Physical Activity Behaviour and Motivation During and Following Pulmonary and Cardiac Rehabilitation: A Repeated Measures Study

BACKGROUND

Exercise rehabilitation programmes are important for long-term health and wellbeing among people with cardiac and pulmonary diseases. Despite this, many people struggle to maintain their physical activity once rehabilitation ends. This repeated measures study tracked changes in physical activity behaviour and motivation during and after completing a community-based exercise rehabilitation programme.

METHODS

Cardiac and pulmonary exercise rehabilitation patients (N = 31) completed six once-monthly measures of physical activity (MET·min), self-determined motivation, intention, and habit strength for rehabilitation exercise (within rehabilitation sessions) and lifestyle physical activity (outside of rehabilitation sessions). Linear regression and random effects models with estimated marginal means were used to test for associations between physical activity motivation and behaviour and change during and post-rehabilitation.

RESULTS

Overall physical activity decreased after rehabilitation (823 MET·min) despite patients becoming more self-determined for lifestyle physical activity during rehabilitation. More self-determined motivation, stronger intentions, and stronger habits were associated with more lifestyle physical activity behaviour. However, none of these motivation variables were significantly associated with rehabilitation exercise behaviour.

CONCLUSIONS

Among community-based cardiac and pulmonary rehabilitation patients, physical activity levels decreased following exercise rehabilitation programmes. The findings revealed clear distinctions in the motivation of rehabilitation exercise compared to lifestyle physical activity. Exercise rehabilitation programmes might improve the longevity of outcomes by integrating approaches to enhance lifestyle physical activity beyond the clinic.

Prevalence of Return to Work in Cardiovascular Patients After Cardiac Rehabilitation: A Systematic Review and Meta-analysis

The present systematic review and meta-analysis aimed to clarify the effects of cardiac rehabilitation (CR) on the prevalence of return to work (RTW) in cardiovascular diseases (CVDs) patients. CR plays a very important role in the management of CVDs and improves the patients' physical activity, quality of life, and a decrease in the cost of healthcare. RTW is the most important goal in the rehabilitation of CVD patients. PubMed, Web of Science, Scopus, and Google scholar were searched systematically from inception up to January 2021 for English published clinical trials and observational studies. In total, 16 studies were analyzed, of them, 8 were controlled studies. Pooled results showed that the mean age of patients was 52.30 (50.04, 54.57). The prevalence of RTW in the CR attending group was 66% (60%, 71%) and in the control group was 58% (47%, 68%). Subgroup analysis showed that the proportion of RTW was higher in white-collars 76% (73%-79%) compared to. blue-collars 63% (56%-70%). Out-patient CR with 72% (61%-81%) RTW was more effective compared to in-patient CR with 62% (44%- 78%) and usual care (control). It can be concluded that CR especially out-patient CR increases the prevalence of RTW but not much. Improved and appropriate CR programs related to each individual's disease and patient condition which follow the valid guidelines might help to increase the effectiveness of CR in terms of RTW.

A Systematic Review and Meta-analysis on the Prevalence of Smoking Cessation in Cardiovascular Patients After Participating in Cardiac Rehabilitation

Smoking is the most important modifiable cardiovascular risk factor causes around approximately one of every 4 cardiovascular-related deaths worldwide. Cardiac rehabilitation (CR) is the standard way of management of heart diseases after myocardial infraction. This study aimed to determine the prevalence of cardiovascular patients' quit smoking after participation in CR. PubMed, EMBASE, Web of Science, Scopus, and google scholar were searched systematically. In total, 18 studies were analyzed. Results showed that the mean age of smokers' were 54.80 (52.06, 57.55), and of them 53 % (22%, 83%) quit smoking after participating in CR. Subgroup analysis showed that among type of CR the most effective one was the educational along with physical exercise (comprehensive CR) cause 99% (98%, 100%) smoking cessation (SC). Group-based methods with76% (57%, 94%) of quitters showed to be more effective than individual-based. It can be concluded that CR has been effective in terms of smoking cessation.

Depression Is Associated With Reduced Outpatient Cardiac Rehabilitation Completion Rates: A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS

PURPOSE

Depression is associated with recurrent cardiac events and death in patients with coronary heart disease and congestive heart failure. Furthermore, depression may be associated with reduced completion of outpatient cardiac rehabilitation (CR), an empirically supported treatment for patients with coronary heart disease and congestive heart failure that reduces recurrent coronary events and cardiac mortality. The goal of the current systematic review and meta-analysis was to explore the association between depression and outpatient CR completion.

METHOD

A systematic literature review cross-referenced 3 electronic databases (PsycINFO, MEDLINE, and Dissertation Abstracts International) from inception through February 15, 2015. Studies quantifying an association between depression and outpatient CR completion were identified for review. A random-effects model was used to pool quantitative data, moderators were tested, and publication bias was analyzed.

RESULTS

Seventeen studies with 19 independent samples consisting of 30 586 cardiac patients were included in the meta-analysis. A moderate inverse relationship between depression and outpatient CR completion was observed (g = -0.44; 95% CI, -0.59 to -0.29), indicating that depressed CR patients were significantly less likely to complete their prescribed CR programs. No significant moderator variables were identified. A minor amount of publication bias was detected.

CONCLUSION

Depression is associated with reduced outpatient CR completion rates. Future research should focus on attendance interventions for depressed CR patients, as completion of outpatient CR reduces cardiac and all-cause mortality.

Regional Variability in the Access to Cardiac Rehabilitation in Poland

Equitable access to cardiological rehabilitation services is one of the important elements in the effectiveness of the treatment of cardiovascular diseases as cardiological rehabilitation is an important part of circulatory system disease prevention and treatment. However, in many countries among others, Poland suffers from the underutilization of cardiac rehabilitation services. Cardiovascular diseases are the worldwide number one cause of mortality, morbidity, and disability and are responsible for the substantial increase in health care costs. Thus, the aim of the research was the analysis of geographical accessibility to cardiac rehabilitation services in Poland. Perkal's method was employed in this research. The conducted research allowed to recognize the regional variation, but also made it possible to classify Polish voivodeships in terms of the level of availability achieved. This enables the identification of voivodeships that provide a good, or even very good, access to cardiology rehabilitation services and those characterized by low, or very low access. It was found that there was a slight regional variability in the access to cardiological rehabilitation services. However, the sufficient development of a rehabilitation infrastructure has been also recognized.

Self-Actualization: Self-Care Outcomes among Elderly Patients with Hypertension

Background:

This study aims to analyze the experiences of older patients with hypertension to realize the outcomes of their self-care behaviors for controlling hypertension.

Materials and Methods:

This is a qualitative research with a conventional content analysis approach. The participants consisting of 23 people were selected through purposive sampling. Data were collected through semi-structured interviews until data were saturated. Granheim and Lundman's conventional content analysis was applied to analyze the data.

Results:

After data analysis, four main categories including self-efficacy, active lifestyle, spirituality, and stress management were obtained. These categories show the experience and outcomes of self-care behaviors among elderly patients with hypertension.

Conclusions:

Awareness of the elderly of their potentials and role in disease control in addition to relying on the power of spirituality provides positive results in hypertension management. Self-actualization of the elderly resulted in resisting against the destructive effects of internal and external stress and moving in the direction of growth. Health professionals should be vigilant to encourage and promote education about the importance and advantages of self-care for elderlies.

Associations of baseline depressed mood and happiness with subsequent well-being in cardiac patients

RATIONALE

The relationship between depressive symptoms and adverse outcomes for patients with cardiac problems has been well established for several decades. However, less is known about other factors that may influence psychosocial outcomes for cardiac patients.

OBJECTIVE

To evaluate the association between baseline happiness and depressed mood on later psychosocial functioning among cardiac patients.

METHOD

Participants (N = 250) were patients who had received medical treatment at an academic medical center for a cardiac event. Participants completed questionnaires at two time points: Approximately 2 weeks after they had been discharged from the hospital (baseline) and again 12 weeks later. Participants completed validated measures of depressed mood, happiness, health distress, expectations about health, and quality of life.

RESULTS

Baseline depressed mood and happiness both significantly predicted health-related distress and depressive symptoms at follow up. Happiness ratings were associated with lower distress and depressed mood, whereas scores for depressive symptoms showed the opposite pattern. Happiness, but not depressed mood, was a significant predictor of more positive quality of life ratings. Conversely, only depressed mood was a significant predictor of less positive expectations about health.

CONCLUSION

The results of this study suggest that investigating positive baseline affect in addition to depressed mood provides additional useful information that may help explain why some patients have more negative outcomes following cardiac events.

A descriptive study of effect-size reporting in research reviews

AIM

To describe effect-size reporting in research reviews completed in support of evidence-based practice in nursing.

BACKGROUND

Many research reviews report nurses' critical appraisal of level, quality and overall strength of evidence available to address clinical questions. Several studies of research-review quality suggest effect-size information would be useful to include in these reviews, but none focused on reviewers' attention to effect sizes.

DESIGN

Descriptive.

METHODS

One hundred and four reviews indexed in CINAHL as systematic reviews and published from July 2012-February 2014 were examined. Papers were required to be peer-reviewed, written in English, contain an abstract and have at least one nurse author. Reviews were excluded if they did not use critical appraisal methods to address evidence of correlation, prediction or effectiveness. Data from remaining papers (N = 73) were extracted by three or more independent coders using a structured coding form and detailed codebook. Data were stored, viewed and analysed using Microsoft Office Excel^® spreadsheet functions.

RESULTS

Sixteen percent (n = 12) of the sample contained effect-size information. Of the 12, six included all the effect-size information recommended by APA guidelines. Independent of completeness of reporting, seven contained discussion of effect sizes in the paper, but none included effect-size information in abstracts.

CONCLUSION

Research reviews available to practicing nurses often fail to include information needed to accurately assess how much improvement may result from implementation of evidence-based policies, programs, protocols or practices. Manuscript reviewers are urged to hold authors to APA standards for reporting/discussing effect-size information in both primary research reports and research reviews.

Supporting cardiac patient physical activity: a brief health psychological intervention

Background

One of the most important risk factors for coronary artery disease is physical inactivity. Health psychological research demonstrates the importance of planning for behaviour change success. Consequently, a health action process approach (HAPA) model-based design to support the uptake of physical activity was initiated for the first time in an acute cardiac ward.

Methods

For impact evaluation, a control group (CG) and an intervention group (IG) of coronary artery disease patients were compared in a controlled longitudinal study. Baseline assessment included socio-demographic variables, intentions regarding physical activity, and actual physical activity prior to the coronary artery disease event. Follow-up data were collected 2 and 6 months after discharge.

Results

In total, 193 patients participated in this controlled longitudinal study (63 ± 9 years; CG: N = 78; IG: N = 115). The IG reported a higher increase in physical activity (p < 0.05), intentions, and coping planning (p < 0.05), and also in action planning and control (p < 0.01) 2 months after discharge. Both CG and IG increased their physical activity 6 months after discharge to the point of no significant difference (p = 0.664).

Conclusions

A HAPA model-based health psychological intervention on an acute cardiac ward is able to increase patients’ physical activity over the short term. However, integration of follow-up interventions (preferable in cardiac rehabilitation settings) would be necessary to support sustained physical activity.

Empowered to gain a new foothold in life--A study of the meaning of participating in cardiac rehabilitation to patients afflicted by a minor heart attack

This study aimed to investigate what it means to patients afflicted by a minor heart attack to participate in cardiac rehabilitation (CR). CR is well-established internationally to support patients towards moving forward in satisfying, healthy, and well-functioning lives. Studies indicate that patients achieve improvement in quality of life when participating in CR. However, knowledge of how patients are supported during CR is sparse. Moreover, knowledge of what participating in CR means to patients afflicted by a minor heart attack is lacking. In-depth knowledge in this area is crucial in order to understand these patients' particular gains and needs. In a phenomenological-hermeneutic frame field observations, focus group interviews, and individual interviews were conducted among 11 patients during and after their participation in CR. Field notes and transcribed interviews underwent three-phased interpretation. It was found that patients were supported to gain renewed balance in their lives during CR. Three themes were identified: (1) receiving a helpful but limited caring hand, (2) being supported to find new values in life, and (3) developing responsibility for the remaining time. The patients were carefully guided through a difficult time and supported to continue in healthy everyday lives. They were given hope which enabled them to find themselves a new foothold in life with respect to their own sense of well-being. This guidance and a sense of hopefulness were provided by heart specialists and more seasoned heart patients. In conclusion, patients were empowered to achieve a healthier lifestyle and improve their personal well-being during CR. However, structural barriers in the programme prevented adequate support regarding the patients' total needs. Knowledge of the benefits of CR emphasizes the significance of the programme and highlights the importance of high inclusion. Efforts should be made to develop more flexible and longer lasting programmes and further involvement of relatives must be considered.

Effect of Endurance Cardiovascular Training Intensity on Erectile Dysfunction Severity in Men With Ischemic Heart Disease

The protective effect of physical activity on arteries is not limited to coronary vessels, but extends to the whole arterial system, including arteries, in which endothelial dysfunction and atherosclerotic changes are one of the key factors affecting erectile dysfunction development. The objective of this study was to report whether the endurance training intensity and training-induced chronotropic response are linked with a change in erectile dysfunction intensity in men with ischemic heart disease. A total of 150 men treated for ischemic heart disease, who suffered from erectile dysfunction, were analyzed. The study group consisted of 115 patients who were subjected to a cardiac rehabilitation program. The control group consisted of 35 patients who were not subjected to any cardiac rehabilitation. An IIEF-5 (International Index of Erectile Function) questionnaire was used for determining erectile dysfunction before and after cardiac rehabilitation. Cardiac training intensity was objectified by parameters describing work of endurance training. The mean initial intensity of erectile dysfunction in the study group was 12.46 ± 6.01 (95% confidence interval [CI] = 11.35-13.57). Final erectile dysfunction intensity (EDI) assessed after the cardiac rehabilitation program in the study group was 14.35 ± 6.88 (95% CI = 13.08-15.62), and it was statistically significantly greater from initial EDI. Mean final training work was statistically significantly greater than mean initial training work. From among the parameters describing training work, none were related significantly to reduction of EDI. In conclusion, cardiac rehabilitation program-induced improvement in erection severity is not correlated with endurance training intensity. Chronotropic response during exercise may be used for initial assessment of change in cardiac rehabilitation program-induced erection severity.