Initiation and Maintenance of Exercise Behavior in Older Women: Predictors from the Social Learning Model

The purpose of the present study was to determine the extent to which modifiable social learning constructs predicted long-term adherence to an exercise program in older individuals. Participants were 189 women aged 59 to 78 years and diagnosed with low bone density. Exercise behavior was assessed at 3-month intervals. Self-efficacy, readiness for change, orientation toward exercise, social support in general, and support specifically for exercise were measured at baseline and at 12-month follow-up. Analyses indicated that initial adoption of exercise behavior was best predicted by readiness to change. Maintenance was predicted by self-efficacy for exercise, and exercise behavior at 12 months was predicted by social support for exercise. The results were seen as supportive of the stages and processes of change model of health behavior change. Implications of the findings for interventions to enhance adoption and maintenance of exercise programs by older women are discussed.     

Long-term effects of two psychological interventions on physical exercise and self-regulation following coronary rehabilitation

In cardiac rehabilitation programs, patients learn how to adopt a healthier lifestyle, including regular, strenuous physical activity. Long-term success is only modest despite good intentions. To improve exercise adherence, a 3-group experiment was designed that included innovative psychological interventions. All 3 groups underwent a standard care rehabilitation program. Patients in the 2 treatment groups were instructed not only to produce detailed action plans but also to develop barrier-focused mental strategies. On top of this, in 1 of these groups a weekly diary was kept for 6 weeks to increase a sense of action control. At the end of a standard cardiac rehabilitation program, 240 patients were randomly assigned to these treatment groups plus a standard care control group. Treatments resulted in more physical activity at follow-up and better adherence to recommended levels of exercise intensity. Moreover, self-regulatory skills such as planning and action control were improved by the treatments. Follow-up analyses demonstrated the mediating mechanisms of self-regulatory skills in the process of physical exercise maintenance. Findings imply that interventions targeting self-regulatory skills can enable postrehabilitation patients to reduce behavioral risk factors and facilitate intended lifestyle changes.     

Self-efficacy for exercise in cardiac rehabilitation: review and recommendations

Despite the numerous physical and psychosocial benefits of exercise for coronary heart disease survivors, non-adherence to cardiac rehabilitation (CR) exercise is a major problem. Adherence to the lifestyle behavior change associated with CR involves both physical and self-regulatory skills. While self-regulatory efficacy is clearly linked to exercise adherence and adjustment, the literature on the relationship between self-efficacy and exercise among CR participants has not been systematically reviewed. A search of relevant databases identified 41 CR studies. Few studies measured self-regulatory efficacy for actions that facilitate adherence. Most studies examined self-efficacy during the intensive center-based phase of CR, with little attention to long-term maintenance. The CR literature could benefit by examining (a) self-efficacy as a major rehabilitation outcome, (b) measurement of self-regulatory efficacy for behavior change, (c) suspected moderators of self-efficacy (i.e. gender, age), and (d) self-efficacy relative to maintenance.     

Evaluation of an Intervention to Increase Self-Efficacy for Independent Exercise in Cardiac Rehabilitation

Adherence to independent exercise is an essential outcome of cardiac rehabilitation (CR), yet limited theory-based interventions to improve adherence exist. This study tested the effects of an intervention based on Bandura's conceptualization of self-efficacy. The self-efficacy coaching intervention (SCI), a supplement to standard care, was designed to increase self-efficacy for independent exercise and independent exercise behavior in CR. We examined whether the SCI vs. attention control (AC) resulted in improved exercise self-efficacy (ESE), barriers self-efficacy (BARSE), and minutes of independent exercise for CR participants (n = 65). While between-group differences did not reach significance (p > .10) for any of the outcome measures, significant within-group changes were noted in BARSE scores and independent exercise (p < .001) for the SCI group. Change in independent exercise for the AC group was also significant (p =. 006). Further study is needed to explore whether short-term changes translate into maintenance of independent exercise participation after program completion.     

心脏病复健与运动效能感的提高

本研究就心脏病的复健对运动效能感及运动能力的影响进行评估。 43名心脏病患者年龄 41～ 82岁 (平均 63.5± 1 0 .0岁 )。结果显示　运动效能感与运动能力有显著关系 ;病人在参与渐进运动练习的复健治疗后 ,不但对日常的体能活动有更大的自信 ,实际的运动能力亦显著提高     

Psychological Readiness for Anterior Cruciate Ligament Surgery: Describing and Comparing the Adolescent and Adult Experiences

OBJECTIVE: Our objectives were to describe the preoperative mood levels and psychological readiness levels of patients undergoing primary reconstruction of the anterior cruciate ligament (ACL) and to examine differences between adolescent and adult sports medicine patients relative to psychological readiness for ACL surgery. DESIGN AND SETTING: Subjects prospectively completed assessments of preoperative mood and psychological readiness for ACL surgery and rehabilitation. SUBJECTS: The sample consisted of subjects (N = 121) involved, on average, in sport or exercise participation 12.5 h/wk (SD = 7.5); subgroups included adolescents (15-19 years of age, n = 67) and adults (>/=30 years of age, n = 32). MEASUREMENTS: Subjects preoperatively provided self-reported assessments of demographics, mood disturbances, 10 psychological processes of change (consciousness raising, dramatic relief, environmental reevaluation, social liberation, self-reevaluation, counterconditioning, helping relationships, reinforcement management, stimulus control, and self-liberation), decisional balance (pros versus cons of surgery), and self-efficacy. RESULTS: Relative to the first objective, subjects reported more pros than cons associated with surgery and relatively high levels of self-efficacy. Relative to the second objective, a significant main effect was noted (Wilks lambda = 0.58, P <.01), with 42% of the variance in the dependent variables being attributed to differences among adolescents as compared with adults. Follow-up analyses indicated that, as compared with adults, adolescents reported higher mood disturbances, more pros associated with surgery, and greater use of dramatic relief, environmental reevaluation, social liberation, helping relationships, and self-liberation. CONCLUSIONS: It may be advantageous to screen patients preoperatively relative to their psychological readiness for surgery and rehabilitation. Also, adolescents reported higher preoperative mood-disturbance levels than adults but higher levels of what would be considered "psychological readiness" for surgery.     

Self-efficacy and motivation to quit during participation in a smoking cessation program

The associations between failure to quit and posttreatment self-efficacy and motivation were examined among 600 African American smokers enrolled in a randomized trial testing the efficacy of bupropion for smoking cessation. Participants also received brief motivational counseling and were followed for 6 months. Baseline levels of self-efficacy and motivation for all participants were high (8.2 and 8.5 on a 10-point scale, respectively). Longitudinal analyses indicated that smokers who failed to quit were less likely than quitters to report high self-efficacy and motivation from posttreatment to follow-up. However, examination of mean self-efficacy and motivation scores at posttreatment and follow-up revealed that smokers continued to sustain high self-efficacy and motivation. Mean self-efficacy and motivation scores differed by less than 1 point from baseline levels, even though the majority of participants failed to quit smoking. Results suggest that unsuccessful participation in a smoking cessation program does not meaningfully reduce smokers’ self-efficacy and motivation to quit. This study was supported by research grant ROI CA77856 from the National Cancer Institute to Dr. Ahluwalia. Dr. Mayo was supported in part by research grant R24 CA95835 from the National Cancer Institute. Glaxo-Wellcome, Inc. provided study medication. This work is based on a study submitted by the first author in partial fulfillment of the requirements for the Ph.D. degree at the University of Kansas. An earlier version of this article was presented at the Society of Behavioral Medicine annual meeting, March 2002, Washington, DC.     

Process and outcome in cardiac rehabilitation: an examination of cross-lagged effects

Cardiac rehabilitation patients improve cardiorespiratory fitness and quality of life, yet therapeutic processes that produce these changes remain unknown. A cross-lagged panel design was used to determine whether early-treatment enhancement of self-efficacy regarding abilities to change diet and exercise habits and the quality of the patient-staff working alliance predicted late-treatment changes in a wide range of outcomes, but not vice versa. Eighty cardiac patients participating in a 12-week program completed measures at early, mid- and late treatment. Early-treatment changes in exercise self-efficacy predicted late-treatment changes in activity level, depression, and working alliance, but not vice versa. Diet self-efficacy changes correlated with concurrent changes in fat intake and body weight. Early-treatment changes in cardiorespiratory fitness and activity level predicted late-treatment changes in working alliance, but not vice versa. Findings suggest that increased exercise self-efficacy represents an important therapeutic mechanism by which rehabilitation gains are realized. ((c) 2004 APA, all rights reserved)     

Self-efficacy and mood in cardiac rehabilitation: should gender be considered?

The authors proposed to (a) determine the influence of phase II cardiac rehabilitation (CR) on task and barrier efficacy and mood in men and women, (b) determine the influence of task and barrier efficacy on postphase II CR exercise adherence, and (c) examine the bidirectional relationship between self-efficacy and mood. Fifty-seven men and 24 women completed task and barrier efficacy scales and the anxiety, depression, and vigor subscales 3 to 5 weeks before phase II CR, immediately before and after phase II CR, and 6 to 10 weeks after phase II CR. They found that the women had significantly larger increases in task and barrier efficacy from pre- to postphase II CR than the men did, whereas both men and women had a significant decline at follow-up. Men and women had a similar decrease in anxiety and an increase in vigor during phase II CR. However, vigor significantly declined at follow-up. All changes in mood were significantly related to changes in task and barrier efficacy.     

Self-efficacy and the maintenance of exercise participation in older adults

The role played by exercise self-efficacy in the maintenance of exercise participation of previously sedentary middle-aged adults 4 months after the termination of a formal exercise program is reported. Correlational and multiple regression analyses examined the influence of self-efficacy, physiological (aerobic capacity, sex, body composition), and behavioral (past exercise frequency and intensity) parameters in the maintenance of exercise participation. Self-efficacy significantly predicted exercise behavior at follow-up when controlling for biological and behavioral influences. Aerobic capacity, exercise efficacy, and exercise behavior in combination were significantly related to current energy expenditure in aerobic physical activity. The discussion focuses on the need to examine the impact of different correlates of exercise behavior at different stages of the exercise process.This project was funded by Grant AG07907 from the National Institute on Aging.     

Efficacy of a self-directed behavioral health change program: Weight,body composition,cardiovascular fitness,blood pressure,health risk,and psychosocial mediating variables

This study assessed the efficacy of a comprehensive behavioral health program designed to promote self-initiated change in overweight healthy middle-aged adults (M=49 years). Three treatment groupss (total n=25) differing in type of social support provided (i.e., group plus professional versus group plus peer versus group only) received 13 treatment sessions and 6 maintenance sessions scheduled over a full year. A self-directed change intervention taught several cognitive-behavioral techniques as they applied to exercise adherence, weight reduction/maintenance, and stress management. Combined treatment groups (n=25) improved significantly more than an assessment only control group (n=9) in weight, percentage body fat, cardiovascular fitness, exercise adherence, health-risk appraisal, chronic tension (MBHI, scale A), and systolic and diastolic blood pressure at both post-treatment and 6-month follow-up assessments. Self-motivation, group treatment attendance, and health-risk appraisal significantly related (r's=.30–.56) to several posttreatment and follow-up measures of behavioral health change. No significant differences were found among the three treatment groups on any of the outcome measures.This study was partially funded by the Crescenta-Canada YMCA.     

The Effects of Message Framing on Exercise Adherence and Health Beliefs Among Patients in a Cardiac Rehabilitation Program

This experiment examined the effects of framed health education messages on exercise adherence among patients entering a cardiac rehabilitation program, as well as the mediating effects of health-related cognitions. Patients read gain-framed, loss-framed, or no messages about the importance of exercise with regard to heart disease and completed measures of health beliefs using the Health Belief Model (HBM). Over the following 3-month period, patients in the gain-framed message condition exercised more than did those in the no message condition. Significant between-group differences were observed on the HBM constructs of perceived susceptibility to heart disease and barriers to exercise, but these health beliefs did not mediate the effects of the educational messages. The results suggest value in using gain-framed educational materials in the cardiac population.     

Exercise behaviour change in 40 to 65‐year‐old women: The SWEAT Study (Sedentary Women Exercise Adherence Trial)

Objective: The purpose of this study was to examine the relation between self‐reported psychological processes and changes in exercise behaviour in an 18‐month longitudinal stage‐based intervention trial in 115 initially sedentary women aged 40‐65 years. Design: A two‐way factorial design was used. Methods: Participants were assigned randomly to either moderate or vigorous and either home or centre‐based exercise. After six months, all participants exercised at home. Participants completed questionnaires at baseline, six, 12 and 18 months which assessed stage of exercise behaviour, self‐efficacy, decisional balance and processes of change. Results: 28 patterns of stage change were identified across the 18 months with 6.1% remaining sedentary and 45% demonstrating linear movement from contemplation to action to maintenance to continued maintenance. Two interpretable clusters were identified within both the contemplation (at baseline) and action (at six months) stages. Cluster membership, however, did not influence behaviour change. For participants demonstrating a linear pattern of change, self‐efficacy for overcoming barriers and behavioural processes increased from contemplation to action. Self‐efficacy for exercise competence increased from contemplation to action but was more pronounced for the vigorous exercise groups. Decisional balance showed a three‐way interaction and there was no change for experimental processes. There was no change in any variable from action to maintenance. Conclusions: The intervention was seen to be effective regardless of location or intensity of exercise. The relevance of substages is questionable in stage‐based interventions as women with a profile suggesting less readiness to change or sustain change were just as likely to adopt or maintain exercise.     

Rehabilitation outcomes following percutaneous coronary interventions (PCI)

This prospective study evaluated the effect of an individualized, comprehensive, home-based cardiac rehabilitation program combining exercise training with risk factor modification and psychosocial counseling on risk factors, psychological well-being, functional capacity, and work resumption in 99 post-percutaneous coronary interventions (PCI) patients randomized to control (standard care plus telephone follow-up, n=49) or intervention (individualized, comprehensive, home-based cardiac rehabilitation, n=50) groups. Data were collected at time 1 (T(1)) during hospital admission, time 2 (T(2)) approximately 2 months post-PCI, and time 3 (T(3)) approximately 12 months post-PCI. Results suggest that the allocation to an individualized, comprehensive, home-based cardiac rehabilitation program provided more advantageous outcomes. At both follow-ups, the intervention group showed within-group improvement in serum cholesterol levels (P<0.02; P<0.01) and exercise participation (P<0.001; P<0.001) with differences in exercise participation favoring the intervention group (P<0.01) at T(2). Repeated measures ANOVA showed significant improvements over time in body mass index (BMI) (P<0.01), psychological well-being (P<0.001), and functional capacity (P<0.001) for both groups. More patients in the intervention group had returned to work at T(2) (P<0.001) and did so more quickly (P<0.01). These findings suggest that an individualized, comprehensive, home-based cardiac rehabilitation program improves risk factor profiles and work resumption patterns for patients following PCI.     

Psychological effects and mediators of a group multi-component program for breast cancer survivors

This study evaluated the short-term impact of YWCA Encore, a mixed-modality group exercise and information support program for breast cancer patients situated in the community setting. Australian post-surgical breast cancer patients (N = 162) were assigned to either the 8-week Encore intervention or a Waitlist control. Intervention impact was assessed in terms of quality of life, cancer-specific distress, and social support. Changes in familiarity with exercise, self-efficacy and social support were tested as mediators of the intervention impact on quality of life. Overall adherence and satisfaction with the program were high. Significant enhancements at follow-up for quality of life and social support were evident for intervention compared with control participants. Familiarity with exercise and self-efficacy satisfied the requirements for mediation of quality of life. These findings provide evidence for psychosocial benefits of YWCA Encore multi-component program and support the use of such community-based programs for breast cancer survivors. The role of exercise familiarity and self-efficacy as probable mediators of the multi-component intervention is a critical finding and highlights the need for future investigations into the underlying mediating processes of similar interventions for cancer patients.     

Change in self-efficacy during cardiac rehabilitation and the role of perceived overprotectiveness

Self-efficacy (SE) is an important outcome following cardiac rehabilitation (CR) when claiming benefits to patients and improving existing programs. This study evaluated change in SE during 6 weeks of multidisciplinary CR with either a high or low-frequency exercise training program. The role of overprotectiveness of the spouse, as it potentially counteracts improvement in SE, was examined. Coronary patients (n = 114) were randomized into both types of program. Overprotectiveness (patient perception) was assessed prior to rehabilitation. Self-efficacy in the domains controlling symptoms (SE-CS) and maintaining function (SE-MF), were assessed prior to and immediately after rehabilitation. Three findings pertain to program improvement: (1) As predicted, the low-frequency program enhanced SE-CS more than the high-frequency program, suggesting that experiencing success in daily activities and active engagement of the patient seem more decisive factors in improving SE than the frequency of exercise. (2) Changes in SE in both programs fell short of clinical meaning, suggesting the need to use self-efficacy theory more vigorously. (3) Overprotectiveness significantly predicted adverse change in SE in the high-frequency program, suggesting the need to include counseling for cardiac couples in CR when applicable.     

The effects of a transtheoretical model-based exercise stage-matched intervention on exercise behavior in patients with coronary heart disease: A randomized controlled trial

Objective

To determine whether a transtheoretical model-based exercise stage-matched intervention (ESMI) has positive effects on the exercise behavior of sedentary patients with coronary heart disease (CHD).

Methods

The study was a randomized controlled trial with a repeated measures design. Participants (N = 196) were randomly allocated to either a conventional (C) group, a patient education (PE) group, or an ESMI group. Exercise behavior was measured by exercise stages of change, exercise self-efficacy, exercise decisional balance, and duration of moderate exercise at baseline, immediate post-intervention, and at 3- and 6-month follow-up.

Results

Our results showed that the ESMI group demonstrated a more positive shift in exercise stages of change (p < 0.01), higher exercise self-efficacy (p < 0.01), greater exercise benefits (p < 0.01), fewer exercise barriers (p < 0.01), and longer moderate exercise duration (minutes/week) (p < 0.01) after completion of the 8-week intervention compared with the C and PE groups. These significantly positive effects were maintained at 3- and 6-month follow-up.

Conclusion

The transtheoretical model-based ESMI had significantly positive effects on the exercise behavior of sedentary CHD patients.

Practice implications

It is important to provide a structured education program for CHD patients, preferably guided by the transtheoretical model.     

Preventing relapse in obesity through posttreatment maintenance systems: Comparing the relative efficacy of two levels of therapist support

The present study compared the relative effectiveness of a therapist-supported maintenance condition with a minimal contact maintenance condition in preventing relapse following an obesity treatment program. Thirty-two subjects who completed an initial 12-week cognitive/behavioral plus aerobic exercise treatment program were matched on absolute weight loss and randomly assigned to one of two maintenance conditions. Subjects were assessed at pretreatment, posttreatment, and 3, 6, and 12 months following posttreatment using measures of weight, blood pressure, and depression. Three- and six-month follow-up results indicated that subjects who participated in the therapist-supported maintenance group continued to lose weight and/or maintained therapy-induced weight loss to a greater degree than control subjects. At the 12-month follow-up assessment therapist-supported subjects maintained therapy-induced weight loss better than the control subjects. These findings suggest that maintenance programs which provide continued contact emphasizing relapse prevention training may be an important adjunct in the maintenance of therapy-induced weight loss.This project was supported in part by the Florida Mental Health Institute of the University of South Florida 32446.