title: Self-efficacy, psychosocial factors, and exercise behavior in traditional versus modified cardiac rehabilitation.
abstract: 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.
authors.affiliation: Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, Palo Alto, Calif, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Carlson
authors.forename: G J
authors.initials: GJ
authors.lastname: Norman
authors.forename: D L
authors.initials: DL
authors.lastname: Feltz
authors.forename: B A
authors.initials: BA
authors.lastname: Franklin
authors.forename: J A
authors.initials: JA
authors.lastname: Johnson
authors.forename: S K
authors.initials: SK
authors.lastname: Locke
mesh_terms: 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