Maintenance of Exercise After Phase II Cardiac Rehabilitation

Abstract

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. Purpose The efficacy of a home-based intervention to support exercise maintenance among patients who had completed Phase II cardiac rehabilitation versus contact control was evaluated. Design An RCT was used to evaluate the intervention. Data were collected in 2005–2010 and analyzed in 2010. Setting/participants One hundred and thirty patients (mean age = 63.6 years [SD=9.7], 20.8% female) were randomized to exercise counseling (Maintenance Counseling group, n=64) or contact control (Contact Control group, n=66). Intervention Maintenance Counseling group participants received a 6-month program of exercise counseling (based on the Transtheoretical Model and Social–Cognitive Theory) delivered via telephone, as well as print materials and feedback reports. Main outcome measures Assessments of physical activity (7-Day PAR), motivational readiness for exercise, lipids and physical functioning were conducted at baseline, 6 and 12 months. Objective accelerometer data were collected at the same time-points. Fitness was assessed via maximal exercise stress tests at baseline and 6 months. Results The Maintenance Counseling group reported significantly higher exercise participation than the Contact Control group at 12 months (difference of 80 minutes, 95% CI 22,137). Group differences in exercise at 6 months were nonsignificant. The intervention significantly increased the probability of participants’ exercising at or above physical activity guidelines and attenuated regression in motivational readiness versus the Contact Control Group at 6 and 12 months. Self-reported physical functioning was significantly higher in the Maintenance Counseling group at 12 months. No group differences were seen in fitness at 6 months or lipid measures at 6 and 12 months. Conclusions A telephone-based intervention can help maintain exercise, prevent regression in motivational readiness for exercise and improve physical functioning in this patient population.

Effects of remote feedback in home-based physical activity interventions for older adults: A systematic review

“…6) [20][21][22][23][24][25][26][27] and eight low-quality [7,[28][29][30][31][32][33][34]. Evidence in the 16 studies was conflicting though, as fewer than 75% reported consistent findings.…”

“…Social-cognitive strategies to enhance self-efficacy were used in two studies [29,31,36]. Eleven other studies mentioned using individualized feedback, education or encouragement [10,21,22,24,26,27,29,30,34,37,43]. The studies using a direct remote contact strategy did not report using specific theory-based motivational or coaching strategies [40][41][42].…”

Using Pedometer Step-Count Goals to Promote Physical Activity in Cardiac Rehabilitation: A Feasibility Study of a Controlled Trial

“…Previous reports have indicated that interventions which are most effective in promoting PA among cardiac patients include prompt self-monitoring and specific goal setting [4], but reports of pedometer-based interventions have included little methodological detail of how the pedometers were actually used [5][6][7][8]. Other work has reported that patients who engaged in some form of PA at home were more active than those who only engaged in exercise during CR sessions [18] but only 8% of that study's participants reached the recommended minimum level of weekly PA.…”

“…Recent reviews indicate that interventions which emphasise selfmonitoring, goal setting, identification of barriers to change and consideration of relapse prevention are most likely to yield positive outcomes for patients [3,4]. The use of pedometers in self-monitoring has been reported to be associated with increased levels of PA among cardiac patients [5][6][7][8] but information about how pedometers are actually used in goal setting and self-monitoring is scant. More detail would facilitate the translation of previous findings into clinical practice.…”

Encouragement to be More Physically Active or to Lessen Sedentary Behavior; Are These Two as the Same?

“…We almost found no study in contrast with this finding. Although the recommended level of PA for boys is more than girls (28,(30)(31)(32)(33), some social inequalities and social barriers may be the common cause for such differences (34).…”