How important are individual counselling, expectancy beliefs and autonomy for the maintenance of exercise after cardiac rehabilitation?
OBJECTIVE
We examined whether autonomy supportive and self-efficacy enhancing individual lifestyle counselling was associated with improved maintenance of exercise and physical capacity compared with group based counselling. We also tested whether self-efficacy beliefs and autonomous motivation was associated with improved maintenance of exercise over time.


METHODS
Randomised controlled trial and longitudinal study of predictor variables. One hundred and seventy six (38 female) patients mainly with coronary heart disease were randomized to either have standard group based rehabilitation or to additionally receive the intervention. Patients were recruited from a 4-week cardiac rehabilitation programme with two years follow-up at Krokeide Centre in Bergen, Norway.


RESULTS
We found no statistically significant between-group differences. The groups showed an overall improvement of their self-evaluated physical capacity during the two years of the study, corresponding 7% change of score (p<0.001). The composite exercise score improved 6% during follow-up (p<0.001). Intensity of exercise activities improved 17% from inclusion to 24 months' follow-up (p<0.001). Self-efficacy for increased exercise, general expectancy and autonomous motivation were significant predictors of increased exercise and physical capacity. Controlled motivation hampered physical capacity improvement.


CONCLUSIONS
Among this self-selected and motivated group of rehabilitation patients we found no additional effect of adding individual counselling to group-based interventions. Based on longitudinal documentation this cardiac rehabilitation programme improves long-term maintenance of exercise and physical capacity and this maintenance is related to autonomous motivation, general expectancy and self-efficacy.
Mildestvedt
Thomas
T
Department of Public Health and Primary Health Care, Section for General Practice, University of Bergen. thomas.mildestvedt@isf.uib.no
Meland
Eivind
E
Eide
Geir Egil
GE
D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003327:Coronary Disease / Q000517:prevention & control / Q000534:rehabilitation*; D003376:Counseling; D015444:Exercise / Q000523:psychology*; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009042:Motivation; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D055502:Secondary Prevention; D020377:Self Efficacy; D012944:Social Support; D012959:Socioeconomic Factors