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Hamborg TG, Andersen RM, Skou ST, Clausen MB, Jäger M, Zangger G, Simonÿ C, Grøntved A, Brønd JC, Soja AMB, Tang LH. mHealth intervention including text messaging and behaviour change techniques to support maintenance of physical activity after cardiac rehabilitation: A single-arm feasibility study. Digit Health 2024; 10:20552076241239243. [PMID: 38495859 PMCID: PMC10943751 DOI: 10.1177/20552076241239243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 03/19/2024] Open
Abstract
Objective To evaluate the feasibility of a mobile health-supported intervention in patients with cardiovascular diseases after completion of a cardiac rehabilitation programme. Methods The feasibility study was performed in two hospitals and one municipality in Region Zealand, Denmark. Eligible participants were ≥18 years old, participated in a supervised cardiac rehabilitation programme, had access to a mobile phone, and could walk 3 m independently. Participants received a 12-week intervention utilizing behaviour change techniques, consisting of action planning, text messages, and phone support. Feasibility was assessed using pre-defined progression criteria, which included recruitment (≥75%), retention (≥80%), accelerometer data completeness (≥80%), coordinator (phone support) time (≤30 min), the response rate on patient-reported outcomes (≥90%), adherence (≥75% respond to ≥75% of messages), and acceptability (≥75%). The secondary outcome of objective physical activity was assessed with accelerometers. Results Ten women and 30 men with cardiovascular diseases aged 63.5 (±9.8 SD) participated. The progression criteria for retention (90%), accelerometer data completeness (83%), coordinator time (9.9 min), adherence (83%), and acceptability (82%) were at acceptable levels, exceptions were progression criteria for recruitment (35%) being below acceptable levels for recruitment, and response rate on patient-reported outcomes (75%). High satisfaction (92.6%) with the intervention was found. All objectively measured physical activity levels remained unchanged from baseline to follow-up. No serious adverse events related to the intervention were reported. Conclusion Mobile health-supported maintenance of physical activity after cardiac rehabilitation completion was feasible, safe, and acceptable. Yet, changes to improve recruitment and response rate are needed before conducting a large-scale effect evaluation.
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Affiliation(s)
- Trine G Hamborg
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Rune M Andersen
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Mikkel B Clausen
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Madalina Jäger
- Danish Center for Motivation and Behaviour Change, University of Southern Denmark, Odense, Denmark
| | - Graziella Zangger
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Charlotte Simonÿ
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anders Grøntved
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jan C Brønd
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anne M B Soja
- Department of Medicine 1, Section of Cardiology, Holbæk Hospital, Holbæk, Denmark
| | - Lars H Tang
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Funaki K, Adachi T, Kameshima M, Fujiyama H, Iritani N, Tanaka C, Sakui D, Hara Y, Sugiura H, Yamada S. Factors Associated With Changes in Objectively Measured Moderate to Vigorous Physical Activity in Patients After Percutaneous Coronary Intervention: A Prospective Cohort Study. J Phys Act Health 2023; 20:279-291. [PMID: 36812917 DOI: 10.1123/jpah.2022-0396] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 12/03/2022] [Accepted: 01/05/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND This study aimed to clarify factors affecting changes in moderate to vigorous physical activity (MVPA) in patients 1 to 3 months after undergoing percutaneous coronary intervention (PCI). METHODS In this prospective cohort study, we enrolled patients aged <75 years who underwent PCI. MVPA was objectively measured using an accelerometer at 1 and 3 months after hospital discharge. Factors associated with increased MVPA (≥150 min/wk at 3 mo) were analyzed in participants with MVPA < 150 minutes per week at 1 month. Univariate and multivariate logistic regression analyses were performed to explore variables potentially associated with increasing MVPA, using MVPA ≥ 150 minutes per week at 3 months as the dependent variable. Factors associated with decreased MVPA (<150 min/wk at 3 mo) were also analyzed in participants with MVPA ≥ 150 minutes per week at 1 month. Logistic regression analysis was performed to explore factors of declining MVPA, using MVPA < 150 minutes per week at 3 months as the dependent variable. RESULTS We analyzed 577 patients (median age 64 y, 13.5% female, and 20.6% acute coronary syndrome). Increased MVPA was significantly associated with participation in outpatient cardiac rehabilitation (odds ratio 3.67; 95% confidence interval, 1.22-11.0), left main trunk stenosis (13.0; 2.49-68.2), diabetes mellitus (0.42; 0.22-0.81), and hemoglobin (1.47, per 1 SD; 1.09-1.97). Decreased MVPA was significantly associated with depression (0.31; 0.14-0.74) and Self-Efficacy for Walking (0.92, per 1 point; 0.86-0.98). CONCLUSIONS Identifying patient factors associated with changes in MVPA may provide insight into behavioral changes and help with individualized PA promotion.
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Affiliation(s)
- Kuya Funaki
- Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, Nagoya,Japan
| | - Takuji Adachi
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya,Japan
| | | | - Hiroaki Fujiyama
- Department of Cardiac Rehabilitation, Nagoya Heart Center, Nagoya,Japan
| | - Naoki Iritani
- Department of Cardiac Rehabilitation, Toyohashi Heart Center, Toyohashi,Japan
| | - Chikako Tanaka
- Department of Cardiac Rehabilitation, Toyohashi Heart Center, Toyohashi,Japan
| | - Daisuke Sakui
- Department of Cardiac Rehabilitation, Gifu Heart Center, Gifu,Japan
| | - Yasutaka Hara
- Department of Cardiac Rehabilitation, Gifu Heart Center, Gifu,Japan
| | - Hideshi Sugiura
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya,Japan
| | - Sumio Yamada
- Department of Cardiology, Aichi Medical University, Nagakute,Japan
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3
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Gutenberg J, Kulnik ST, Niebauer J, Crutzen R. Determinants of Physical Activity in the Cardiac Population: Protocol for a Systematic Review. JMIR Res Protoc 2022; 11:e39188. [PMID: 36069762 PMCID: PMC9494216 DOI: 10.2196/39188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/22/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lack of physical activity is a critical contributing risk factor to cardiovascular disease. Hence, regular physical activity is a mainstay in the primary and secondary prevention of cardiovascular disease. Despite the extensive promotion of physical activity in both primary and secondary prevention programs, including cardiac rehabilitation, physical activity levels in the cardiac population remain low. Therefore, it is crucial to understand critical determinants that influence physical activity behavior. OBJECTIVE This study aims to deliver a systematic review of studies with collated observational data exploring the association between determinants and physical activity behavior in the target population. These new insights inform the design of future interventions targeted at lasting heart-healthy physical activity behavior in the cardiac population. METHODS Primary studies with observational quantitative data on determinants and their association with physical activity behavior in the cardiac population will be included. Information on relevant primary studies will be retrieved from various databases, including Embase, CINAHL, MEDLINE, PsycInfo, and Web of Science Core Collection. Six reviewers will independently double-screen articles. Studies will be selected according to the prespecified inclusion and exclusion criteria. Data will be extracted and entered into suitable worksheets. The US-based National Heart, Lung, and Blood Institute's Study Quality Assessment Tool for Observational Studies will be used to assess the quality of all eligible primary studies. The results will be presented in a descriptive and narrative synthesis. If the type and quality of data are suitable, meta-analyses will be conducted. Study reporting will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. RESULTS Data collection started in September 2020, and the literature search was updated in July 2021. Data synthesis is ongoing, and the literature search will be updated in October 2022. CONCLUSIONS This review will be valuable to relevant stakeholders, including clinicians and health care professionals, intervention developers, and decision makers in health care. It lays a comprehensive foundation for understanding the determinants of physical activity to inform the design of secondary prevention interventions relevant to the cardiac population. TRIAL REGISTRATION PROSPERO CRD42020206637; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=206637. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/39188.
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Affiliation(s)
- Johanna Gutenberg
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria.,Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Stefan Tino Kulnik
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Josef Niebauer
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria.,University Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Rik Crutzen
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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Andersen RM, Skou ST, Clausen MB, Jäger M, Zangger G, Grøntved A, Brønd JC, Soja AMB, Tang LH. Maintenance of physical activity after cardiac rehabilitation (FAIR): study protocol for a feasibility trial. BMJ Open 2022; 12:e060157. [PMID: 35383088 PMCID: PMC8984013 DOI: 10.1136/bmjopen-2021-060157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
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 Holbæk 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.
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Affiliation(s)
- Rune Martens Andersen
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Søren Thorgaard Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Mikkel Bek Clausen
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Madalina Jäger
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Graziella Zangger
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anders Grøntved
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jan Christian Brønd
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Lars H Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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5
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Way KL, Birnie D, Blanchard C, Wells G, Dorian P, Jorstad HT, Daha IC, Suskin N, Oh P, Parkash R, Poirier P, Prince SA, Tulloch H, Pipe AL, Hans H, Wilson J, Comeau K, Vidal-Almela S, Terada T, Reed JL. The Physical Activity Levels and Sitting Time of Adults Living with Atrial Fibrillation – The CHAMPLAIN-AF Study. CJC Open 2022; 4:449-465. [PMID: 35607489 PMCID: PMC9123363 DOI: 10.1016/j.cjco.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/06/2022] [Indexed: 11/28/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Kimberley L. Way
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - David Birnie
- Arrhythmia Service, Division of Cardiology, Faculty of Medicine, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - George Wells
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Dorian
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Harald T. Jorstad
- Heart Centre, Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Ioana C. Daha
- Department of Cardiology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Neville Suskin
- Lawson Heath Research Institute, Department of Medicine, Division of Cardiology, Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Paul Oh
- University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Ratika Parkash
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul Poirier
- Faculty of Pharmacy, Université Laval, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada
| | - Stephanie A. Prince
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Heather Tulloch
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew L. Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Harleen Hans
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Janet Wilson
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Katelyn Comeau
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Sol Vidal-Almela
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Hôpital Montfort, Ottawa, Ontario, Canada
| | - Tasuku Terada
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jennifer L. Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Corresponding author: Dr Jennifer L. Reed, Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, Ontario, K1Y 4W7, Canada. Tel.: +1-613-696-7392
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Hannan AL, Hing W, Coombes JS, Gough S, Climstein M, Adsett G, Jayasinghe R, Furness J. Effect of personal activity intelligence (PAI) monitoring in the maintenance phase of cardiac rehabilitation: a mixed methods evaluation. BMC Sports Sci Med Rehabil 2021; 13:124. [PMID: 34629086 PMCID: PMC8503999 DOI: 10.1186/s13102-021-00350-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/27/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Personal activity intelligence (PAI) is a single physical activity metric based upon heart rate responses to physical activity. Maintaining 100 PAI/week is associated with a 25% risk reduction in cardiovascular disease mortality and 50 PAI/week provides 60% of the benefits. The effect of utilising this metric within a cardiac population has not been previously investigated. The aim of this study was to determine the effect of PAI monitoring on the amount and/or intensity of physical activity for people in the maintenance phase of cardiac rehabilitation and to explore participants' perceptions of this approach. METHODS A concurrent mixed methods approach was undertaken. Participants in the maintenance phase of cardiac rehabilitation monitored PAI for six weeks via a wearable physical activity monitoring device (WPAM). In the first three weeks participants were blinded to their PAI score. A quality-of-life questionnaire (EQ-5D-5L) was completed, and semi-structured interviews conducted to investigate attitudes to PAI monitoring. Daily PAI data was collected throughout the 6-week period. RESULTS Twenty participants completed the trial. PAI earned/day was increased after participants could view their data (mean difference: 2.1 PAI/day (95% CI 0.3, 4.0), p = 0.027). The median change in percentage of days participants achieved a Total PAI score of 25 (p = 0.023) and 50 (p = 0.015) were also increased. The mean change in total scores for the EQ-5D-5L and EQVAS were improved after 6 weeks (0.6 ± 1.05; 95% CI (0.11-1.09); p = 0.019); (5.8/100; 95% CI (2.4-9.2); p = 0.002 respectively). Thematic framework analysis identified three global themes (perceptions on the WPAM, PAI and factors affecting exercise). Most participants stated motivation to exercise increased after they could view their PAI data. Many of the participants believed they would continue to use PAI long-term. Others were undecided; the latter primarily due to technical issues and/or preferring devices with greater functionality and attractiveness. All participants would recommend PAI. CONCLUSION This exploratory study showed monitoring PAI via a WPAM increased the amount and/or intensity of physical activity within the cardiac population. Participants found PAI interesting, beneficial, and motivating. If technical issues, aesthetics, and functionality of the WPAM were improved, participants may continue to use the approach long-term. PAI may be a viable strategy to assist people with cardiac disease maintain physical activity adherence.
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Affiliation(s)
- Amanda L Hannan
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia. .,Bond Institute of Health and Sport, 2 Promethean Way, Robina, QLD, 4226, Australia.
| | - Wayne Hing
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.,Water Based Research Unit, Bond University, Gold Coast, Australia
| | - Jeff S Coombes
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Suzanne Gough
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Mike Climstein
- Clinical Exercise Physiology, School of Health and Human Sciences, Southern Cross University, Bilinga, QLD, Australia.,Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, University of Sydney, Sydney, NSW, Australia.,Water Based Research Unit, Bond University, Gold Coast, Australia
| | | | - Rohan Jayasinghe
- Cardiology Department, Gold Coast University Hospital, Queensland, Griffith University, Brisbane, QLD, Australia.,Macquarie University, Sydney, NSW, Australia
| | - James Furness
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.,Water Based Research Unit, Bond University, Gold Coast, Australia
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Achttien RJ, van Lieshout J, Wensing M, Nijhuis-van der Sanden M, Staal JB. The decline in physical activity in aging people is not modified by gender or the presence of cardiovascular disease. Eur J Public Health 2021; 30:333-339. [PMID: 31562513 PMCID: PMC7183365 DOI: 10.1093/eurpub/ckz159] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND A physically active lifestyle decreases the progression of atherosclerosis and consequently reduces cardiovascular mortality. However, activity levels are hampered by aging. The association between aging and physical inactivity might be gender-specific or be modified by the presence of cardiovascular disease (CVD). In this study, we investigated if the association between aging and physical inactivity was different between men and women and between primary and secondary prevention patients. METHODS We performed a cross-sectional analysis of three primary care samples including primary and/or secondary prevention patients (total n = 4726). Baseline data for sample 1 were collected in the years 2013-14, for sample 2 in 2009-10 and for sample 3 in 2009. Activity levels were measured by the patient reported Rapid Assessment of Physical Activity questionnaire. A multilevel regression analysis was used to explore the association between aging and physical inactivity, adjusted for confounders. We examined potential effect modification by gender and the presence of CVD on the association between aging and physical inactivity. RESULTS Multilevel regression revealed that aging was consistently associated with physical inactivity in three out of three samples. This association was, however, not modified by gender or the presence of CVD. CONCLUSIONS Cardiovascular risk management interventions should aim at increasing or maintaining physical activity levels in aging primary care population. This study does not support the notion that extra emphasis should be put in targeting men or women, or people with or without the presence of CVD.
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Affiliation(s)
- Retze J Achttien
- Department IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan van Lieshout
- Department IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michel Wensing
- Department IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Maria Nijhuis-van der Sanden
- Department IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Bart Staal
- Department IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,HAN, Institute of Health Studies, University of Applied Sciences, Research Group Musculoskeletal Rehabilitation, The Netherlands
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8
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Steiner B, Saalfeld B, Elgert L, Haux R, Wolf KH. OnTARi: an ontology for factors influencing therapy adherence to rehabilitation. BMC Med Inform Decis Mak 2021; 21:153. [PMID: 33975585 PMCID: PMC8111729 DOI: 10.1186/s12911-021-01512-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adherence and motivation are key factors for successful treatment of patients with chronic diseases, especially in long-term care processes like rehabilitation. However, only a few patients achieve good treatment adherence. The causes are manifold. Adherence-influencing factors vary depending on indications, therapies, and individuals. Positive and negative effects are rarely confirmed or even contradictory. An ontology seems to be convenient to represent existing knowledge in this domain and to make it available for information retrieval. METHODS First, a manual data extraction of current knowledge in the domain of treatment adherence in rehabilitation was conducted. Data was retrieved from various sources, including basic literature, scientific publications, and health behavior models. Second, all adherence and motivation factors identified were formalized according to the ontology development methodology METHONTOLOGY. This comprises the specification, conceptualization, formalization, and implementation of the ontology "Ontology for factors influencing therapy adherence to rehabilitation" (OnTARi) in Protégé. A taxonomy-oriented evaluation was conducted by two domain experts. RESULTS OnTARi includes 281 classes implemented in ontology web language, ten object properties, 22 data properties, 1440 logical axioms, 244 individuals, and 1023 annotations. Six higher-level classes are differentiated: (1) Adherence, (2) AdherenceFactors, (3) AdherenceFactorCategory, (4) Rehabilitation, (5) RehabilitationForm, and (6) RehabilitationType. By means of the class AdherenceFactors 227 adherence factors, thereof 49 hard factors, are represented. Each factor involves a proper description, synonyms, possibly existing acronyms, and a German translation. OnTARi illustrates links between adherence factors through 160 influences-relations. Description logic queries implemented in Protégé allow multiple targeted requests, e.g., for the extraction of adherence factors in a specific rehabilitation area. CONCLUSIONS With OnTARi, a generic reference model was built to represent potential adherence and motivation factors and their interrelations in rehabilitation of patients with chronic diseases. In terms of information retrieval, this formalization can serve as a basis for implementation and adaptation of conventional rehabilitative measures, taking into account (patient-specific) adherence factors. OnTARi also enables the development of medical assistance systems to increase motivation and adherence in rehabilitation processes.
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Affiliation(s)
- Bianca Steiner
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Braunschweig, Germany.
| | - Birgit Saalfeld
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover, Germany
| | - Lena Elgert
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover, Germany
| | - Reinhold Haux
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Braunschweig, Germany
| | - Klaus-Hendrik Wolf
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover, Germany
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9
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Lee S, Collins EG. Factors influencing physical activity after cardiac surgery: An integrative review. Heart Lung 2021; 50:136-145. [DOI: 10.1016/j.hrtlng.2020.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/18/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
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Williamson TM, Moran C, McLennan A, Seidel S, Ma PP, Koerner ML, Campbell TS. Promoting adherence to physical activity among individuals with cardiovascular disease using behavioral counseling: A theory and research-based primer for health care professionals. Prog Cardiovasc Dis 2020; 64:41-54. [PMID: 33385411 DOI: 10.1016/j.pcad.2020.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
Physical activity (PA) promotion remains a cornerstone of primary and secondary prevention efforts to reduce morbidity and mortality from cardiovascular disease (CVD). While frontline health care providers (HCPs; e.g., family physicians, cardiologists, registered nurses, nurse practitioners, etc.) are in an optimal position to administer PA-promoting interventions to their patients, many HCPs may feel ill-equipped to address common obstacles to implementing and maintaining complex health behavior change. Behavioral counseling refers to a collection of theory- and empirically-supported strategies and approaches to health behavior promotion that can be learned and applied by HCPs for CVD prevention and treatment. In this selective review, we discuss prominent theories of health behavior change and the empirical intervention literature regarding PA promotion in community and CVD-samples and provide practical recommendations for integrating effective behavioral counseling strategies to clinical practice for frontline HCPs. We argue that behavioral counseling interventions for PA can be effectively executed within the contextual constraints of health settings through subtle shifts in communication strategies and brief counseling approaches. The administration of behavioral counseling for PA by HCPs has enormous potential to reduce CVD incidence and progression at a population level.
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Affiliation(s)
| | - Chelsea Moran
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Andrew McLennan
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sydney Seidel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Patrick P Ma
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Total Cardiology Bridgeland, Calgary, AB, Canada
| | | | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA.
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11
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Reid RD, Wooding EA, Blanchard CM, Moghei M, Harris J, Proulx GA, Prince SA, Mullen KA, Ghisi GM, Krahn M, Chessex C, Pipe AL, Mark AE, Grace SL. A Randomized Controlled Trial of an Exercise Maintenance Intervention in Men and Women After Cardiac Rehabilitation (ECO-PCR Trial). Can J Cardiol 2020; 37:794-802. [PMID: 33161148 DOI: 10.1016/j.cjca.2020.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/19/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Exercise maintenance interventions are needed for cardiac rehabilitation (CR) graduates to maintain moderate and vigorous-intensity physical activity (MVPA). We tested an exercise facilitator intervention (EFI) to promote exercise maintenance compared with usual care (UC) separately in men and women. METHODS This was a 3-site, randomized (1:1), parallel-group, superiority trial (ECO-PCR). CR graduates were stratified by site and sex and randomly allocated (concealed). EFI participants received a face-to-face introductory session, 5 small-group counseling teleconferences, and 3 personal calls from a trained facilitator over 50 weeks. In-person assessments were undertaken at baseline and 26 and 52 weeks after randomization. The primary outcome was weekly minutes of MVPA, measured by accelerometer. Secondary outcomes were exercise capacity, risk factors, quality of life, and enrollment in community-based exercise programs. Effects were tested with the use of linear mixed models. RESULTS A total of 449 CR graduates (135 women, 314 men) were randomised (n = 226 EFI, n = 223 UC). In the intention-to-treat analysis for men and for women, there were no significant effects for treatment or time on MVPA. In a planned secondary analysis that considered only those adherent to EFI (completed ≥ 66% of sessions; per-protocol), bouted MVPA (ie, in sustained bouts of ≥ 10 min) was higher in women in the EFI group (mean = 132.6 ± 135.2 min/wk at 52 weeks) compared with UC (111.8 ± 113.1; P = 0.013). Regarding secondary outcomes, in women, a treatment group main effect was observed for blood pressure (P = 0.011) and exercise capacity (P = 0.019; both per-protocol) favouring EFI; no other differences were observed. CONCLUSIONS In this trial of CR completers, an EFI showed promise for women, but was ineffective in men.
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Affiliation(s)
- Robert D Reid
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada.
| | | | | | | | - Jennifer Harris
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Guy-Anne Proulx
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Kerri A Mullen
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Murray Krahn
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Caroline Chessex
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Andrew L Pipe
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada
| | | | - Sherry L Grace
- York University, Toronto, Ontario, Canada; University Health Network, University of Toronto, Toronto, Ontario, Canada
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12
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Studer B, Geniole SN, Becker ML, Eisenegger C, Knecht S. Inducing illusory control ensures persistence when rewards fade and when others outperform us. Psychon Bull Rev 2020; 27:809-818. [PMID: 32424621 PMCID: PMC7399668 DOI: 10.3758/s13423-020-01745-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Persisting even when the rewards of continued effort are fading is essential for achieving long-term goals, skills, and good health, alike. Yet, we often quit when things get hard. Here, we tested whether augmenting the feeling of control through external measures increases persistence under such discouraging circumstances. In two laboratory experiments, we first induced illusory control by manipulating the base-rate of positive outcomes and then tested the effect of this elevation of participants' perceived control upon their persistence under diminishing returns and in a competition against a stronger opponent. Induced illusory control significantly enhanced people's persistence in both of these motivationally challenging situations. Our findings demonstrate that motivation is dependent upon perceived, rather than objective, control, and reveal that this can be leveraged to counteract quitting behavior when things get hard, for instance in rehabilitation, physical activity interventions, or other training settings.
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Affiliation(s)
- Bettina Studer
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
- Department of Neurology, Mauritius Hospital Meerbusch, Meerbusch, Germany.
| | - Shawn N Geniole
- Neuropsychopharmacology and Biopsychology Unit, Faculty of Psychology, University of Vienna, Vienna, Austria
- Social-Neuroendocrinology Laboratory, Department of Psychology, Nipissing University, North Bay, Ontario, Canada
- Department of Psychology, University of the Fraser Valley, Abbotsford, Canada
| | - Maike L Becker
- Neuropsychopharmacology and Biopsychology Unit, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Christoph Eisenegger
- Neuropsychopharmacology and Biopsychology Unit, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Stefan Knecht
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Mauritius Hospital Meerbusch, Meerbusch, Germany
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13
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Zhao M, Veeranki SP, Magnussen CG, Xi B. Recommended physical activity and all cause and cause specific mortality in US adults: prospective cohort study. BMJ 2020; 370:m2031. [PMID: 32611588 PMCID: PMC7328465 DOI: 10.1136/bmj.m2031] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the association between recommended physical activity according to the 2018 physical activity guidelines for Americans and all cause and cause specific mortality using a nationally representative sample of US adults. DESIGN Population based cohort study. SETTING National Health Interview Survey (1997-2014) with linkage to the National Death Index records to 31 December 2015. PARTICIPANTS 479 856 adults aged 18 years or older. EXPOSURES Participant self-reports of the amount of leisure time spent in aerobic physical activity and muscle strengthening activity each week were combined and categorised into four groups: insufficient activity, aerobic activity only, muscle strengthening only, and both aerobic and muscle strengthening activities according to the physical activity guidelines. MAIN OUTCOME MEASURES All cause mortality and cause specific mortality (cardiovascular disease, cancer, chronic lower respiratory tract diseases, accidents and injuries, Alzheimer's disease, diabetes mellitus, influenza and pneumonia, and nephritis, nephrotic syndrome, or nephrosis) obtained from the National Death Index records. RESULTS During a median follow-up of 8.75 years, 59 819 adults died from all causes, 13 509 from cardiovascular disease, 14 375 from cancer, 3188 from chronic lower respiratory tract diseases, 2477 from accidents and injuries, 1470 from Alzheimer's disease, 1803 from diabetes mellitus, 1135 from influenza and pneumonia, and 1129 from nephritis, nephrotic syndrome, or nephrosis. Compared with those who did not meet the physical activity guidelines (n=268 193), those who engaged in recommended muscle strengthening activity (n=21 428; hazard ratio 0.89, 95% confidence interval 0.85 to 0.94) or aerobic activity (n=113 851; 0.71, 0.69 to 0.72) were found to be at reduced risk of all cause mortality; and even larger survival benefits were found in those engaged in both activities (n=76 384; 0.60, 0.57 to 0.62). In addition, similar patterns were reported for cause specific mortality from cardiovascular disease, cancer, and chronic lower respiratory tract diseases. CONCLUSIONS Adults who engage in leisure time aerobic and muscle strengthening activities at levels recommended by the 2018 physical activity guidelines for Americans show greatly reduced risk of all cause and cause specific mortality. These data suggest that the physical activity levels recommended in the guidelines are associated with important survival benefits.
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Affiliation(s)
- Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Sreenivas P Veeranki
- Precision Health Economics and Outcomes Research, Los Angeles, CA, USA
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, 7000 Hobart, Australia
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan250012, China
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Broers ER, Gavidia G, Wetzels M, Ribas V, Ayoola I, Piera-Jimenez J, Widdershoven JW, Habibović M. Usefulness of a Lifestyle Intervention in Patients With Cardiovascular Disease. Am J Cardiol 2020; 125:370-375. [PMID: 31761149 DOI: 10.1016/j.amjcard.2019.10.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/23/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Abstract
The importance of modifying lifestyle factors in order to improve prognosis in cardiac patients is well-known. Current study aims to evaluate the effects of a lifestyle intervention on changes in lifestyle- and health data derived from wearable devices. Cardiac patients from Spain (n = 34) and The Netherlands (n = 36) were included in the current analysis. Data were collected for 210 days, using the Fitbit activity tracker, Beddit sleep tracker, Moves app (GPS tracker), and the Careportal home monitoring system. Locally Weighted Error Sum of Squares regression assessed trajectories of outcome variables. Linear Mixed Effects regression analysis was used to find relevant predictors of improvement deterioration of outcome measures. Analysis showed that Number of Steps and Activity Level significantly changed over time (F = 58.21, p < 0.001; F = 6.33, p = 0.01). No significant changes were observed on blood pressure, weight, and sleep efficiency. Secondary analysis revealed that being male was associated with higher activity levels (F = 12.53, p < 0.001) and higher number of steps (F = 8.44, p < 0.01). Secondary analysis revealed demographic (gender, nationality, marital status), clinical (co-morbidities, heart failure), and psychological (anxiety, depression) profiles that were associated with lifestyle measures. In conclusion results showed that physical activity increased over time and that certain subgroups of patients were more likely to have a better lifestyle behaviors based on their demographic, clinical, and psychological profile. This advocates a personalized approach in future studies in order to change lifestyle in cardiac patients.
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15
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Avila A, Claes J, Buys R, Azzawi M, Vanhees L, Cornelissen V. Home-based exercise with telemonitoring guidance in patients with coronary artery disease: Does it improve long-term physical fitness? Eur J Prev Cardiol 2019; 27:367-377. [PMID: 31787026 DOI: 10.1177/2047487319892201] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Home-based interventions might facilitate the lifelong uptake of a physically active lifestyle following completion of a supervised phase II exercise-based cardiac rehabilitation. Yet, data on the long-term effectiveness of home-based exercise training on physical activity and exercise capacity are scarce. OBJECTIVE The purpose of the TeleRehabilitation in Coronary Heart disease (TRiCH) study was to compare the long-term effects of a short home-based phase III exercise programme with telemonitoring guidance to a prolonged centre-based phase III programme in coronary artery disease patients. The primary outcome was exercise capacity. Secondary outcomes included physical activity behaviour, cardiovascular risk profile and health-related quality of life. METHODS Ninety coronary artery disease patients (80 men) were randomly assigned to 3 months of home-based (30), centre-based (30) or a control group (30) on a 1:1:1 basis after completion of their phase II ambulatory cardiac rehabilitation programme. Outcome measures were assessed at discharge of the phase II programme and after one year. RESULTS Eighty patients (72 (91%) men; mean age 62.6 years) completed the one-year follow-up measurements. Exercise capacity and secondary outcomes were preserved in all three groups (Ptime > 0.05 for all), irrespective of the intervention (Pinteraction > 0.05 for all). Eighty-five per cent of patients met the international guidelines for physical activity (Ptime < 0.05). No interaction effect was found for physical activity. CONCLUSION Overall, exercise capacity remained stable during one year following phase II cardiac rehabilitation. Our home-based exercise intervention was as effective as centre-based and did not result in higher levels of exercise capacity and physical activity compared to the other two interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT02047942. https://clinicaltrials.gov/ct2/show/NCT02047942.
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Affiliation(s)
- Andrea Avila
- Department of Rehabilitation Science, KU Leuven, Belgium
| | - Jomme Claes
- Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Roselien Buys
- Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - May Azzawi
- Cardiovascular Research Group, Manchester Metropolitan University, UK
| | - Luc Vanhees
- Department of Rehabilitation Science, KU Leuven, Belgium
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16
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Amount and Socio-Ecological Correlates of Exercise in Men and Women at Cardiac Rehabilitation Completion. Am J Phys Med Rehabil 2019; 97:816-824. [PMID: 29846189 DOI: 10.1097/phm.0000000000000972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to describe (1) the amount of physical activity (PA) in cardiac rehabilitation (CR) graduates by sex, and (2) the correlates of their PA. DESIGN Secondary analysis of baseline data from a randomized trial was undertaken. Graduates were recruited from three CR programs. Participants completed a questionnaire, which assessed constructs from the socio-ecological model (i.e., individual-level, social- and physical-environmental levels). Physical activity was measured objectively using an ActiGraph GT3X accelerometer. Multilevel modeling was performed. RESULTS Two hundred fifty-five patients consented, of which 200 (78.4%) completed the survey and provided valid accelerometer data. Participants self-reported engaging in a mean ± standard deviation of 184.51 ± 129.10 min of moderate-to-vigorous-intensity PA (MVPA) per week (with men engaging in more than women, P < 0.05). Accelerometer data revealed participants engaged in 169.65 ± 136.49 mins of MVPA per week, with 43 (25.1%) meeting recommendations. In the mixed models, the socio-ecological correlate significantly related to greater self-reported MVPA was self-regulation (P = 0.01); the correlate of accelerometer-derived MVPA was neighborhood aesthetics (P = 0.02). CONCLUSIONS Approximately one-quarter of CR program completers are achieving MVPA recommendations, although two-thirds perceive they are. The CR programs should exploit accelerometry and promote self-regulation skills, namely, self-monitoring, goal-setting, positive reinforcement, time management, and relapse prevention. Patients should be encouraged to exercise in pleasing locations.
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17
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Achttien R, van Lieshout J, Wensing M, van der Sanden MN, Staal JB. Symptoms of depression are associated with physical inactivity but not modified by gender or the presence of a cardiovascular disease; a cross-sectional study. BMC Cardiovasc Disord 2019; 19:95. [PMID: 31023228 PMCID: PMC6482537 DOI: 10.1186/s12872-019-1065-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 03/24/2019] [Indexed: 12/13/2022] Open
Abstract
Background Depressive symptomatology may act as a barrier to enhance physical activity. This phenomenon is predominantly found in patients with an established cardiovascular disease (CVD) and in female patients. This cross-sectional study investigated (1) the association between symptoms of depression and physical inactivity, and (2) whether this association is different between primary and secondary prevention patients, and between men and women. Methods The study design concerns a secondary analysis of baseline data from a randomized clinical trial, including primary and secondary prevention patients (n = 2184; mean age 71.6 ± 8.94), from 34 general practitioner panels. The Rapid Assessment of Physical Activity questionnaire (RAPA) was used to measure patient reported activity levels. Symptoms of depression were determined using the Patient Health Questionnaire (PHQ-9). Multilevel linear regression analysis was used to explore the association between symptoms of depression and physical activity while adjusting for confounders. Gender and whether or not having a CVD were considered as potential effect modifiers for the association between symptoms of depression and inactivity. Results Symptoms of depression were associated with lower levels of physical activity. This association was neither different for men and women nor for primary and secondary prevention patients. Conclusion In primary care patients’ symptoms of depression were associated with physical inactivity. This association was not modified by gender or the presence of a CVD. Future research should focus on lifestyle interventions aiming at the increase of physical activity levels, while emphasizing on improving symptoms of depression in men, women, and patients both with and without a history of CVD.
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Affiliation(s)
- Retze Achttien
- Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, The Netherlands.
| | - Jan van Lieshout
- Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, The Netherlands
| | - Michel Wensing
- Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, The Netherlands.,Health services research and implementation science in healthcare, Heidelberg University, Heidelberg, Germany
| | - Maria Nijhuis van der Sanden
- Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, The Netherlands
| | - J Bart Staal
- Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, The Netherlands.,Research group Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
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18
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Goodwin AM, Duran AT, Kronish IM, Moise N, Sanchez GJ, Garber CE, Schwartz JE, Diaz KM. Factors associated with objectively measured exercise participation after hospitalization for acute coronary syndrome. Int J Cardiol 2019; 275:1-5. [PMID: 30391064 DOI: 10.1016/j.ijcard.2018.09.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 09/20/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Guidelines recommend exercise for secondary prevention of acute coronary syndrome (ACS), however adherence to guidelines is low. A paucity of data examining factors associated with objectively-measured exercise post-discharge in ACS survivors exists. The purpose of this study was to identify factors associated with exercise during the 5 weeks after ACS discharge. METHODS A sample of 151 ACS patients treated at a university hospital were enrolled into an observational cohort study and wore an accelerometer for 35 days post-discharge. Days on which participants accumulated ≥30 min of moderate-to-vigorous physical activity in bouts ≥10 min were considered exercise days. Participants were categorized as non-exercisers (0 exercise days) or exercisers (≥1 exercise day). A multi-variable logistic regression model was used to examine the association between exercise and socio-demographics, depression, SF-12 physical and mental health scores, disease severity, length of hospitalization, and percutaneous coronary intervention. RESULTS 39.7% of participants were non-exercisers. Factors associated with non-exercise were age (OR: 1.11; 95% CI: 1.06-1.17, p < 0.001), female sex (OR: 2.76; 95% CI: 1.10-6.95, p = 0.031), and lower SF-12 physical health score (OR: 0.94; 95% CI: 0.90-0.98, p = 0.005). CONCLUSION In ACS patients in whom exercise participation was objectively measured for 5 weeks post-discharge, demographic and poor physical health factors were associated with non-exercise. These findings identify populations (e.g. older adults, women) at especially high risk for being physically inactive in whom more intense intervention may be warranted.
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Affiliation(s)
- Ashley M Goodwin
- Teachers College, Columbia University, 525 W. 120th Street, Box 93, New York, NY 10027, USA; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168 Street, PH 9, New York, NY 10032, USA.
| | - Andrea T Duran
- Teachers College, Columbia University, 525 W. 120th Street, Box 93, New York, NY 10027, USA; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168 Street, PH 9, New York, NY 10032, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168 Street, PH 9, New York, NY 10032, USA
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168 Street, PH 9, New York, NY 10032, USA
| | - Gabriel J Sanchez
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168 Street, PH 9, New York, NY 10032, USA
| | - Carol Ewing Garber
- Teachers College, Columbia University, 525 W. 120th Street, Box 93, New York, NY 10027, USA
| | - Joseph E Schwartz
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168 Street, PH 9, New York, NY 10032, USA; Department of Psychiatry and Behavioral Science, Stony Brook University, 101 Nicolls Road, Stony Brook, NY 11794, USA
| | - Keith M Diaz
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168 Street, PH 9, New York, NY 10032, USA
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19
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McKee G, Mooney M, O’Donnell S, O’Brien F, Biddle MJ, Moser DK. A cohort study examining the factors influencing changes in physical activity levels following an acute coronary syndrome event. Eur J Cardiovasc Nurs 2018; 18:57-66. [DOI: 10.1177/1474515118786203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Low physical activity has long been identified as a risk factor for coronary heart disease. Aims: The aim of this study was to determine the factors that influence changes in the physical activity of patients following an acute coronary syndrome event. Methods: The prospective, inferential cohort design recruited patients admitted to hospital following an acute coronary syndrome event across five research sites. Physical activity was assessed using the short form international physical activity questionnaire. Results: Data were collected at baseline and 3 months on 380 patients. The sample profile was: 21% women; body mass index 28 ± 4.6; unstable angina 36%; ST-segment elevation myocardial infarction 25%; non-ST-segment elevation myocardial infarction 39% and a mean age of 63 ± 11.8. There was a significant improvement in physical activity at 3 months ( n=380, t=−3.704, P≤0.001). All regression models, baseline, 3 months and change in physical activity were significant ( p≤0.001). Low physical activity was associated with: at baseline not having health insurance, older age and depression; at 3 months not having health insurance, not in employment and low baseline physical activity; and improvement in physical activity was associated with low physical activity at baseline and not being in employment. Conclusions: While physical activity improved significantly, 45% did not reach guideline recommendation levels at 3 months post-event. Physical activity change was little influenced by sociodemographic, clinical, psychological and behavioural factors, suggesting the need to look elsewhere such as behavioural change and improved processes across the care divide to improve physical activity in this at-risk population.
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Affiliation(s)
- Gabrielle McKee
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Mary Mooney
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Sharon O’Donnell
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Frances O’Brien
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
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Correlates of Exercise Self-efficacy in a Randomized Trial of Mind-Body Exercise in Patients With Chronic Heart Failure. J Cardiopulm Rehabil Prev 2017; 36:186-94. [PMID: 26959498 DOI: 10.1097/hcr.0000000000000170] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE Exercise self-efficacy is one of the strongest predictors of physical activity behavior. Prior literature suggests that tai chi, a mind-body exercise, may increase self-efficacy; however, this is not extensively studied. Little is known about the factors associated with development of exercise self-efficacy in a population with heart failure. METHODS We utilized data from a randomized controlled trial of 12 weeks of group tai chi classes versus education in patients with chronic heart failure (n = 100). Multivariable linear regression was used to explore possible correlates of change in exercise self-efficacy in the entire sample and in the subgroup who received tai chi (n = 50). Covariates included baseline quality of life, social support, functional parameters, physical activity, serum biomarkers, sociodemographics, and clinical heart failure parameters. RESULTS Baseline 6-minute walk (β=-0.0003, SE = 0.0001, P = .02) and fatigue score (β= 0.03, SE = 0.01, P = .004) were significantly associated with change in self-efficacy, with those in the lowest tertile for 6-minute walk and higher tertiles for fatigue score experiencing the greatest change. Intervention group assignment was highly significant, with self-efficacy significantly improved in the tai chi group compared to the education control over 12 weeks (β= 0.39, SE = 0.11, P < .001). In the tai chi group alone, lower baseline oxygen uptake (β=-0.05, SE = 0.01, P = .001), decreased mood (β=-0.01, SE = 0.003, P = .004), and higher catecholamine level (epinephrine β= 0.003, SE = 0.001, P = .005) were significantly associated with improvements in self-efficacy. CONCLUSIONS In this exploratory analysis, our initial findings support the concept that interventions like tai chi may be beneficial in improving exercise self-efficacy, especially in patients with heart failure who are deconditioned, with lower functional status and mood.
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Nielsen JB, Leppin A, Gyrd-Hansen DE, Jarbøl DE, Søndergaard J, Larsen PV. Barriers to lifestyle changes for prevention of cardiovascular disease - a survey among 40-60-year old Danes. BMC Cardiovasc Disord 2017; 17:245. [PMID: 28899356 PMCID: PMC5596487 DOI: 10.1186/s12872-017-0677-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 09/04/2017] [Indexed: 11/10/2022] Open
Abstract
Background Elimination of modifiable risk factors including unhealthy lifestyle has the potential for prevention of 80% of cardiovascular disease cases. The present study focuses on disclosing barriers for maintaining specific lifestyle changes by exploring associations between perceiving these barriers and various sociodemographic and health-related characteristics. Methods Data were collected through a web-based questionnaire survey and included 962 respondents who initially accepted treatment for a hypothetical cardiovascular risk, and who subsequently stated that they preferred lifestyle changes to medication. Logistic regression was used to analyse associations between barriers to lifestyle changes and relevant covariates. Results A total of 45% of respondents were identified with at least one barrier to introducing 30 min extra exercise daily, 30% of respondents reported at least one barrier to dietary change, and among smokers at least one barrier to smoking cessation was reported by 62% of the respondents. The perception of specific barriers to lifestyle change depended on sociodemographic and health-related characteristics. Conclusion We observed a considerable heterogeneity between different social groups in the population regarding a number of barriers to lifestyle change. Our study demonstrates that social inequality exists in the ability to take appropriate preventive measures through lifestyle changes to stay healthy. This finding underlines the challenge of social inequality even in populations with equal and cost-free access to health care. Our study suggests supplementing traditional public campaigns to counter cardiovascular disease by using individualized and targeted initiatives.
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Affiliation(s)
- Jesper Bo Nielsen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, J.B.Winsløwvej 9, DK-5000, Odense, Denmark.
| | - Anja Leppin
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Niels Bohrs Vej 9, DK-6700, Esbjerg, Denmark
| | - Dort E Gyrd-Hansen
- COHERE, Department of Public Health, University of Southern Denmark, J.B.Winsløwvej 9, DK-5000, Odense, Denmark
| | - Dorte Ejg Jarbøl
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, J.B.Winsløwvej 9, DK-5000, Odense, Denmark
| | - Jens Søndergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, J.B.Winsløwvej 9, DK-5000, Odense, Denmark
| | - Pia Veldt Larsen
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J.B.Winsløwvej 9, DK-5000, Odense, Denmark
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Woda A, Haglund K, Belknap RA, Sebern M. Self-Care Behaviors of African Americans Living with Heart Failure. J Community Health Nurs 2017; 32:173-86. [PMID: 26529103 DOI: 10.1080/07370016.2015.1087237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
African Americans have a higher risk of developing heart failure (HF) than persons from other ethnic groups. Once diagnosed, they have lower rates of HF self-care and poorer health outcomes. Promoting engagement in HF self-care is amenable to change and represents an important way to improve the health of African Americans with HF. This study used a community-based participatory action research methodology called photovoice to explore the practice of HF self-care among low-income, urban, community dwelling African Americans. Using the photovoice methodology, themes emerged regarding self-care management and self-care maintenance.
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Affiliation(s)
- Aimee Woda
- a College of Nursing , Marquette University , Milwaukee , Wisconsin
| | - Kristin Haglund
- a College of Nursing , Marquette University , Milwaukee , Wisconsin
| | - Ruth Ann Belknap
- a College of Nursing , Marquette University , Milwaukee , Wisconsin
| | - Margaret Sebern
- a College of Nursing , Marquette University , Milwaukee , Wisconsin
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23
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Bouaziz W, Vogel T, Schmitt E, Kaltenbach G, Geny B, Lang PO. Health benefits of aerobic training programs in adults aged 70 and over: a systematic review. Arch Gerontol Geriatr 2016; 69:110-127. [PMID: 27912156 DOI: 10.1016/j.archger.2016.10.012] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/09/2016] [Accepted: 10/29/2016] [Indexed: 01/03/2023]
Abstract
Aging is intrinsically associated with a progressive decline in muscle strength and mass, and aerobic capacity. This contributes to reduced mobility and impaired quality of life (QoL) among seniors. Regular physical activity, and more particularly aerobic training (AT), has demonstrated benefits on adults' health. The aim of this review was to assess the current level of evidence regarding the health benefits of AT in the population aged 70 years and over. A comprehensive, systematic database search for manuscripts was performed. Two reviewers independently assessed interventional studies for potential inclusion. Cardiovascular, metabolic, functional, cognitive, and QoL outcomes were targeted. Fifty-three studies were included totalling 2051 seniors aged 70 years and over. Studies selected were divided into 5 categories according to their main outcomes: cardiovascular function (34 studies), metabolic outcomes (26 studies), functional fitness (19 studies), cognitive functions (8 studies), and QoL (3 studies). With a good level of evidence but a wide heterogeneity between study designs, a significant and beneficial effect of AT was measured on the 5 outcomes. For QoL results showed a significant but slighter improvement. This systematic review highlights the benefits of AT on seniors' health outcome such as cardiovascular, functional, metabolic, cognitive, and QoL outcomes although the optimal program remains unclear. When more studies regarding this specific population are needed to determine the most favourable exercise program, clinicians should nevertheless encourage older adults over 70 to participate in AT programs to favour active and healthy ageing.
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Affiliation(s)
- Walid Bouaziz
- Geriatric Department, Medical school and University Hospitals of Strasbourg, Strasbourg, France; Department of Physiology and EA-3072, Medical school, Strasbourg University, Strasbourg, France.
| | - Thomas Vogel
- Geriatric Department, Medical school and University Hospitals of Strasbourg, Strasbourg, France; Department of Physiology and EA-3072, Medical school, Strasbourg University, Strasbourg, France
| | - Elise Schmitt
- Geriatric Department, Medical school and University Hospitals of Strasbourg, Strasbourg, France; Department of Physiology and EA-3072, Medical school, Strasbourg University, Strasbourg, France
| | - Georges Kaltenbach
- Geriatric Department, Medical school and University Hospitals of Strasbourg, Strasbourg, France
| | - Bernard Geny
- Department of Physiology and EA-3072, Medical school, Strasbourg University, Strasbourg, France; Functional Explorations Department, Medical school and University Hospitals of Strasbourg, Strasbourg, France
| | - Pierre Olivier Lang
- Health and Wellbeing Academy, Anglia Ruskin University, Cambridge, United Kingdom; Geriatric and Rehabilitation Geriatric Division, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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Alharbi M, Gallagher R, Neubeck L, Bauman A, Prebill G, Kirkness A, Randall S. Exercise barriers and the relationship to self-efficacy for exercise over 12 months of a lifestyle-change program for people with heart disease and/or diabetes. Eur J Cardiovasc Nurs 2016; 16:309-317. [PMID: 27562115 DOI: 10.1177/1474515116666475] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Barriers to exercise are common in people with coronary heart disease (CHD) and/or diabetes mellitus (DM), and may influence self-efficacy for exercise. PURPOSE The purpose of this study was to describe the exercise barriers experienced by people who have CHD and/or DM participating in the Healthy Eating and Exercise Lifestyle Program and to determine whether these barriers influence self-efficacy. METHODS Participants ( n = 134) identified their barriers to exercise and completed the self-efficacy for exercise survey at baseline, at 4 months (following structured and supervised exercise) and at 12 months (following home-based exercise with three follow-up calls). RESULTS The sample mean age was 63.6 years (SD 8.5) and 58% were male. Barriers to exercise were reported by 88% at baseline, 76% at 4 months, and 47% at 12 months. The most common barriers were lack of motivation (40.3%), lack of time overall (30.6%), and lack of time due to family commitments (17.2%). Only motivation changed significantly over time from baseline (40%) to 4 months (23%, p = 0.040). Lower self-efficacy for exercise was associated with lack of motivation at 12 months only, more depressive symptoms at baseline and 4 months, and a CHD diagnosis and higher body mass index at 12 months. In contrast, male gender and having higher self-efficacy at baseline were associated with higher self-efficacy for exercise at 4 and 12 months. CONCLUSION Patients identified many exercise barriers despite participating in a lifestyle-change program. Lack of motivation negatively influenced self-efficacy for exercise at 12 months. Other factors needing attention include baseline self-efficacy, depressive symptoms, being female, being more overweight, and having CHD.
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Affiliation(s)
- Muaddi Alharbi
- 1 Charles Perkins Centre, University of Sydney, Australia
| | | | - Lis Neubeck
- 1 Charles Perkins Centre, University of Sydney, Australia
| | - Adrian Bauman
- 1 Charles Perkins Centre, University of Sydney, Australia
| | | | | | - Sue Randall
- 4 Sydney Nursing School, University of Sydney, Australia
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Reid R, Blanchard CM, Wooding E, Harris J, Krahn M, Pipe A, Chessex C, Grace SL. Ecologically optimizing exercise maintenance in men and women post-cardiac rehabilitation: Protocol for a randomized controlled trial of efficacy with economics (ECO-PCR). Contemp Clin Trials 2016; 50:116-23. [PMID: 27475772 DOI: 10.1016/j.cct.2016.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Exercise-based cardiac rehabilitation (CR) participation results in increased cardio-metabolic fitness, which is associated with reduced mortality. However, many graduates fail to maintain exercise post-program. ECO-PCR investigates the efficacy and cost-effectiveness of a social ecologically-based intervention to increase long-term exercise maintenance following the completion of CR. METHODS/DESIGN A three-site, 2-group, parallel randomized controlled trial is underway. 412 male and 192 female (N=604) supervised CR participants are being recruited just before CR graduation. Participants are randomized (1:1 concealed allocation) to intervention or usual care. A 50-week exercise facilitator intervention has been designed to assist CR graduates in the transition from structured, supervised exercise to self-managed home- or community-based (e.g., Heart Wise Exercise programs) exercise. The intervention consists of 8 telephone contacts over the 50week period: 3 individual and 5 group. Assessments occur at CR graduation, and 26, 52 and 78weeks post-randomization. The primary outcome is change in minutes of accelerometer-measured moderate to vigorous-intensity physical activity (MVPA) from CR graduation to 52weeks post-randomization. Secondary measures include exercise capacity, quality of life, and cardiovascular risk factors. Analyses will be undertaken based on intention-to-treat. For the primary outcome, an analysis of variance will be computed to test the change in minutes of MVPA in each group between CR graduation and 52week follow-up (2 [arm]×2 [time]). Secondary objectives will be assessed using mixed-model repeated measures analyses to compare differences between groups over time. Mean costs and quality-adjusted life years for each arm will be estimated.
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Affiliation(s)
- Robert Reid
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada.
| | - Chris M Blanchard
- Dalhousie University, 5790 University Avenue, Halifax, Nova Scotia B3H 1V7, Canada.
| | - Evyanne Wooding
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada.
| | - Jennifer Harris
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada.
| | - Murray Krahn
- University of Toronto, 144 College Street, Toronto, ON M5S 3M2, Canada.
| | - Andrew Pipe
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada.
| | - Caroline Chessex
- University Health Network, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada.
| | - Sherry L Grace
- University Health Network, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada; York University - Bethune 368, 4700 Keele St., Toronto, ON M3J 1P3, Canada.
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26
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Santaularia N, Caminal J, Arnau A, Perramon M, Montesinos J, Abenoza Guardiola M, Jaarsma T. The efficacy of a supervised exercise training programme on readmission rates in patients with myocardial ischemia: results from a randomised controlled trial. Eur J Cardiovasc Nurs 2016; 16:201-212. [PMID: 27162127 DOI: 10.1177/1474515116648801] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The results of research into the outcomes of physical rehabilitation and its relationship with post-myocardial ischaemia survival and readmissions are inconclusive. Our primary aim was to evaluate the efficacy of a supervised exercise training programme in terms of decreasing hospital cardiac readmission in patients with myocardial ischaemia. METHODS We conducted a randomised controlled trial including patients with myocardial ischaemia. Eligible patients were assigned to a control group receiving standard care or to an intervention group that took part in a supervised exercise training programme. The follow-up period was 12 months after hospital discharge. RESULTS Of 478 patients assessed for eligibility, 86 were randomised to the control group ( n = 44) or the intervention group ( n = 42). Cardiac readmission rates were 14% versus 5% ( p = 0.268) in the control and intervention groups, respectively, and all-cause readmission rates were 23% versus 15% ( p = 0.34). There were no deaths in either group. More control patients were treated in the emergency services (50% vs. 24%; p = 0.015). In terms of health-related quality of life, patients in the intervention group presented with significant increases in functional capacity and mobility. More intervention patients returned to work (77.3% vs. 36.0%; p = 0.005). CONCLUSIONS The supervised physical exercise programme was effective at reducing the number of emergency room visits and at increasing the percentage of patients who returned to work. It also improved patients' exercise capacity and increased their health-related quality of life. Although the results were promising, the programme was not associated with a significant reduction in cardiac and all-cause readmission rates.
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Affiliation(s)
- Núria Santaularia
- 1 Department of Rehabilitation, Althaia Xarxa Assistencial Universitària de Manresa, Spain
| | - Josefina Caminal
- 2 Department of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Anna Arnau
- 3 Clinical Research Unit, Althaia Xarxa Assistencial Universitària de Manresa, Spain
| | - Montserrat Perramon
- 4 Department of Cardiology, Althaia Xarxa Assistencial Universitària de Manresa, Spain
| | - Jesus Montesinos
- 3 Clinical Research Unit, Althaia Xarxa Assistencial Universitària de Manresa, Spain
| | | | - Tiny Jaarsma
- 5 Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Sweden
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Effects of Self-care Health Behaviors on Quality of Life Mediated by Cardiovascular Risk Factors Among Individuals with Coronary Artery Disease: A Structural Equation Modeling Approach. Asian Nurs Res (Korean Soc Nurs Sci) 2016; 10:158-63. [DOI: 10.1016/j.anr.2016.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 01/26/2016] [Accepted: 03/28/2016] [Indexed: 11/17/2022] Open
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Hardcastle SJ, McNamara K, Tritton L. Using Visual Methods to Understand Physical Activity Maintenance following Cardiac Rehabilitation. PLoS One 2015; 10:e0138218. [PMID: 26381147 PMCID: PMC4575075 DOI: 10.1371/journal.pone.0138218] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 08/27/2015] [Indexed: 11/26/2022] Open
Abstract
Few studies have explored the factors associated with long-term maintenance of exercise following cardiac rehabilitation. The present study used auto-photography and interviews to explore the factors that influence motivation and continued participation in physical activity among post cardiac rehabilitation patients. Twenty-three semi-structured interviews were conducted alongside participant-selected photographs or drawings with participants that had continued participation in physical activity for at least two years following the cardiac rehabilitation programme. Participants were recruited from circuit training classes in East Sussex in the UK. Thematic content analysis revealed seven main themes: fear of death and ill health avoidance, critical incidents, overcoming aging, social influences, being able to enjoy life, provision of routine and structure, enjoyment and psychological well-being. Fear of death, illness avoidance, overcoming aging, and being able to enjoy life were powerful motives for continued participation in exercise. The social nature of the exercise class was also identified as a key facilitator of continued participation. Group-based exercise suited those that continued exercise participation post cardiac rehabilitation and fostered adherence.
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Affiliation(s)
- Sarah J. Hardcastle
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
- * E-mail:
| | - Keira McNamara
- Department of Clinical Sciences, Brunel University, London, United Kingdom
| | - Larette Tritton
- School of Sport and Service Management, University of Brighton, Brighton, United Kingdom
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Vancampfort D, De Hert M, Stubbs B, Soundy A, De Herdt A, Detraux J, Probst M. A systematic review of physical activity correlates in alcohol use disorders. Arch Psychiatr Nurs 2015; 29:196-201. [PMID: 26165972 DOI: 10.1016/j.apnu.2014.08.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/13/2014] [Accepted: 08/20/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Physical activity might promote mental and physical health in persons with alcohol use disorder. Understanding the barriers and facilitators of participation in physical activity in persons with alcohol use disorder is an essential first step in order to devise effective physical activity interventions. OBJECTIVE The present review provides a systematic quantitative review of the correlates of physical activity in people with alcohol use disorder. METHODS Major electronic databases were searched by two independent authors from inception until June 2014. Keywords included 'physical activity' or 'exercise' and 'alcohol dependence' or 'alcohol abuse' or 'alcohol use disorders' or 'alcoholism'. RESULTS Five papers evaluating 14 correlates were included. Three studies reported that alcohol dependence was unrelated to physical activity behavior, while alcohol abuse showed positive associations in 2 studies. No demographic variable was related with physical activity participation. Functional impairments and distress associated with alcohol use disorders including increased smoking rates, obesity, anxiety, depression and a lower self-efficacy may limit one's ability to be physically active. Data on social, environmental and policy related factors are currently lacking. No included study assessed physical activity levels utilizing objective measurements (e.g. pedometers, accelerometers). CONCLUSION Although the literature on physical activity correlates in persons with alcohol use disorder still is equivocal, our varied findings support the hypothesis that the participation in physical activity by people with alcohol use disorder is determined by a range of complex factors.
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Affiliation(s)
- Davy Vancampfort
- KU Leuven Department of Neurosciences, UPC KU Leuven, Kortenberg, Kortenberg, Belgium; KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.
| | - Marc De Hert
- KU Leuven Department of Neurosciences, UPC KU Leuven, Kortenberg, Kortenberg, Belgium
| | - Brendon Stubbs
- School of Health and Social Care, University of Greenwich, London, UK
| | - Andrew Soundy
- Department of Physiotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - Amber De Herdt
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
| | - Johan Detraux
- KU Leuven Department of Neurosciences, UPC KU Leuven, Kortenberg, Kortenberg, Belgium
| | - Michel Probst
- KU Leuven Department of Neurosciences, UPC KU Leuven, Kortenberg, Kortenberg, Belgium; KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
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Ghisi GLDM, Grace SL, Thomas S, Oh P. Behavior determinants among cardiac rehabilitation patients receiving educational interventions: an application of the health action process approach. PATIENT EDUCATION AND COUNSELING 2015; 98:612-621. [PMID: 25638305 DOI: 10.1016/j.pec.2015.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 01/09/2015] [Accepted: 01/10/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To (1) test the effect of a health action process approach (HAPA) theory-based education program in cardiac rehabilitation (CR) compared to traditional education on patient knowledge and HAPA constructs; and, (2) investigate the theoretical correlates of exercise behavior among CR patients receiving theory-based education. METHODS CR patients were exposed to an existing or HAPA-based 6 month education curriculum in this quasi-experimental study. Participants completed a survey assessing exercise behavior, HAPA constructs, and knowledge pre and post-program. RESULTS 306 patients consented to participate, of which 146 (47.7%) were exposed to the theory-based educational curriculum. There was a significant improvement in patients' overall knowledge pre- to post-CR, as well as in some HAPA constructs and exercise behavior, regardless of curriculum (p < 0.05). Path analysis revealed that knowledge was significantly related to intention formation, and intentions to engage in exercise were not directly related to behavior, which required action planning. CONCLUSIONS The theoretically-informed education curriculum was not associated with greater knowledge or exercise behavior as expected. Education in CR improves knowledge, and theoretical constructs related to exercise behavior. PRACTICE IMPLICATIONS Educational curricula should be designed to not only increase patients' knowledge, but also enhance intentions, self-efficacy, and action planning.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Exercise Sciences Department, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Canada; Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
| | - Sherry L Grace
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Scott Thomas
- Exercise Sciences Department, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Canada
| | - Paul Oh
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
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Huffman JC, Moore SV, DuBois CM, Mastromauro CA, Suarez L, Park ER. An exploratory mixed methods analysis of adherence predictors following acute coronary syndrome. PSYCHOL HEALTH MED 2014; 20:541-50. [PMID: 25495864 DOI: 10.1080/13548506.2014.989531] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Adherence to cardiac health behaviors is a critical predictor of prognosis in the months following an acute coronary syndrome (ACS). However, there has been minimal concomitant study of multiple nonadherence risk factors, as assessed via record review, structured assessments, and qualitative interviews, among hospitalized ACS patients. Accordingly, we completed an exploratory mixed methods study with 22 individuals who were admitted for ACS and had suboptimal pre-ACS adherence to physical activity, heart-healthy diet, and/or medications, defined by a Medical Outcomes Study Specific Adherence Scale (MOS SAS) score <15/18. During hospitalization, participants underwent quantitative assessments of sociodemographic, medical, and psychological variables, followed by in-depth semi-structured interviews to explore intentions, plans, and perceived barriers related to post-discharge health behavior changes. The MOS SAS was readministered at 3 months and participants were designated as persistently nonadherent (MOS SAS <15; n = 9) or newly adherent (n = 13). Interviews were transcribed and coded by trained raters via content analysis, and quantitative variables were compared between groups using chi-square analysis and independent-samples t-tests. On our primary qualitative analysis, we found that participants with vaguely described intentions/plans regarding health behavior change, and those who focused on barriers to change that were perceived as static, were more likely to be persistently nonadherent. On exploratory quantitative analyses, greater medical burden, diabetes, depressive symptoms, and low optimism/positive affect at baseline were associated with subsequent post-ACS nonadherence (all p < .05). In conclusion, this appears to be the first study to prospectively examine all of these constructs in hospitalized ACS patients, and we found that specific factors were associated with nonadherence to key health behaviors 3 months later. Therefore it may be possible to predict future nonadherence in ACS patients, even during hospitalization, and specific interventions during admission may be indicated to prevent adverse outcomes among patients at highest risk for post-ACS nonadherence.
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Affiliation(s)
- Jeff C Huffman
- a Department of Psychiatry , Massachusetts General Hospital , 55 Fruit Street/Blake 11, Boston , MA , USA
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Byun W, Ozemek C, Riggin K, Strath S, Kaminsky L. Correlates of objectively measured physical activity in cardiac patients. Cardiovasc Diagn Ther 2014; 4:406-10. [PMID: 25414828 DOI: 10.3978/j.issn.2223-3652.2014.10.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 10/15/2014] [Indexed: 11/14/2022]
Abstract
Cardiac patients would benefit from increasing their physical activity (PA) levels. Understanding of factors that influence cardiac patients' PA participation would benefit the development of effective interventions. Therefore, the purpose of this study was to determine correlates of objectively-measured PA in cardiac patients. Participants were 65 cardiac patients (74% male, 95% white), age 58.6±10.6 years. The amount of time spent in PA was measured by ActiGraph GT3X accelerometers for 7 days prior to joining cardiac rehabilitation programs (CRP). A total of 25 potential determinants of PA across multiple domains (demographic, clinical, psychosocial, and behavioral) were measured via self-reported questionnaire and clinical examinations. Backward elimination model selection procedures were performed to examine associations of potential determinants with total PA (min/day) and moderate-to-vigorous PA (MVPA) (min/day). Patients spent 153.8±62.8 and 8.4±8.1 min/day in total PA and MVPA, respectively. Across four domains, ten and five potential correlates were found to be significant in univariate analyses for MVPA and total PA, respectively. In the final model, functional capacity, PA readiness, and participation in regular exercise were positively associated with MVPA (R(2) =26.6%). Functional capacity and PA readiness were also positively associated with total PA (R(2) =15.9%). Future initiatives to increase PA levels in cardiac patients could be improved by considering patients' functional capacity, PA readiness, and exercise history in designing interventions.
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Affiliation(s)
- Wonwoo Byun
- 1 Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58102, USA ; 2 Master of Public Health Program, North Dakota State University, Fargo, ND, USA ; 3 Clinical Exercise Physiology Program, Human Performance Laboratory, Ball State University, Muncie, IN 47306, USA ; 4 Cardiopulmonary Rehabilitation Program, Indiana University Health - Ball Memorial Hospital, Muncie, IN, USA ; 5 Department of Kinesiology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA ; 6 Center for Aging and Translational Research, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Cemal Ozemek
- 1 Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58102, USA ; 2 Master of Public Health Program, North Dakota State University, Fargo, ND, USA ; 3 Clinical Exercise Physiology Program, Human Performance Laboratory, Ball State University, Muncie, IN 47306, USA ; 4 Cardiopulmonary Rehabilitation Program, Indiana University Health - Ball Memorial Hospital, Muncie, IN, USA ; 5 Department of Kinesiology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA ; 6 Center for Aging and Translational Research, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Katrina Riggin
- 1 Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58102, USA ; 2 Master of Public Health Program, North Dakota State University, Fargo, ND, USA ; 3 Clinical Exercise Physiology Program, Human Performance Laboratory, Ball State University, Muncie, IN 47306, USA ; 4 Cardiopulmonary Rehabilitation Program, Indiana University Health - Ball Memorial Hospital, Muncie, IN, USA ; 5 Department of Kinesiology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA ; 6 Center for Aging and Translational Research, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Scott Strath
- 1 Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58102, USA ; 2 Master of Public Health Program, North Dakota State University, Fargo, ND, USA ; 3 Clinical Exercise Physiology Program, Human Performance Laboratory, Ball State University, Muncie, IN 47306, USA ; 4 Cardiopulmonary Rehabilitation Program, Indiana University Health - Ball Memorial Hospital, Muncie, IN, USA ; 5 Department of Kinesiology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA ; 6 Center for Aging and Translational Research, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Leonard Kaminsky
- 1 Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58102, USA ; 2 Master of Public Health Program, North Dakota State University, Fargo, ND, USA ; 3 Clinical Exercise Physiology Program, Human Performance Laboratory, Ball State University, Muncie, IN 47306, USA ; 4 Cardiopulmonary Rehabilitation Program, Indiana University Health - Ball Memorial Hospital, Muncie, IN, USA ; 5 Department of Kinesiology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA ; 6 Center for Aging and Translational Research, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Alharbi M, Gallagher R, Kirkness A, Sibbritt D, Tofler G. Long-term outcomes from Healthy Eating and Exercise Lifestyle Program for overweight people with heart disease and diabetes. Eur J Cardiovasc Nurs 2014; 15:91-9. [PMID: 25344059 DOI: 10.1177/1474515114557222] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 10/07/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND The benefits of exercise and weight reduction for overweight or obese people with coronary heart disease and/or diabetes mellitus are well recognised. The Healthy Eating and Exercise Lifestyle Program demonstrated these outcomes at 4 months, but longer-term outcomes are not yet reported. AIM To determine whether positive weight, body mass index, waist and exercise duration outcomes were sustained in the long term (12 months) and to identify the independent predictors of these outcomes at 4 and 12 months. METHODS Longitudinal design, combining data of all Healthy Eating and Exercise Lifestyle Program participants (intervention and wait-list control, n = 134). Participants had a body mass index between 27 and 39 kg/m(2) and had completed cardiac rehabilitation and/or diabetes education programmes. Healthy Eating and Exercise Lifestyle Program intervention included an active phase of two 1-hour group-based supervised structured exercise sessions every week for 4 months and four 90-minute group information and support sessions. The maintenance phase included one 90-minute group-based booster information session and three 15-minute goal-focused telephone follow-up calls over 8 months. RESULTS Participants had statistically significant reductions from baseline in weight, body mass index and waist circumference and improvements in exercise duration and capacity at 4 and 12 months. Time, self-efficacy, depressive symptoms and male gender were independent predictors for body mass index, waist and/or exercise duration (p < 0.05). CONCLUSION The Healthy Eating and Exercise Lifestyle Program was an effective programme to achieve and sustain weight loss and increase exercise participation over 1 year.
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Affiliation(s)
| | | | - Ann Kirkness
- North Shore Cardiovascular Education Centre, Royal North Shore Hospital, Australia
| | | | - Geoffrey Tofler
- Northern Sydney Clinical School, Royal North Shore Hospital, Australia
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Sweet SN, Fortier MS, Strachan SM, Blanchard CM, Boulay P. Testing a Longitudinal Integrated Self-Efficacy and Self-Determination Theory Model for Physical Activity Post-Cardiac Rehabilitation. Health Psychol Res 2014; 2:1008. [PMID: 26973926 PMCID: PMC4768554 DOI: 10.4081/hpr.2014.1008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 03/11/2013] [Accepted: 03/13/2013] [Indexed: 11/23/2022] Open
Abstract
Self-determination theory and self-efficacy theory are prominent theories in the physical activity literature, and studies have begun integrating their concepts. Sweet, Fortier, Strachan and Blanchard (2012) have integrated these two theories in a cross-sectional study. Therefore, this study sought to test a longitudinal integrated model to predict physical activity at the end of a 4-month cardiac rehabilitation program based on theory, research and Sweet et al.'s cross-sectional model. Participants from two cardiac rehabilitation programs (N=109) answered validated self-report questionnaires at baseline, two and four months. Data were analyzed using Amos to assess the path analysis and model fit. Prior to integration, perceived competence and self-efficacy were combined, and labeled as confidence. After controlling for 2-month physical activity and cardiac rehabilitation site, no motivational variables significantly predicted residual change in 4-month physical activity. Although confidence at two months did not predict residual change in 4-month physical activity, it had a strong positive relationship with 2-month physical activity (β=0.30, P<0.001). The overall model retained good fit indices. In conclusion, results diverged from theoretical predictions of physical activity, but self-determination and self-efficacy theory were still partially supported. Because the model had good fit, this study demonstrated that theoretical integration is feasible.
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Affiliation(s)
- Shane N. Sweet
- School of Psychology, University of Ottawa, Ontario, Canada
| | | | - Shaelyn M. Strachan
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chris M. Blanchard
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Pierre Boulay
- Faculty of Physical Education and Sports, University of Sherbrooke, Sherbrooke, Québec, Canada
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Abstract
PURPOSE Physical inactivity has been identified as a distinct health risk. However, little is known about how this can vary at leisure and work in cardiac patients. The aim of this study was to examine the prevalence and predictors of inactivity during leisure and work in the 12 months following a cardiac event in Australian cardiac patients. METHODS A total of 346 patients consecutively admitted to hospital with acute coronary syndrome or to undergo coronary artery bypass graft surgery were interviewed in hospital, and 4 and 12 months later. Leisure and occupational physical activity was measured using the Stanford Brief Activity Survey. Sociodemographic, psychosocial, and clinical data were also collected. RESULTS The prevalence of leisure-time physical inactivity declined over time, with 52% inactive preevent and 29% inactive at 12 months. Approximately 50% of participants were physically inactive in their work, regardless of whether this was measured before or after the cardiac event. Logistic regression revealed that the significant predictors of leisure-time physical inactivity at 12 months were non-home ownership (OR = 2.19; P = .007) and physical inactivity in leisure-time prior to the event (OR = 2.44; P = .001). The significant predictors of occupational physical inactivity at 12 months were white-collar occupation (OR = 3.10; P < .001) and physical inactivity at work prior to the event (OR = 12.99; P < .001). CONCLUSIONS Preevent physical inactivity, socioeconomic, and clinical factors predicted both leisure and work inactivity after an acute cardiac event. Effective interventions could be designed and implemented to target those most at risk of being physically inactive at work or leisure.
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A twin-sibling study on the relationship between exercise attitudes and exercise behavior. Behav Genet 2013; 44:45-55. [PMID: 24072598 DOI: 10.1007/s10519-013-9617-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 09/14/2013] [Indexed: 12/18/2022]
Abstract
Social cognitive models of health behavior propose that individual differences in leisure time exercise behavior are influenced by the attitudes towards exercise. At the same time, large scale twin-family studies show a significant influence of genetic factors on regular exercise behavior. This twin-sibling study aimed to unite these findings by demonstrating that exercise attitudes can be heritable themselves. Secondly, the genetic and environmental cross-trait correlations and the monozygotic (MZ) twin intrapair differences model were used to test whether the association between exercise attitudes and exercise behavior can be causal. Survey data were obtained from 5,095 twins and siblings (18-50 years). A genetic contribution was found for exercise behavior (50 % in males, 43 % in females) and for the six exercise attitude components derived from principal component analysis: perceived benefits (21, 27 %), lack of skills, support and/or resources (45, 48 %), time constraints (25, 30 %), lack of energy (34, 44 %), lack of enjoyment (47, 44 %), and embarrassment (42, 49 %). These components were predictive of leisure time exercise behavior (R(2) = 28 %). Bivariate modeling further showed that all the genetic (0.36 < |rA| < 0.80) and all but two unique environmental (0.00 < |rE| < 0.27) correlations between exercise attitudes and exercise behavior were significantly different from zero, which is a necessary condition for the existence of a causal effect driving the association. The correlations between the MZ twins' difference scores were in line with this finding. It is concluded that exercise attitudes and exercise behavior are heritable, that attitudes and behavior are partly correlated through pleiotropic genetic effects, but that the data are compatible with a causal association between exercise attitudes and behavior.
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Predicting Exercise Adherence for Patients with Obesity and Diabetes Referred to a Cardiac Rehabilitation and Secondary Prevention Program. Can J Diabetes 2013; 37:189-94. [PMID: 24070842 DOI: 10.1016/j.jcjd.2013.03.370] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 03/21/2013] [Accepted: 03/21/2013] [Indexed: 11/20/2022]
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Everyday Physical Activity in Ambulatory Heart Transplant Candidates: the Role of Expected Health Benefits, Social Support, and Potential Barriers. Int J Behav Med 2013; 21:248-57. [DOI: 10.1007/s12529-013-9304-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Vancampfort D, Correll CU, Probst M, Sienaert P, Wyckaert S, De Herdt A, Knapen J, De Wachter D, De Hert M. A review of physical activity correlates in patients with bipolar disorder. J Affect Disord 2013; 145:285-91. [PMID: 22889526 DOI: 10.1016/j.jad.2012.07.020] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 07/16/2012] [Accepted: 07/16/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Existing studies do suggest that physical activity interventions may be feasible and have a role in promoting mental and physical health in patients with bipolar disorder. The present review evaluates systematically quantitative studies of correlates of physical activity in patients with bipolar disorder. METHODS We searched EMBASE, PsycINFO, PubMed, and CINAHL from their inception, combining the medical subject headings 'bipolar disorder' or 'mania' or 'manic depression' with 'physical activity' or 'physical inactivity' or 'exercise'. RESULTS Out of 40 potentially eligible studies, 11 papers evaluating 26 correlates were included. Correlates that were associated with lower physical activity participation were lower self-efficacy, presence of medical co-morbidity, lower educational status and social isolation. Less consistent variables associated with lower physical activity participation included higher BMI, older age, financial strains, not being connected to a health care service, and minority ethnicity. A larger study sample size was related to a higher proportion of significant associations (p=0.04). Current gaps in literature which need to be examined more in detail are the role of psychiatric symptoms, environmental and policy-level factors. LIMITATIONS The diversity of physical activity measures and subject samples prevented us to perform a meta-analysis. CONCLUSIONS All significant correlates should be confirmed in prospective studies and interventions to improve the modifiable variables should be developed and evaluated. The reviewed data also demonstrate that validation studies on physical activity measurements are highly needed.
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Affiliation(s)
- Davy Vancampfort
- University Psychiatric Center, Catholic University Leuven, Campus Kortenberg, Kortenberg, Belgium.
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40
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Amireault S, Godin G, Vézina-Im LA. Determinants of physical activity maintenance: a systematic review and meta-analyses. Health Psychol Rev 2013. [DOI: 10.1080/17437199.2012.701060] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Bentley D, Khan S, Oh P, Grace S, Thomas S. Physical activity behavior two to six years following cardiac rehabilitation: a socioecological analysis. Clin Cardiol 2012; 36:96-102. [PMID: 23280429 DOI: 10.1002/clc.22084] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 11/13/2012] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) promotes long-term positive health behaviours, such as physical activity (PA), in patients following a cardiovascular event. We have limited knowledge of long-term PA and its correlates. Therefore, this research examined both PA behaviour and socioecological correlates among elderly graduates 2-6 years following CR. HYPOTHESIS CR graduates will have a moderate PA level in the long term. Greater PA will be associated with various multilevel correlates. METHODS This was a retrospective, cross-sectional study which quantified PA using the Physical Activity Scale for the Elderly (PASE) and collected information about socioecological correlates at the intrapersonal, interpersonal and health service levels. Both univariate and multivariate analyses assessed PA and PA correlates. RESULTS The majority of the 584 participants were older (69.8 ± 9.8), male (80.3%), and well educated (75.4% ≥ some post-secondary). Average time since CR graduation was 41.5 ± 11.5 months. Seventy five percent of CR graduates reported current weekly PA levels that met, or exceeded, Canadian PA guidelines (>150 minutes of moderate-vigorous PA). Univariate analyses identified 13 PASE score correlates. Multivariate analyses identified age, PA enjoyment, current work status, CR staff support, location of primary residence, and perceived health as significantly associated with higher PASE scores (p < 0.001). CONCLUSIONS Three and a half years post-CR graduates had high PA levels. Greater PA was associated with several modifiable multilevel correlates at all levels of influence. Understanding correlates of long-term PA behaviour among CR graduates will help identify groups at risk for nonadherence and assist with continued program development.
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Affiliation(s)
- Danielle Bentley
- Department of Exercise Science, University of Toronto, Toronto, Canada.
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Alosco ML, Spitznagel MB, Miller L, Raz N, Cohen R, Sweet LH, Colbert LH, Josephson R, Waechter D, Hughes J, Rosneck J, Gunstad J. Depression is associated with reduced physical activity in persons with heart failure. Health Psychol 2012; 31:754-62. [PMID: 22924448 DOI: 10.1037/a0028711] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Reduced physical activity is common in persons with heart failure (HF). However, studies of correlates and modifiers of physical activity in this population rarely employ objective measures. Motivational and mood related factors that may exacerbate inactivity in HF patients are also rarely investigated. In this study, we examined the relationship between physical activity as assessed by accelerometry, and depression in older adults with HF. METHODS At baseline, older adults with HF (N = 96; 69.81 ± 8.79) wore an accelerometer for seven days, and completed a brief fitness assessment, neuropsychological testing, and psychosocial measures including the Beck Depression Inventory-II (BDI-II). Medical and demographic history was obtained through record review and self-report. RESULTS Accelerometer measures showed that HF patients averaged 587 minutes of sedentary time and just 0.31 minutes of vigorous activity per day. Lower daily step count was associated with poorer quality of life and reduced cognitive function. A multiple linear regression adjusting for important demographic and medical variables found that greater number of depressive symptoms on the BDI-II independently predicted lower physical activity levels. CONCLUSION Consistent with past work, the current study found that low physical activity is common in older adults with HF. Depression is an independent predictor of physical activity in older adults with HF and reduced physical activity is associated with numerous adverse psychosocial outcomes. Future studies need to determine whether treatment of depression can boost physical activity and thus improve health outcomes in this population.
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Affiliation(s)
- Michael L Alosco
- Department of Psychology, Kent State University, Kent, OH 44242, USA.
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Abstract
Adherence is critical to the overall management of individuals at risk for and with cardiovascular disease. It forms an interplay between the patient, provider, and health care system and includes barriers that have been encountered within all 3 domains. Improving adherence to exercise, diet, and medication as well as focusing on addictive disorders such as smoking cessation requires patient, provider, and health care system approaches. The use of the cognitive/behavioral elements of health behavior change and communication strategies such as motivational interviewing and coaching serve to enhance overall adherence. Continuous quality improvement initiatives at the system level of change also increase the likelihood that teams will succeed in helping individuals change their behavior. Cardiac rehabilitation programs offer a unique opportunity for health care professionals to play a key role in supporting individuals through the health behavior change process.
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Affiliation(s)
- Nancy Houston Miller
- Stanford Cardiac Rehabilitation Program, Stanford University School of Medicine, Palo Alto, California, USA.
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Vancampfort D, Knapen J, Probst M, Scheewe T, Remans S, De Hert M. A systematic review of correlates of physical activity in patients with schizophrenia. Acta Psychiatr Scand 2012; 125:352-62. [PMID: 22176559 DOI: 10.1111/j.1600-0447.2011.01814.x] [Citation(s) in RCA: 212] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The present review evaluates systematically the published quantitative studies of correlates of PA in patients with schizophrenia. METHOD EMBASE, PsycINFO, PubMed, ISI Web of Science, CINAHL and PEDro were searched from their inception to 1 July 2011 combining the medical subject heading 'schizophrenia' with 'physical activity' or 'physical inactivity' or 'exercise' or 'health education' or 'health behaviour' or 'health promotion'. RESULTS Out of 68 potentially eligible studies, 25 papers (n = 25,013) evaluating 36 correlates were included. Correlates consistently associated with lower PA participation are the presence of negative symptoms and cardio-metabolic comorbidity. Also, side-effects of antipsychotic medication, lack of knowledge on cardiovascular disease risk factors, no belief in the health benefits, a lower self-efficacy, other unhealthy lifestyle habits and social isolation correlated with lower PA participation. The quality of the PA measurement was not related to the proportion of significant associations (χ(2) = 3.8, P = 0.07). Current gaps in literature that need to be examined more in detail are the role of environmental and policy-level factors on PA participation in patients with schizophrenia. CONCLUSION All correlates should be confirmed in prospective studies, and interventions to improve the modifiable variables should be developed and evaluated.
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Affiliation(s)
- D Vancampfort
- University Psychiatric Centre Catholic University Leuven, Campus Kortenberg, The Netherlands.
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Blanchard C, Rainham D, McSweeney J, Spence J, McDonnell L, Rhodes R, Reid R, McGannon K, Edwards N. Community SES, perceived environment, and physical activity during home-based cardiac rehabilitation: is there a need to consider the urban vs. rural distinction? J Urban Health 2012; 89:285-95. [PMID: 22402918 PMCID: PMC3324610 DOI: 10.1007/s11524-011-9661-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Physical activity (MVPA) levels during home-based cardiac rehabilitation (CR) remain problematic. Consequently, the present study examined the association between MVPA and urban vs. rural residential status and the perceived environment in patients attending home-based CR. A total of 280 patients completed a questionnaire assessing demographic, clinical, MVPA, and perceived environmental variables measured at baseline and 3 months later. Patient addresses were geocoded and linked to the 2006 Canadian census to establish the urban/rural distinction. Results showed that urban and rural patients had similar baseline MVPA and improvements in MVPA by 3 months. Several perceived environmental variables were significantly related to MVPA throughout home-based CR that were common and urban/rural-specific. Therefore, although there does not appear to be an urban vs. rural advantage in MVPA levels during home-based CR, there does appear to be environmental/MVPA-specific relationships specific to urban and rural patients that may warrant attention.
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Understanding physical activity during home-based cardiac rehabilitation from multiple theoretical perspectives. J Cardiopulm Rehabil Prev 2011; 31:173-80. [PMID: 21796061 DOI: 10.1097/hcr.0b013e3181ff0dfe] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE : Previous studies have shown that moderate-to-vigorous physical activity (MVPA) levels during home-based cardiac rehabilitation (CR) have been problematic. Consequently, the present study examined the utility of the theory of planned behavior, protection motivation theory, and social cognitive theory in explaining physical activity (PA) during a Canadian home-based CR program. METHODS : Patients (N = 280, mean age 62.8 years; 95.4% white, 72.5% male, 78.9% married, 52.3% retired, 48.0% income more than $60000; and 33.8% postmyocardial infarction) completed a questionnaire at program onset and a MVPA assessment at 3-month followup. RESULTS : Path analyses showed that each theory accounted for 28% to 34% of the variance in PA. The theory of planned behavior showed that perceived behavior control was the key predictor of 3-month MVPA (β = .36), whereas protection motivation theory showed that intention (β = .30) was the key predictor. Finally, barrier self-efficacy (β = .21) and the availability of home PA equipment (β = .15) were the key predictors of 3-month MVPA within social cognitive theory. CONCLUSION : All 3 theories appeared to be viable options to inform the development of a MVPA intervention during home-based CR. However, the key constructs to target within each theory varied, suggesting the need to potentially use multiple theories to inform intervention development.
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Tierney S, Elwers H, Sange C, Mamas M, Rutter MK, Gibson M, Neyses L, Deaton C. What influences physical activity in people with heart failure? A qualitative study. Int J Nurs Stud 2011; 48:1234-43. [DOI: 10.1016/j.ijnurstu.2011.03.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 03/02/2011] [Accepted: 03/04/2011] [Indexed: 11/17/2022]
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49
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Behavioural interventions to increase the physical activity of cardiac patients: a review. ACTA ACUST UNITED AC 2011; 18:15-32. [PMID: 20502341 DOI: 10.1097/hjr.0b013e32833ace0e] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To examine the behaviour change techniques that have been used in physical activity (PA) interventions to increase PA during and after completing cardiac rehabilitation (CR) and for patients who do not attend CR (non-CR). PubMed, PsychINFO, SPORTdiscus, Web of Science, Prowler and Cochrane databases were searched to identify studies that described an intervention delivered to adults in the CR and non-CR contexts that focused solely on promoting PA. Twenty-three studies (14 post-CR and nine non-CR) were included in this review. Findings showed that interventions can increase PA; however, there were notable differences across CR contexts in their purpose, the participant demographics, and some of the behaviour change techniques used. Techniques shown to be most effective in the post-CR context were self-monitoring, setting specific goals, identifying barriers and developing plans for relapse prevention. In the non-CR context, unsupervised home-based interventions were shown to be effective at increasing PA, particularly when accompanied by follow-up prompts, general encouragement, specific goals set by the researcher and self-monitoring. Post-CR and non-CR interventions can result in improved PA outcomes; however, the research in this area is limited. More interventions are needed that target PA-only, particularly in the non-CR context.
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Rosenberg DE, Bombardier CH, Hoffman JM, Belza B. Physical activity among persons aging with mobility disabilities: shaping a research agenda. J Aging Res 2011; 2011:708510. [PMID: 21748010 PMCID: PMC3124953 DOI: 10.4061/2011/708510] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 04/17/2011] [Indexed: 11/20/2022] Open
Abstract
With the aging of the baby boomer population and their accompanying burden of disease, future disability rates are expected to increase. This paper summarizes the state of the evidence regarding physical activity and aging for individuals with mobility disability and proposes a healthy aging research agenda for this population. Using a previously published framework, we present evidence in order to compile research recommendations in four areas focusing on older adults with mobility disability: (1) prevalence of physical activity, (2) health benefits of physical activity, (3) correlates of physical activity participation, and, (4) promising physical activity intervention strategies. Overall, findings show a dearth of research examining physical activity health benefits, correlates (demographic, psychological, social, and built environment), and interventions among persons aging with mobility disability. Further research is warranted.
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Affiliation(s)
- Dori E. Rosenberg
- Harborview Medical Center, Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA
| | - Charles H. Bombardier
- Harborview Medical Center, Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA
| | - Jeanne M. Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Basia Belza
- School of Nursing, University of Washington, Seattle, WA 98195, USA
- School of Public Health, University of Washington, Seattle, WA 98195, USA
- Coordinating Center, CDC Healthy Aging Research Network, University of Washington, Seattle, WA 98195, USA
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