based cardiac rehabilitation (CBCR) program by individuals with established coronary heart disease. Methods: Twenty-four long-term adherers (15 men, 9 women; age 67.7 ± 16.7 yr) took part in focus-group discussions. Results: Constant comparative analysis supported previous research in terms of the importance of referral procedures, social support, and knowledge of health benefits in influencing uptake and adherence to CBCR. Results also highlighted the routine of a structured class and task-, barrier-, and recovery-specific self-efficacy as necessary to sustain long-term adherence for this specific clinical group. Discussion: Older adults themselves provide rich information on how to successfully support their long-term adherence to structured exercise sessions. Further research into how to build these components into any exercise program is necessary. Cardiovascular disease is the most common cause of mortality and morbidity in the world, accounting for 30% of all causes of death (Yusuf, Reddy, Ounpuu, & Anand, 2001). In the case of individuals with existing coronary heart disease, evidence suggests that exercise capacity is the strongest predictor of mortality in comparison with other known cardiovascular risk factors (Myers et al., 2002). Individuals who have suffered a cardiac event are encouraged to undergo cardiac rehabilitation (CR), the purpose of which is to educate patients on the meaning of heart disease and associated risk factors and help them implement the changes necessary to reduce these risk factors and prevent secondary occurrence. CR consists of four phases, of which physical activity is a key component. The aim is to gradually build up the patients' exercise capacity by educating them on the importance of physical activity (Phases I and II), encouraging them to attend supervised (generally hospital-based) exercise classes (Phase III), and helping them maintain
British Journal of Health Psychology, 2006
Objectives The aim of the present study was to test two brief planning interventions designed to encourage cardiac patients to engage in regular physical exercise following discharge from rehabilitation. The interventions comprised action plans on (a) when, where, and how to act, and (b) coping plans on how to deal with anticipated barriers.Design and method An experimental longitudinal trial was conducted to test two interventions that either focused on action planning alone, or on a combination of action planning and coping planning. A total of 211 participants completed assessments at baseline and 2 months after discharge. Participants were randomly assigned to either one of the intervention groups or a standard‐care control group.Results Participants in the combined planning group did significantly more physical exercise 2 months post‐discharge than those in the other groups.Conclusions The theoretical distinction between action planning and coping planning as introduced in the ...
Maintenance of Exercise After Phase II Cardiac Rehabilitation
American Journal of Preventive Medicine, 2011
Background-Patients who have completed Phase II cardiac rehabilitation have low rates of maintenance of exercise after program completion, despite the importance of sustaining regular exercise to prevent future cardiac events.
Effects of a CHANGE intervention to increase exercise maintenance following cardiac events
Annals of Behavioral Medicine, 2006
Background: Despite participation in a cardiac rehabilitation program, there is a downward trajectory of exercise participation during the year following a cardiac event. Purpose: The purpose of this study was to test the effectiveness of CHANGE (Change Habits by Applying New Goals and Experiences), a lifestyle modification program designed to increase exercise maintenance in the year following a cardiac rehabilitation program. The CHANGE intervention consists of 5 small-group cognitive-behavioral change counseling sessions in which participants are taught self-efficacy enhancement, problem-solving skills, and relapse prevention strategies to address exercise maintenance problems. Method: Participants (N = 250) were randomly assigned to the CHANGE intervention (supplemental to usual care) or a usual-care-only group. Exercise was measured using portable wristwatch heart rate monitors worn during exercise for 1 year. Cox proportional hazards regression was used to determine differences in exercise over the study year between the study groups. Results: Participants in the usual-care group were 76% more likely than those in the CHANGE group to stop exercising during the year following a cardiac rehabilitation program (hazard ratio = 1.76, 95% confidence interval = 1.08-2.86, p = .02) when adjusting for the significant covariates race, gender, comorbidity, muscle and joint pain, and baseline motivation. Most participants, however, had less than recommended levels of exercise amount and intensity. Conclusions: Counseling interventions that use contemporary behavior change strategies, such as the CHANGE intervention, can reduce the number of individuals who do not exercise following cardiac events.
BMC Cardiovascular Disorders, 2016
Background: Although the benefits of supervised physical activity programs in cardiac rehabilitation have been well documented, the amount of physical activity often drops quickly after the end of the supervised period. This trial (registered as ISRCTN77313697) will evaluate the effectiveness of an experimental intervention based on habit formation theory applied to physical activity maintenance. Methods/Design: Cardiovascular patients (N = 56) will be individually randomized into two groups. Two supervised physical activity (SPA) sessions per week will be offered to the first group for 20 weeks. Progressively autonomous physical activity (PAPA) will be offered to the second group as follows: 10 weeks of the same supervised program as the SPA group followed by 10 more weeks in which one supervised session will be replaced by a strategy to build and sustain the habit of autonomous practice of physical activity. The primary outcome is the amount of physical activity measured by the International Physical Activity Questionnaire (IPAQ; Craig et al., Med Sci Sport Exercises 35(8):1381-95, 2003). To compensate for the limited capacity to recruit subjects, multiple IPAQ measurements will be made (at T0, T5, T7, T9 and T12 months after the start of the intervention) and analyzed using the mixed model approach. We will also assess changes in physical and physiological indicators, automaticity of the physical activity behavior, motivation and quality of life. Last, we will assess the cost-effectiveness for each type of program. Discussion: If proven to be effective, the PAPA intervention, which requires fewer supervised sessions, should provide a cost-effective solution to the problem of physical activity maintenance in cardiac rehabilitation.
Exercise Habit of Cardiac Patients after Phase II Cardiac Rehabilitation Programme
Journal of the Hong Kong College of Cardiology
MAK ET AL.: Exercise Habit of Cardiac Patients after Phase II Cardiac Rehabilitation Programme. Objectives: To determine the exercise habit of patients who completed Phase II cardiac rehabilitation programme (CRP) from July 2002 to October 2003. Methods: Phone survey was conducted with patients who self-reported their exercise pattern. Type, frequency, duration, and intensity of exercise; exercise tolerance (ET) in terms of flight of stairs (FOS) achieved and walking distance on level ground, and pre-programme exercise habit were analysed. Results: Among 120 Phase II graduates, 107 patients responded to the survey. Ninety-five patients (70 males), aged 45-82, reported they did exercise weekly. Forty-six patients (48.4%) did not exercise regularly beforehand. Walking was the most common exercise (66.3%). Light and moderate to vigorous-intensity exercises were performed by 47% and 53% of patients respectively. Exercise <3 times/week or spent <30 minutes/session was revealed in 27% of patients. Frequency and duration of exercise were not statistically different between male and female patients. However, patients ≥65 years did exercise more often than their younger counterparts (p= 0.018). Regarding ET, 60% and 63% of patients reported that they could walk for >1 hour on level ground and climb ≥6 FOS at a time respectively. Conclusions: Most patients (88.8%) could achieve regular exercise habit after completion of Phase II CRP. However, more than 25% of patients did not practice exercise accordingly to the exercise guidelines. Education and counselling in long-term maintenance of exercise with appropriate frequency, duration and intensity should be emphasised.
BMJ Open, 2022
Introduction To enhance health and prevent secondary consequences for patients with cardiovascular disease (CVD), maintenance of an active lifestyle following participation in cardiac rehabilitation (CR) is important. However, levels of physical activity often decrease after completion of a structured CR programme. Models that support long-term behaviour change with a sustained level of physical activity are imperative. The aim of this study is to evaluate the feasibility of a mobile health intervention based on the Health Action Process Approach theoretical model of behaviour change in patients with CVD for 3 months after completion of a CR programme. Methods and analysis In a feasibility trial design, we will recruit 40 participants from CR programmes at Slagelse Hospital, the City of Slagelse (municipality), or Holbaek Hospital. After completing the standard structured CR programme, each participant will create an action plan for physical activity together with a physiotherapist. Following that, participants are sent 2 weekly text messages for 3 months. The first text message prompts physical activity, and the second will check if the action plan has been followed. If requested by participants, a coordinator will call and guide the physical activities behaviour. The feasibility of this maintenance intervention is evaluated based on predefined progression criteria. Physical activity is measured with accelerometers at baseline and at 3 months follow-up. Ethics and dissemination Study approval was waived (EMN-2021-00020) by the Research Ethics Committee of Region Zealand, Denmark. Study results will be made public and findings disseminated to patients, health professionals, decision-makers, researchers and the public. Trial registration number NCT05011994.
Journal of Sport and Exercise Psychology
During the process of health behavior change, individuals pass different phases characterized by different demands and challenges that have to be mastered. To overcome these demands successfully, phase-specific self-efficacy beliefs are important. The present study distinguishes between task self-efficacy, maintenance self-efficacy, and recovery self-efficacy. These phase-specific beliefs were studied in a sample of 484 cardiac patients during rehabilitation treatment and at follow-up 2 and 4 months after discharge to predict physical exercise at 4 and 12 months follow-up. The three phase-specific self-efficacies showed sufficient discriminant validity and allowed for differential predictions of intentions and behavior. Persons in the maintenance phase benefited more from maintenance self-efficacy in terms of physical exercise than persons not in the maintenance phase. Those who had to resume their physical exercise after a health related break profited more from recovery self-effic...