during recovery ( Ades et al., 2006 ; Oldridge & Stump, 2004 ). Therefore, patients entering cardiac rehabilitation have a considerably lower (by approximately 60% in males) exercise capacity than age-matched individuals free of coronary heart disease ( Ades et al., 2006 ). This concurs with self
Kym Joanne Price, Brett Ashley Gordon, Kim Gray, Kerri Gergely, Stephen Richard Bird and Amanda Clare Benson
Alis Bonsignore, David Field, Rebecca Speare, Lianne Dolan, Paul Oh and Daniel Santa Mina
programs is limited and is not considered standard of care for cancer survivors. 10 , 12 Cardiac rehabilitation (CR) is an integral part of patient care and is recommended by the Canadian Association of Cardiac Prevention and Rehabilitation and the American Heart Association for all patients who have
Juliana Pereira Borges, Mauro Felippe Felix Mediano, Paulo Farinatti, Marina Pereira Coelho, Pablo Marino Correa Nascimento, Gabriella de Oliveira Lopes, Daniel Arkader Kopiler and Eduardo Tibiriçá
It remains unclear whether self-regulated exercise is sufficient to maintain the benefits acquired during formal cardiac rehabilitation (CR). This retrospective observational study investigated the effects of a home-based exercise intervention after discharge from CR upon anthropometric and aerobic capacity markers in clinically stable patients.
Fifty patients with cardiovascular disease were discharged after 6 months of CR and encouraged to maintain aerobic exercise without supervision. Subsequent to 6 months of follow-up, patients were assigned to compliant (n = 34) or noncompliant (n = 16) groups according to their compliance to the home-based program. Maximal aerobic capacity (VO2peak) and anthropometric data were assessed before CR, at discharge, and after 6 months of follow-up.
No statistical differences between compliant and noncompliant groups were observed at baseline and at discharge from CR. At the end of the follow-up, statistical differences across groups were not found for body mass or body mass index, but increases in VO2peak (+3.6 vs. –0.6 ml/kg·min, P = 0.004) and oxygen pulse (+1.5 vs. +0.2 ml/bpm, P = .03) were greater in compliant than noncompliant group.
Self-regulated exercising following CR discharge seems to be effective to maintain gains in exercise capacity acquired during supervised center-based programs.
Antonia M. Martin and Catherine B. Woods
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.
Twenty-four long-term adherers (15 men, 9 women; age 67.7 ± 16.7 yr) took part in focus-group discussions.
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.
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.
Ralph Maddison and Harry Prapavessis
There were three aims to the present study: (a) to test a social cognitive model based on self-efficacy and intention in predicting compliance to exercise in a Phase 2 cardiac rehabilitation (CR) program; (b) to examine temporal patterns of self-efficacy in an 18-week exercise CR program; and (c) to ascertain whether the social-cognitive variables act more as determinant or consequence of exercise behavior during the program. Forty-one participants (29 M, 12 F; mean age 63 ± 9 .81 yrs) with documented ischemic heart disease enrolled in an 18-week supervised walking-based Phase 2 CR exercise program. They completed scales assessing self-efficacy and intention at the beginning of the program (Time 1) and again at Weeks 7 (Time 2) and 13 (Time 3). Compliance behavior was assessed through daily attendance and exercise energy expenditure measures, via metabolic equivalents (ACSM Guidelines, 1995). Data provide general support for the social cognitive model. That is, positive and meaningful relationships were found among self-efficacy, intention, and objectively measured exercise behavior, explaining 16 to 59% of the variance. Results also showed that both task and barrier efficacy significantly improved during the early part of the exercise program and then leveled off during program termination. Finally, results suggest that social-cognitive variables act more as a determinant than a consequence of exercise behavior. The findings underscore the need for scale congruence between the measures of self-efficacy, intention, and objective measures of exercise behavior.
Urte Scholz, Falko F. Sniehotta and Ralf Schwarzer
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-efficacy in terms of physical exercise than persons who were continuously active. Implications for possible interventions are discussed.
Delphine De Smedt, Els Clays, Christof Prugger, Johan De Sutter, Zlatko Fras, Guy De Backer, Dragan Lovic, Anneleen Baert, Kornelia Kotseva and Dirk De Bacquer
The study aim was to assess the physical activity levels as well as the intention to become physically active in patients with stable coronary heart disease (CHD) with a special focus on the association with their risk profile.
Analyses are based on the cross-sectional EUROASPIRE IV surveys. Information was available on 8966 patients in EUROASPIRE III and on 7998 patients in EUROASPIRE IV. Physical activity level according to patients risk profile and their medical management was assessed, the intention to become physically active was investigated and a time trend analysis was performed.
A better cardiovascular risk profile as well as receiving physical activity advice or weight loss advice was associated with better physical activity levels. The physical activity status improved significantly over time, the proportion of patients reporting vigorous physical activity for at least 20 minutes ≥ 3 times/week increased from 14.1% to 20.2% (P < .001). Similarly, a significantly greater proportion of patients are in the maintenance stage (36.6% vs. 27.4%) and a smaller proportion in the precontemplation stage (43.2% vs. 52.3%).
Although an increase was seen in the proportion of patients being adequately physical active, physical activity levels remain suboptimal in many CHD patients.
Gerrie Schäperclaus, Mathieu de Greef, Piet Rispens, Danielle de Calonne, Martin Landsman, Kong I. Lie and Jan Oudhof
An experimental study was carried out to determine the influence of participation in Sports Groups for Patients with Cardiac Problems (SPCP) on physical and mental fitness and on risk factor level after myocardial infarction. SPCP members (n = 74; 67 men and 7 women) were compared with Nonsporting Patients with Cardiac Problems (NPCP, n = 60; 52 men and 8 women). Patients were a random sample from two hospitals in the Netherlands. In comparison with NPCP, the SPCP group showed a greater maximum oxygen uptake, a higher degree of perceived well-being, and a lower risk factor level. After correction for differences in cardiac and personal characteristics, SPCP yielded an independent significant multivariate effect on maximum oxygen uptake, perceived well-being, and risk factor level. Therefore, the application and integration of SPCP in cardiac rehabilitation should be further investigated.
Jonathan Myers, Mandi Dupain, Andrew Vu, Alyssa Jaffe, Kimberly Smith, Holly Fonda and Ronald Dalman
As part of a home-based rehabilitation program, 24 older adult patients (71 ± 3 years) with abdominal aortic aneurysm (AAA) disease underwent 3 days (12 awake hr/day) of activity monitoring using an accelerometer (ACC), a pedometer, and a heart rate (HR) monitor, and recorded hourly activity logs. Subjects then underwent an interview to complete a 3-day activity recall questionnaire (3-DR). Mean energy expenditure (EE) in kcals/ day for HR, ACC, and 3-DR were 1,687 ± 458, 2,068 ± 529, and 1,974 ± 491, respectively. Differences in EE were not significant between 3-DR and ACC, but HR differed from both ACC (p < .001) and 3-DR (p < .01). ACC and 3-DR had the highest agreement, with a coefficient of variation of 7.9% and r = .86. Thus, ACC provided a reasonably accurate reflection of EE based the criterion measure, an activity recall questionnaire. ACC can be effectively used to monitor EE to achieve an appropriate training stimulus during home-based cardiac rehabilitation.
Stephanie Dunn, Sally Lark and Stephen Fallows
Cardiac Rehabilitation (CR) programs are the most cost-effective measure for reducing morbidity associated with Coronary Vascular Disease (CVD). To be more effective there is a need to understand what influences the maintenance of healthy behaviors. This study identifies similar and different influences in CR of the United Kingdom (UK) and New Zealand (NZ).
A retrospective study. Participants had previously been discharged from CR for 6 to 12+ months within the UK (n = 22) and NZ (n = 21). Participant’s attended a focus group. Discussions were digitally recorded, transcribed then thematically analyzed. The CR programs were observed over 2 months to enable comment on findings relating to ‘theory in practice.’
Similar positive patient experiences influencing behavior between groups and countries were; support, education, positive attitude, and motivation. Companionship and exercising alongside people with similar health problems was the major determinant for positive exercise behavior. Barriers to maintaining exercise included; physical disabilities, time constraints, and weather conditions. NZ participants were more affected by external factors (eg, opportunity, access, and time).
Both CR programs were successful in facilitating the maintenance of healthy lifestyles. Exercising with other cardiac patients for support in a structured environment was the strongest influence in maintaining healthy lifestyles beyond CR programs.