Predictors of exercise adherence following participation in a cardiac rehabilitation program

Patients who participate in cardiac rehabilitation programs (CRP) experience significant improvements in quality of life, rehospatilization rates, and mortality associated with cardiovascular disease. The potential efficacy of CRP is limited however, by significant program dropout rates and poor patient adherence to prescribed exercise regimens following rehabilitation. Recently, models of motivational readiness for behavior change, such as the Transtheoretical Model, have been applied to understanding the process of exercise adoption and maintenance. Interventions based on this dynamic model of behavior change have produced significant improvement in adherence to exercise in community and worksite populations. This study investigates the applicability of this model to this special population. Sixty-two men and women completed measures of motivational readiness, self-efficacy, and decisional balance for exercise adoption upon entry into a 12-week cardiac rehabilitation program at posttreatment and at a 3-month follow-up. Patients made significant gains during CRP in time spent exercising and self-efficacy, but not in utilization of the cognitive processes or in the perceived benefits of exercising. Exercise maintenance at follow-up was differentially associated with self-efficacy, decisional balance and use of behavioral processes at posttreatment. Motivation-based models of exercise adoption may provide insights regarding the adoption and maintenance of regular physical activity in cardiac rehabilitation populations.     

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.     

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.     

Helping Middle-Aged Women Translate Physical Activity Intentions Into Action: Combining the Theory of Planned Behavior and Implementation Intentions

The current experiment examined whether women with implementation intentions show greater correspondence between their exercise intentions and behaviors, exercise more frequently, and show changes over time in measures of theory of planned behavior (TPB) constructs and scheduling self-efficacy relative to a control group. Participants were 47 women randomly allocated to an implementation intentions or control condition. Measures of TPB constructs and scheduling self-efficacy were assessed at baseline and 8 weeks later. Regression analyses showed that intentions were a significant predictor of behavior for women in the experimental condition (p .01). A significant Condition * Time interaction was found for scheduling efficacy (p .03) and a nonsignificant interaction was found for perceived behavioral control (p = .06), indicating that only the experimental group increased scheduling self-efficacy and perceived behavioral control. No significant group differences were found for the other TPB constructs or self-reported exercise.     

Predictors of Health Behavior Change After an Integrative Medicine Inpatient Program

Background

Health behavior change can improve physical and psychosocial outcomes in internal medicine patients.

Purpose

This study aims to identify predictors for health behavior change after an integrative medicine inpatient program.

Method

German internal medicine patients' (N?=?2,486; 80 % female; 53.9?±?14.3 years) practice frequency for aerobic exercise (e.g., walking, running, cycling, swimming), meditative movement therapies (e.g., yoga, tai ji, qigong), and relaxation techniques (e.g., progressive relaxation, mindfulness meditation, breathing exercises, guided imagery) was assessed at admission to a 14-day integrative medicine inpatient program, and 3, 6, and 12 months after discharge. Health behavior change was regressed to exercise self-efficacy, stage of change, and health locus of control (internal, external-social, external-fatalistic).

Results

Short-term increases in practice frequency were found for aerobic exercise: short- and long-term increases for meditative movement therapies and relaxation techniques (all p?p?p?Conclusion Health behavior change after an integrative medicine inpatient program was predicted by self-efficacy, stage of change, and health locus of control. Considering these aspects might improve adherence to health-promoting behavior after lifestyle modification programs.     

The development of an evidence-based physical self-management rehabilitation programme for cancer survivors

OBJECTIVE: This paper describes the development of a physical training programme for cancer patients. Four related but conceptually and empirically distinct physical problems are described: decreased aerobic capacity, decreased muscle strength, fatigue and impaired role physical functioning. The study aimed to identify the optimal content for an exercise programme that addresses these four physical problems, based on the highest level of evidence available. The study further aimed to review the evidence available on the delivery of the programmes. The final goal was to develop a programme in which content and delivery are based on the best available evidence. METHODS: Literature searches (PUBMED and MEDLINE, to July 2006) on content looked for evidence about the efficacy of exercise on aerobic capacity, muscle strength, fatigue and impaired role physical functioning. Literature searches on delivery looked for self-management and/or self-efficacy enhancing techniques in relation to outcome, adherence to and/or adoption of a physically active lifestyle. RESULTS: Evidence on the effectiveness of exercise in cancer patients varies and increases when moving from muscle strength (RCT level), fatigue and physical role functioning to aerobic capacity (all at the meta-analysis level). Effect sizes for aerobic capacity were moderate, while effect sizes for fatigue and physical role functioning were zero and/or small. Many of the studies have significant methodological shortcomings. There was some evidence (meta-analyses) that self-management programmes and self-efficacy enhancing programmes have beneficial effects on health outcomes in a variety of chronic diseases, on the quality of life in cancer patients, and on exercise adherence and later exercise behaviour. CONCLUSION: Limited data are available on the effectiveness of exercise for cancer patients. Although evidence supports the positive effects of exercise on exercise capacity during and after completion of cancer treatment, the effects for fatigue and role functioning are ambiguous. Evidence on the effectiveness of progressive exercise training on muscle strength is promising. In addition, some evidence supports the positive effects of self-management programmes and self-efficacy enhancing programmes on health outcomes, exercise adherence and later exercise behaviour. PRACTICE IMPLICATIONS: The resulting programme was developed on the basis of the highest quality of evidence available regarding content and delivery. The content is based on information obtained from the present review, and on the recommendations of the American College of Sports Medicine. Potential advantages of the programme include: (a) tailored physical training towards focusing on the patient's established problems and (b) delivery of the training as a self-management programme that might have beneficial effects on health outcome, exercise adherence and a long-term physically active lifestyle.     

Self-regulatory skills usage strengthens the relations of self-efficacy for improved eating, exercise, and weight in the severely obese: toward an explanatory model

Lack of success with behavioral weight-management treatments indicates a need for a better understanding of modifiable psychological correlates. Adults with class 2 and 3 obesity (N = 183; Mean(BMI) = 42.0 kg/m(2)) volunteered for a 26-week nutrition and exercise treatment, based on social cognitive theory, that focused on self-efficacy and self-regulation applied to increasing cardiovascular exercise and fruit and vegetable consumption. Improved self-efficacy for controlled eating significantly predicted increased fruit and vegetable consumption (R(2) = .15). Improved self-efficacy for exercise significantly predicted increased exercise (R(2) = .46). When changes in self-regulatory skill usage were stepped into the 2 previous equations, the variances accounted for significantly increased. Increases in fruit and vegetable consumption and exercise significantly predicted weight loss (R(2) = .38). Findings suggest that behavioral theory should guide research on weight-loss treatment, and a focus on self-efficacy and self-regulatory skills applied to specific nutrition and exercise behaviors is warranted.     

The role of efficacy cognitions in the prediction of exercise behavior in middle-aged adults

The present study adopted a social cognitive framework to examine the role played by perceptions of personal efficacy in adherence to exercise behavior in sedentary middle-aged adults. Subjects were followed for 5 months in order to study the process of exercise as it moved through the adoption to maintenance stage of the behavior. Participation rates paralleled those reported elsewhere in the literature. Path analytic techniques examined the role over time of efficacy, perceptual, and behavioral indicators of frequency and intensity of exercise. Self-efficacy cognitions were shown to predict adoption of exercise behavior but previous behavior proved to be the strongest predictor of subsequent exercise participation. Results are discussed in terms of examining process versus static design models in exercise and physical activity research. Implications for future research and health promotion are suggested.Funding for this research was provided by Public Health Service Grant AG07907 from the National Institute on aging.     

The mirror does not lie: Acute exercise and self-efficacy

Although acute bouts of exercise have consistently been found to enhance self-efficacy, recent evidence suggests that the exercise environment may moderate this relation. The purpose of this study was to investigate the influence of an acute bout of exercise performed in environments differing in self-evaluative potential on self-efficacy. Forty-three female undergraduates performed 20 min of aerobic exercise in front of and in the absence of a full-length mirror. Self-efficacy was assessed at 4 time points: before entry into the experimental condition, pre-exercise, postexercise, and 20 min postexercise. Results revealed that self-efficacy did not significantly change following exercise or recovery in the no mirror condition. However, the mirror condition resulted in moderate increases in self-efficacy postexercise and large increases following recovery. Results indicate that self-evaluation following exercise may increase one’s perceptions of capabilities and appear to be in contrast to past research demonstrating a negative effect of mirrors on self-efficacy.     

Change in health-related quality of life and social cognitive outcomes in obese,older adults in a randomized controlled weight loss trial: Does physical activity behavior matter?

This article compared the effect of dietary weight loss administered alone (WL) or in combination with aerobic training (WL + AT) or resistance training (WL + RT) on health related quality of life, walking self-efficacy, stair climb self-efficacy, and satisfaction with physical function in older adults with cardiovascular disease or the metabolic syndrome. Participants (N = 249; M _age = 66.9) engaged in baseline assessments and were randomly assigned to one of three interventions, each including a 6-month intensive phase and a 12-month follow-up. Those in WL + AT and WL + RT engaged in 4 days of exercise training weekly. All participants engaged in weekly group behavioral weight loss sessions with a goal of 7–10% reduction in body weight. Participants in WL + AT and WL + RT reported better quality of life and satisfaction with physical function at 6- and 18-months relative to WL. At month 6, WL + AT reported greater walking self-efficacy relative to WL + RT and WL, and maintained higher scores compared to WL at month 18. WL + AT and WL + RT reported greater stair climbing efficacy at month 6, and WL + RT remained significantly greater than WL at month 18. The addition of either AT or RT to WL differentially improved HRQOL and key psychosocial outcomes associated with maintenance of physical activity and weight loss. This underscores the important role of exercise in WL for older adults, and suggests health care providers should give careful consideration to exercise mode when designing interventions.     

Exercise training in healthy type A middle-aged men: effects on behavioral and cardiovascular responses

Thirty-six healthy Type A men (means = 44.4 years) were randomly assigned to either an aerobic exercise training group or a strength and flexibility training group. Subjects completed a comprehensive psychological assessment battery before and after the exercise programs consisting of behavioral, psychometric, and psychophysiological testing. The behavioral assessment consisted of repeated Type A interviews that were videotaped for subsequent component analyses. The psychometric testing included two self-report questionnaires to assess Type A behavior. The psychophysiological test consisted of a standard behavioral challenge, a mental arithmetic task, performed while cardiovascular responses were monitored. Aerobic exercise (AE) training consisted of 12 weeks of continuous walking or jogging at an intensity of at least 70% of subjects' initial maximal oxygen consumption (VO2max) as determined by an initial treadmill test. Strength and flexibility (SF) training consisted of 12 weeks of circuit Nautilus training with no aerobic exercise. After 12 weeks of exercise, the AE group increased their VO2max by 15%, while the SF group did not change. Both groups experienced decreases in overt behavioral manifestations of the Type A behavior pattern and self-reported Type A traits. However, the AE group showed an attenuation of heart rate, systolic and diastolic blood pressure, and estimated myocardial oxygen consumption (MVO2) during the task and had lower blood pressure, heart rate, and (MVO2) during recovery. In contrast, the SF group showed a significant reduction only in DBP during the task, which was likely due to habituation. These results support the use of aerobic exercise as a method for reducing cardiovascular risk among healthy Type A men.     

Exercise and Self-Esteem in Middle-Aged Adults: Multidimensional Relationships and Physical Fitness and Self-Efficacy Influences

In the context of sedentary middle-aged adults, the present study examined the relationships among domain-specific and global levels of self-esteem over the course of a 20-week exercise program. Additionally, the roles played by physical fitness, body composition, self-efficacy, and exercise participation as possible contributors to changes in physical self-worth were examined. Significant improvements in self-esteem at all levels were discovered with global esteem, physical self-worth, and perceptions of physical condition and attractive body increasing. Tests of the hierarchical structure of self-esteem showed greater improvements in physical condition and physical self-worth than global esteem and the relationships between global esteem and subdomain levels were shown to be mediated by physical self-worth. Hierarchical regression analyses showed changes in ratings of importance to have little impact on changes in physical self-worth. Both changes in efficacy and aerobic capacity were demonstrated to account for modest but significant variation in physical self-esteem. Results are discussed in terms of contemporary models of self-esteem, potential mediators of exercise effects on esteem, and the need to measure the constructs of interest appropriately.     

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.     

Self-Regulatory Skills Usage Strengthens the Relations of Self-Efficacy for Improved Eating,Exercise, and Weight in the Severely Obese: Toward an Explanatory Model

Lack of success with behavioral weight-management treatments indicates a need for a better understanding of modifiable psychological correlates. Adults with class 2 and 3 obesity (N = 183; Mean _BMI = 42.0 kg/m²) volunteered for a 26-week nutrition and exercise treatment, based on social cognitive theory, that focused on self-efficacy and self-regulation applied to increasing cardiovascular exercise and fruit and vegetable consumption. Improved self-efficacy for controlled eating significantly predicted increased fruit and vegetable consumption (R ² = .15). Improved self-efficacy for exercise significantly predicted increased exercise (R ² = .46). When changes in self-regulatory skill usage were stepped into the 2 previous equations, the variances accounted for significantly increased. Increases in fruit and vegetable consumption and exercise significantly predicted weight loss (R ² = .38). Findings suggest that behavioral theory should guide research on weight-loss treatment, and a focus on self-efficacy and self-regulatory skills applied to specific nutrition and exercise behaviors is warranted.     

The impact of working life on health behavior: the effect of job strain on the cognitive predictors of exercise

The theory of planned behavior (TPB) and R. A. Karasek's (1979) job strain model were used to investigate the predictors of exercise in a group of employees. A total of 241 employees completed an initial questionnaire; 1 week later 213 employees responded to a questionnaire measuring behavior. Employees in high-strain jobs did significantly less exercise than those in low-strain jobs, although they did not intend to do less, suggesting that work may impede the intention implementation. Intenders who failed to exercise had significantly higher work demands and lower exercise self-efficacy than intenders who succeeded in exercising. Work also affected exercise indirectly through self-efficacy. Thus, work may be a target for behavior change intervention because of its impact at 2 stages of the TPB.     

Feasibility of an exercise intervention for women with postnatal depression: a pilot randomised controlled trial.

BACKGROUND: Postnatal depression is a serious mental health problem that may be reduced by exercise. AIM: This study examined the feasibility of an exercise intervention for women with postnatal depression, and assessed which methods of recruitment are most effective. DESIGN OF STUDY: Randomised controlled trial. SETTING: General practice and the community. METHOD: Participants were recruited from various sources and randomised to an exercise intervention or usual care with follow-up at 12 weeks. As well as assessing feasibility, other trial outcomes included exercise participation and self-efficacy for exercise. Levels of depression were assessed but the study was not powered to show a difference in this. RESULTS: The recruitment rate of eligible patients was 23.1%. The highest recruitment rate was via referral from the psychiatric mother and baby unit (9/28; 32.1%), followed by invitation letters from GPs (24/93; 25.8%). Thirty-eight eligible participants were randomised. At follow-up there was no significant difference in exercise participation between groups. The intervention group reported significantly higher self-efficacy for exercise compared to usual care, but depression scores did not differ. CONCLUSION: Exercise participation over the 12-week period was not significantly increased, possibly because it is difficult to motivate women with postnatal depression to exercise, or the intervention was not sufficiently intensive. Eligible patients were recruited into this study but response rates were low. Optimum methods of recruitment in this difficult-to-reach population are required prior to a substantive trial. Further research is imperative given poorly-evidenced recommendations by the National Institute for Health and Clinical Excellence to consider this treatment.     

Social support and efficacy cognitions in exercise adherence: A latent growth curve analysis

Although a considerable amount of research has established the beneficial effects of social support on health and well-being, relatively little work has focused on identifying those processes by which social support influences various health promoting behaviors. Various lines of research demonstrate converging evidence which suggests that self-efficacy may operate as one possible mediator linking psychosocial influences to positive health functioning associated with regular habitual exercise. The present study examined the relationships among social support, self-efficacy, and the ongoing exercise behavior of sedentary adults. Latent growth modeling techniques were utilized to determine whether self-efficacy served a mediational role in the influence of social support on exercise behaviors. Findings are discussed with reference to the role of cognitive and behavioral mechanisms in the relationship between supportive functions of social networks and improvements in health and well-being associated with regular exercise.Funding for the study was facilitated by Grant No. AGO7907 from the National Institute on Aging, USPHS, awarded to Edward McAuley. Preparation of this article was supported in part by Grant No. MH 46690 from the Prevention Research Branch, NIMH, USPHS.     

Selection for aerobic capacity affects corticosterone, monoamines and wheel-running activity

A positive genetic relationship between aerobic capacity and voluntary exercise has been suggested from earlier studies of mice selected for increased wheel-running activity. To further investigate the relationship between aerobic capacity and exercise behavior, wheel-running activity was studied in female rats bidirectionally selected for intrinsic aerobic capacity (high capacity runners - HCR; low capacity runners - LCR). Aerobic capacity was measured using a forced treadmill paradigm; the subpopulations of animals used in this experiment exhibited a 471% difference in endurance capacity. Rats were housed individually, with or without access to running wheels. Wheel-running activity was recorded and analyzed from weeks two through seven during an eight-week trial to determine voluntary activity levels. HCR animals exhibited 33% greater total wheel-running distance per day compared to LCR rats (16,838.7+1337.30 m versus 12,665.8+893.88 m), which was due to the HCR rats exhibiting increases in both running speed and duration over LCR rats. Differences in the intermittency of wheel running were also observed. HCR rats engaged in more bouts of running per day than LCR rats, and trended towards running faster, for more time, and for longer distances during bouts of running than LCR rats. Following the running trial, measurement of plasma corticosterone concentration and striatal dopaminergic activity showed differences between HCR and LCR rats, suggesting a divergence of physiological systems that could potentially influence locomotor behaviors in these lines. These results are consistent with earlier work, and suggest an evolutionarily conserved relationship between physiological capacity and behavioral activity of exercise.     

Effectiveness of behavioral therapy for chronic low back pain: a component analysis

The effects of outpatient group behavioral therapy including aerobic exercise (BE), behavioral therapy only (B), and aerobic exercise only (E) on pain and physical and psychosocial disability were evaluated and compared in a group of mildly disabled chronic low-back-pain patients. Ninety-six Ss were randomly assigned to the 3 treatments and a waiting-list control (WL) condition and assessed on a variety of patient self-report, spouse-rated, and direct observational measures at pretreatment, posttreatment, and 6- and 12-month follow-ups. Patients in the BE condition, but not the B or E conditions, improved significantly more pretreatment to posttreatment than did WL patients on the patient self-report and observer-rated measures. At both follow-ups, all 3 treatment groups remained significantly improved from pretreatment, with no significant differences among treatments.