What Sustains Long-Term Adherence to Structured Physical Activity After a Cardiac Event (original) (raw)
Related papers
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.
Development and impact of exercise self-efficacy types during and after cardiac rehabilitation
Objective: Cardiovascular disease (CVD) is the leading cause of death in the developed world. Cardiac rehabilitation (CR) is a comprehensive treatment program centered on structured exercise that has been demonstrated to achieve significant decreases in mortality and morbidity in cardiac patients, yet few patients adhere to exercise post-CR and so fail to maintain any health benefits accrued during rehabilitation. One reason for the lack of adherence might be that CR fails to address the challenges to adherence faced by patients when they no longer have the resources and structure of CR to support them. Self-efficacy (SE) is a robust predictor of behavioral persistence. This study therefore focuses on changes in different types of SE during CR and the relationship of SE to subsequent levels of physical activity.
Aim: We aimed to identify patient characteristics and comorbidities that correlate with the initial exercise capacity of cardiac rehabilitation (CR) patients and to study the significance of patient characteristics, comorbidities and training methods for training achievements and final fitness of CR patients. Methods: We studied 557 consecutive patients (51.7 AE 6.9 years; 87.9% men) admitted to a three-week in-patient CR. Cardiopulmonary exercise testing (CPX) was performed at discharge. Exercise capacity (watts) at entry, gain in training volume and final physical fitness (assessed by peak O 2 utilization (VO 2peak ) were analysed using analysis of covariance (ANCOVA) models. Results: Mean training intensity was 90.7 AE 9.7% of maximum heart rate (81% continuous/19% interval training, 64% additional strength training). A total of 12.2 AE 2.6 bicycle exercise training sessions were performed. Increase of training volume by an average of more than 100% was achieved (difference end/beginning of CR: 784 AE 623 watts  min). In the multivariate model the gain in training volume was significantly associated with smoking, age and exercise capacity at entry of CR. The physical fitness level achieved at discharge from CR as assessed by VO 2peak was mainly dependent on age, but also on various factors related to training, namely exercise capacity at entry, increase of training volume and training method. Conclusion: CR patients were trained in line with current guidelines with moderate-to-high intensity and reached a considerable increase of their training volume. The physical fitness level achieved at discharge from CR depended on various factors associated with training, which supports the recommendation that CR should be offered to all cardiac patients.
Maintaining physical activity in cardiac rehabilitation
2006
This chapter describes an intervention that has been used to encourage individuals to remain regularly physically active in exercise-based CR in phases III and IV. The principles of this intervention are also appropriate for all phases of CR. This intervention, called the exercise consultation (EC), is based on the Transtheoretical Model of behaviour change and Relapse Prevention Model (pp. 197-205), and uses cognitive and behavioural strategies to increase and maintain physical activity (Loughlan and Mutrie, 1995, 1997). The strategies used in this EC include: assessing stage of change, decisional balance, overcoming barriers to activity, social support, goal setting, selfmonitoring and relapse prevention. It involves a client-centred, one-to-one counselling approach and encourages individuals to develop an activity plan, tailored to their needs, readiness to change and lifestyle. The EC aims to encourage accumulated physical activity accumulating at least 30 minutes of moderate intensity activity on five days per week (Pate, et al., 1995, stage one, as discussed in Chapter 4). In addition, this level of physical activity may be easier for cardiac patients to incorporate into their daily routine and to sustain in the long term.Thus, the exercise consultation encourages individuals to integrate moderate intensity activity into their daily lives. In addition, EC can help maintain involvement in structured exercise in phases III and IV (SIGN, 2002). ADHERENCE IN CR EXERCISE It is well documented that exercise-based CR accrues many benefits in patients with established coronary artery disease (US Department for Health and Figure 8.1. Relationship between the stages of change and decisional balance, selfefficacy and processes of change. (Adapted from Marshall and Biddle, 2001.) and Exercise, 32, 97.
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.
Exercise dose and all-cause mortality within extended cardiac rehabilitation: a cohort study
Open Heart
Aims To investigate the relationship between exercise participation, exercise 'dose' expressed as metabolic equivalent (MET) hours (h) per week, and prognosis in individuals attending an extended, community-based exercise rehabilitation programme. Methods Cohort study of 435 participants undertaking exercise-based cardiac rehabilitation (CR) in Leeds, West Yorkshire, UK between 1994 and 2006, followed up to 1 November 2013. MET intensity of supervised exercise was estimated utilising serial submaximal exercise test results and corresponding exercise prescriptions. Programme participation was routinely monitored. Cox regression analysis including time-varying and propensity score adjustment was applied to identify predictors of long-term, all-cause mortality across exercise dose and programme duration groups. Results There were 133 events (31%) during a median follow-up of 14 years (range, 1.2 to 18.9 years). The significant univariate association between exercise dose and all-cause mortality was attenuated following multivariable adjustment for other predictors, including duration in the programme. Longer-term adherence to supervised exercise training (>36 months) was associated with a 33% lower mortality risk (multivariate-adjusted HR: 0.67; 95% CI: 0.47 to 0.97; p=0.033) compared with all lesser durations of CR (3, 12, 36 months), even after adjustment for baseline fitness, comorbidities and survivor bias. Conclusion Exercise dose (MET-h per week) appears less important than long-term adherence to supervised exercise for the reduction of long-term mortality risk. Extended, supervised CR programmes within the community may play a key role in promoting long-term exercise maintenance and other secondary prevention therapies for survival benefit.
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.
Journal of Cardiopulmonary Rehabilitation and Prevention, 2013
Encouraging patients to continue regular activity beyond the period of formal cardiac, heart failure, or pulmonary rehabilitation is a challenge faced by all program coordinators. The purpose of this study was to evaluate the feasibility of a community model run by fitness instructors as long-term maintenance for patients exiting a diseasespecific rehabilitation program. ■ METHODS: Heartmoves programs were established in close proximity to all major tertiary hospitals in Brisbane, Queensland, Australia, and all eligible patients were offered supported referral to a program. Referred patients and rehabilitation staff were surveyed regarding perceived barriers to attendance. Referral rates and individual attendance rates for the first 12 weeks were recorded. ■ RESULTS: Over 12 months, 241 patients were referred to a community Heartmoves class, of whom 141 (59%) attended at least once and 76 (32% of referrals, 54% of initial attendees) attended more than 6 of the first 12 weeks. Preattendance surveys identified concerns about quality and safety, as well as social and logistic barriers. The programs proved to be sustainable, as evidenced by the growth of programs from 18 at the end of the project to 31 over a 18-month period. ■ CONCLUSIONS: A supported referral pathway to Heartmoves provides a feasible and acceptable model for maintenance exercise following cardiac, heart failure, and pulmonary rehabilitation. Strategies that recognize and address barriers perceived by participants and by rehabilitation program staff should be part of the supported referral process.
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.