Self-efficacy, psychosocial factors, and exercise behavior in traditional versus modified cardiac rehabilitation.
BACKGROUND
Self-efficacy and social support are established determinants of exercise adherence and have potential usefulness for tailoring independent exercise regimens for cardiac patients. Highly supervised traditional cardiac rehabilitation programs may be a barrier for independent exercise self-efficacy in low - and moderate-risk patients.


OBJECTIVE
The authors evaluated changes in psychosocial measures including self-efficacy and social support in 80 cardiac patients with low to moderate risk randomized to a traditional cardiac rehabilitation protocol (TP) or modified protocol (MP). These measures also were assessed for their potential to predict subsequent exercise behavior.


METHODS
The TP (n = 38) emphasized a supervised exercise regimen and included continuous electrocardiogram (ECG) monitoring for 3 months. The lower cost MP (n = 42) emphasized independent exercise and included group education/support meetings, and gradually weaned patients from continuous ECG monitoring and direct medical supervision.


RESULTS
Repeated measures analyses of variance indicated that MP patients had higher levels of self-efficacy for independent exercise without continuous ECG monitoring (P < .05). No other protocol differences were found. Multiple regression analyses using the pooled sample (excluding dropouts) indicated that self-efficacy for independent exercise was the only significant predictor of exercise over 6 months (R2=.28 [adjusted R2= .221 P < .01). In contrast to previous reports, social support for exercise was not a significant predictor of exercise behavior.


CONCLUSIONS
These findings suggest cardiac rehabilitation programs for low- and moderate-risk patients should emphasize educational and patient monitoring methods that promote patient self-efficacy for independent exercise. Programs that emphasize highly supervised exercise including longer term use of continuous ECG monitoring may impair self-efficacy for independent exercise. Longer-term studies are needed to fully determine the value of using psychosocial measures for designing individualized exercise programs and predicting long-term exercise behavior in cardiac patients.
Carlson
J J
JJ
Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, Palo Alto, Calif, USA.
Norman
G J
GJ
Feltz
D L
DL
Franklin
B A
BA
Johnson
J A
JA
Locke
S K
SK
D000368:Aged; D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000523:psychology; D004562:Electrocardiography; D005081:Exercise Therapy; D005260:Female; D006331:Heart Diseases / Q000523:psychology / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D020377:Self Efficacy; D012944:Social Support