Illness cognition as a predictor of exercise habits and participation in cardiac prevention and rehabilitation programs after acute coronary syndrome

Abstract

BackgroundDespite well-established medical recommendations, many cardiac patients do not exercise regularly either independently or through formal cardiac prevention and rehabilitation programs (CPRP). This non-adherence is even more pronounced among minority ethnic groups. Illness cognition (IC), i.e. the way people perceive the situation they encounter, has been recognized as a crucial determinant of health-promoting behavior. Few studies have applied a cognitive perspective to explain the disparity in exercising and CPRP attendance between cardiac patients from different ethnic backgrounds. Based on the Health Belief Model (HBM) and the Common Sense Model (CSM), the objective was to assess the association of IC with exercising and with participation in CPRP among Jewish/majority and Arab/minority patients hospitalized with acute coronary syndrome.MethodsPatients (N = 420) were interviewed during hospitalization (January-2009 until August- 2010) about IC, with 6-month follow-up interviews about exercise habits and participation in CPRP. Determinants that predict active lifestyle and participation in CPRP were assessed using backward stepwise logistic regression.ResultsPerceived susceptibility to heart disease and sense and personal control were independently associated with exercising 6 months after the acute event (OR = 0.58, 95% CI: 0.42-0.80 and OR = 1.09, 95% CI: 1.02-1.17, per unit on a 5-point scale). Perceived benefits of regular exercise and a sense of personal control were independently associated with participation in CPRP (OR = 1.56, 95% CI: 1.12-2.16 and OR = 1.08, 95% CI: 1.01-1.15, per unit on a 5-point scale). None of the IC variables assessed could explain the large differences in health promoting behaviors between the majority and minority ethnic groups.ConclusionsIC should be taken into account in future interventions to promote physical activity and participation in CPRP for both ethnic groups. Yet, because IC failed to explain the gap between Arab and Jewish patients in those behaviors, other explanatory pathways such as psychological state or cultural views should be considered as potential areas for further research.

Identifying barriers to participation in cardiac prevention and rehabilitation programmes via decision tree analysis: establishing targets for remedial interventions

“…We have also identified non-cultural barriers including lower socioeconomic position (SEP), history of coronary heart disease (CHD), diagnosis of unstable angina pectoris (UAP) (compared with myocardial infarction (MI)), absence of a recommendation to participate in CPRP in the discharge letter, absence of a visit to the rehabilitation centre during hospitalisation, the lack of a driving license, 16 17 high levels of anxiety and depression, 18 low perceived benefits of regular exercise, and a low sense of personal control. 19 Although we were able to identify those predictors of participation in CPRP, our previous reports did not evaluate the relative contribution of each barrier, and also did not provide clinically relevant cut-off points at which each variable becomes a barrier, a prerequisite for any serious endeavour of tailoring interventions for the most in-need populations. Therefore, in the current study we analyse, in a comprehensive manner, all the putative barriers to participation in CPRP evaluated in the cohort, including the cultural and psychological aspects.…”

“…Sociodemographic characteristics , which included ethnicity (Jews/Arabs), gender, age, birth place (Israel/other), marital status, level of education (highest certificate/degree earned), employment status (gainfully employed or not), economic situation (subjective assessment), religiosity, health services supplier membership and subjective SEP. 19 22 …”

Relationships between illness representations, physical activity and depression in chronic kidney disease

“…The positive association between personal control and levels of physical activity has also been established in CVD research studies (Reges et al . ; Mosleh & Almalik ).…”

The effects of a nurse‐supervised home exercise programme on improving patients’ perceptions of the benefits and barriers to exercise: A randomised controlled trial

“…In Reges et al. 's, () study, patients with a strong belief in the benefits of exercise tended to participate in the rehabilitation programme, but did not necessarily engage in exercise on their own. In this study, patients engaged in regular home exercise, which helped them to restore their functional ability, as indicated by the patients’ gait speed and 10‐repetition sit‐to‐stand performance (Tao et al., ).…”