title: Effect of the self-monitoring approach on exercise maintenance during cardiac rehabilitation: a randomized, controlled trial.
abstract: OBJECTIVE
  To evaluate the effect of the self-monitoring approach (SMA) on self-efficacy for physical activity (SEPA), exercise maintenance, and objective physical activity level over a 6-mo period after a supervised 6-mo cardiac rehabilitation (CR) program.
  
  
  METHODS
  We conducted a randomized, controlled trial with 45 myocardial infarction patients (38 men, seven women; mean age, 64.2 yrs) recruited after completion of an acute-phase, exercise-based CR program. Patients were randomly assigned to an SMA group (n = 24) or control group (n = 21). Along with CR, the subjects in the SMA group self-monitored their weight and physical activity for 6 mos. The SMA used in this study was based on Bandura's self-efficacy theory and was designed to enhance confidence for exercise maintenance. The control group participated in CR only. All patients were evaluated with the SEPA assessment tool. Exercise maintenance, SEPA scores, and objective physical activity (average steps per week) as a caloric expenditure were assessed at baseline and during a 6-mo period after the supervised CR program.
  
  
  RESULTS
  Mean period from myocardial infarction onset did not differ significantly between the SMA and control groups (12.1 +/- 1.3 vs. 12.2 +/- 1.2 mos, P = 0.692). All patients maintained their exercise routine in the SMA group. Mean SEPA score (90.5 vs. 72.7 points, P < 0.001) and mean objective physical activity (10,458.7 vs. 6922.5 steps/wk, P < 0.001) at 12 mos after myocardial infarction onset were significantly higher in the SMA than control group. SEPA showed significant positive correlation with objective physical activity (r = 0.642, P < 0.001).
  
  
  CONCLUSIONS
  SMA during supervised CR may effectively increase exercise maintenance, SEPA, and objective physical activity at 12 mos after myocardial infarction onset.
authors.affiliation: Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital, Kawasaki, Japan.
authors.forename: Kazuhiro P
authors.initials: KP
authors.lastname: Izawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Watanabe
authors.forename: Kazuto
authors.initials: K
authors.lastname: Omiya
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Hirano
authors.forename: Koichiro
authors.initials: K
authors.lastname: Oka
authors.forename: Naohiko
authors.initials: N
authors.lastname: Osada
authors.forename: Setsu
authors.initials: S
authors.lastname: Iijima
mesh_terms: D000704:Analysis of Variance; D001835:Body Weight / Q000502:physiology; D015444:Exercise; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D007564:Japan; D007717:Knee / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D018482:Muscle, Skeletal / Q000502:physiology; D009203:Myocardial Infarction / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care; D010101:Oxygen Consumption / Q000502:physiology; D012648:Self Care; D020377:Self Efficacy; D011795:Surveys and Questionnaires