Relationship of proxy efficacy and reliance to home-based physical activity after cardiac rehabilitation.

Objective: To examine cardiac rehabilitation program (CRP) participants' beliefs about their interventionists (proxy efficacy and reliance), self-efficacy, and exercise behavior during transition to home-based exercise. Participants and Design: Participants were 44 (16 women and 28 men) CRP outpatients (Mage = 59.43 ± 13.53 years). The design was prospective, with proxy efficacy and reliance as well as self-efficacy being used to predict two outcomes: self-regulatory self-efficacy and home-based exercise. Results: After self-regulatory efficacy reported earlier in the program was controlled for, proxy reliance predicted later program self-regulatory efficacy for home-based exercise (adjusted R2 = .10, p = .02). Proxy efficacy for self-regulation predicted home-based exercise frequency (adjusted R2 = .18, p = .01). Greater proxy efficacy for self-regulation was associated with higher exercise frequency. Conclusion: CRP participants' beliefs in the capabilities of their exercise consultants to help them develop self-regulatory skills play a role in how much exercise they do after supervised rehabilitation. Yet, individuals who strongly rely on their interventionists to assist them in exercising report weaker self-efficacy for exercising on their own. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Common and specific process factors in cardiac rehabilitation: Independent and interactive effects of the working alliance and self-efficacy.

Objective: Therapeutic processes in cardiac rehabilitation programs are virtually unexamined. Models were tested by which changes in the working alliance between patient and staff (agreement on goals/tasks; emotional bond) may affect outcomes in conjunction with changes in patient self-efficacy to change their diets and increase exercise. Design: Cardiac patients (n = 79) participated in a 12-week program, and completed assessments at early, mid, and late treatment. Main Outcome Measures: Changes in cardiac depression, physical health, perceived exertion during exercise, rate/pressure product at submaximal exercise tolerance, weight loss, return to work, total fat intake. Results: Early-treatment changes in agreement on goals/tasks were related to changes in psychosocial factors and perceived exertion during exercise independent of effects of changes in self-efficacy. Early-treatment changes in goals/tasks and self-efficacy interacted to predict changes in cardiorespiratory fitness, weight loss, and return to work such that patients high on both goals/tasks and self-efficacy showed the most gains. Conclusion: Sound therapeutic relationships between patients and staff may play an important role in facilitating the achievement of a wide-range of salutary outcomes during cardiac rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does barrier efficacy mediate the gender-exercise adherence relationship during phase II cardiac rehabilitation?

Objective: To determine whether barrier efficacy (i.e., confidence in one's ability to perform an elemental task under challenging conditions) mediated the gender-exercise adherence relationship in Phase 11 cardiac rehabilitation. Study Design and Participants: A questionnaire concerning 9 exercise barriers was administered to 98 Phase 11 cardiac rehabilitation patients (50 male and 48 female). Results: Men had significantly higher exercise adherence rates, F(l, 96) = 7.22, p = .01, effect size = .53, and barrier efficacy, F(l, 95) = 17.50, p     

Use of an efficacy-enhancing message to influence the self-regulatory efficacy of cardiac rehabilitation participants: A field experiment.

Objective: To examine whether a message designed to target sources of self-efficacy information could increase self-regulatory efficacy for independent exercise among cardiac rehabilitation (CR) participants. Study Design: Randomized controlled field experiment. Method: Fifty-four participants completed premanipulation measures of self-regulatory efficacy and exercise intentions, then were randomly assigned to read either an efficacy-enhancing or control message. Participants completed postmanipulation measures of self-regulatory efficacy, intentions, agreement with action plans, and behavioral commitment. Results: A 2 × 2 repeated-measures multivariate analysis of variance revealed a significant Message × Time interaction (p     

Promoting self-determined motivation for exercise in cardiac rehabilitation: The role of autonomy support.

Objective: Using self-determination theory (SDT), we examined relationships between cardiac rehabilitation (CR) participants’ perceived autonomy support, motivation for exercise, and exercise behavior. Research Method/Design: Male CR outpatients (N = 53; Mage = 62.83 ± 10.78 years). The design was correlational (cross-sectional and prospective), examining relationships between perceived autonomy support and motivation for exercise at Week 4 of CR participation as well as motivation and CR attendance and other indicators of exercise behavior (frequency, duration, total exercise time) at a 1-week follow-up, 10 weeks later. Results: Perceived autonomy support was correlated with self-determined motivation, r(53) = .32, p r(53) = .34, p R2 = .27; β = .52, p     

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Growth trajectories of exercise self-efficacy in older adults: Influence of measures and initial status.

Objective: This study examined differential trajectories of exercise-related self-efficacy beliefs across a 12-month randomized controlled exercise trial. Method: Previously inactive older adults (N = 144; M age = 66.5) were randomly assigned to one of two exercise conditions (walking, flexibility-toning-balance) and completed measures of barriers self-efficacy (BARSE), exercise self-efficacy (EXSE), and self-efficacy for walking (SEW) across a 12-month period. Changes in efficacy were examined according to efficacy type and interindividual differences. Latent growth curve modeling was employed to (a) examine average levels and change in each type of efficacy for the collapsed sample and by intervention condition and (b) explore subpopulations (i.e., latent classes) within the sample that differ in their baseline efficacy and trajectory. Results: Analyses revealed two negative trends in BARSE and EXSE at predicted transition points, in addition to a positive linear trend in SEW. Two subgroups with unique baseline efficacy and trajectory profiles were also identified. Conclusion: These results shed new light on the relationship between exercise and self-efficacy in older adults. They also highlight the need for strategies for increasing and maintaining efficacy within interventions, namely targeting participants who start with a disadvantage (lower efficacy) and integrating efficacy-boosting strategies for all participants prior to program end. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Determinants of exercise intention and behavior during and after phase 2 cardiac rehabilitation: An application of the theory of planned behavior.

Objective: To evaluate the theory of planned behavior (TPB) as a framework for understanding exercise motivation during and after Phase 2 cardiac rehabilitation (CR). Design and Participants: Patients (57 men and 24 women) completed a TPB questionnaire that included attitudes, subjective norms, perceived behavioral control, and exercise intentions pre- and post-Phase 2 CR. Results: During Phase 2 CR, regression analyses indicated that attitude, subjective norm, and perceived behavioral control (PBC) explained 38% of the variance in exercise intention while intention explained 23% of the variance in exercise adherence. At postrehabilitation follow-up, attitudes, subjective norm, and PBC explained 51 % of the variance in exercise intention while intention explained 23% of the variance in exercise adherence. Conclusion: The TPB is a useful framework for understanding exercise intentions and behavior both during and after Phase 2 CR. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of pulmonary rehabilitation on self-efficacy, quality of life, and exercise tolerance.

Objective: The objective of the present study was to investigate changes in psychological, physiological, and behavioral-performance variables as a function of pulmonary exercise rehabilitation. Study Design and Participants: Forty patients diagnosed with chronic obstructive pulmonary disease (COPD) were recruited for participation in a 12-week outpatient pulmonary rehabilitation program. Measures: Measures included 6-min walking distance (exercise tolerance), 6-min walking distance self-efficacy, overall quality of life, dyspnea, fatigue, and emotional function. Results: Results revealed significant improvements over the course of the program in each of these measures, regardless of disease severity. In addition, improvements in exercise tolerance were significantly associated with increases in self-efficacy, which, in turn, were significantly related to improved quality of life. Conclusions: The results support the tenets of social-cognitive theory and suggest that participation in an outpatient pulmonary rehabilitation program can provide both physiological and psychological benefits for individuals with COPD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical Activity-Related Well-Being in Older Adults: Social Cognitive Influences.

In this study, the pattern and correlates of physical activity-related well-being in older adults (N = 174; men = 49, women = 125; mean age = 66 years) were examined across a 6-month exercise trial. Baseline levels of self-efficacy fitness, importance of physical activity, and social support and exercise participation across the trial were used as correlates of positive and negative feeling states. Psychological responses to physical activity were assessed on a bimonthly basis across the trial. Latent growth curve analyses indicated significant growth in positive well-being over the 6-month period, with increases reaching a threshold at 4 months. Self-efficacy was inversely related to change in positive well-being across the trial. Frequency of activity and increases in well-being over the trial were significant predictors of self-efficacy at program termination. Findings suggest the social cognitive context of the exercise experience may have influence on exercise-related well-being. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Dyadic Investigation of Exercise Support Between Cardiac Patients and Their Spouses.

The authors examined married partners' similarity in reported exercise behavior as a moderator of the association between social support for exercise provided and received by extending an actor-partner dyadic effects model. Participants were married cardiac rehabilitation patients and their spouses (N=99 couples). For couples similar in their reported exercise behavior, a significant association was found between both partners' independent reports of providing exercise support to and receiving exercise support from one another (n=49 couples). However, for couples differing in their reported exercise behavior (n=50 couples), no association was found between either partner's provision and receipt of support for exercise. Findings have the potential to inform practitioners of patients who may not be receiving adequate social support for their recommended exercise. Future interventions may consider implementing dyadic educational or motivational strategies with patients and their spouses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in the outcomes of participants in home programs compared to those in structured cardiac rehabilitation programs

This study compared gender differences in outcomes of patients who had had coronary bypass surgery and either attended structured cardiac rehabilitation programs or participated in home programs. The principal advantages related to patients' attending a structured hospital-based outpatient rehabilitation program, compared to a home program, included increased exercise adherence for males and females, increased knowledge about the condition for males, and increased stress control for females. Return to work, self-efficacy, and aspects of self-care such as adherence to a medication regimen and smoking cessation were not significantly different, regardless of type of program, for either sex. In general, females at home fared the worst regarding lifestyle changes, showing decreased exercise adherence, decreased ability to control stress, and no significant increase in knowledge about their medical condition.     

Responsiveness of Health-Related Quality of Life Outcome Measures in Cardiac Rehabilitation: Comparison of Cardiac Rehabilitation Outcome Measures.

Assessment instruments that are not responsive to change are unsuitable as outcome tools in cardiac rehabilitation because they underestimate the psychosocial benefits of program attendance. Nine questionnaires were assessed for responsiveness with the standardized response mean (SRM). Questionnaires were allocated into 3 batteries, and each battery was completed by cardiac rehabilitation and comparison participants at 2 time points (411 and 375 participants in total, respectively). There was a high degree of variability in the responsiveness of instrument subscales. The positive affect subscale of the Global Mood Scale (J. Denollet, 1993a) was the most responsive (SRM = 0.62). Further information on the comparative responsiveness of psychosocial scales is important to optimize instrument selection for outcome studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-efficacy as a marker of cardiac function and predictor of heart failure hospitalization and mortality in patients with stable coronary heart disease: Findings from the Heart and Soul Study.

Objective: The authors sought to evaluate the association of self-efficacy with objective measures of cardiac function, subsequent hospitalization for heart failure (HF), and all-cause mortality. Design: Observational cohort of ambulatory patients with stable CHD. The authors measured self-efficacy using a published, validated, 5-item summative scale, the Sullivan Self-Efficacy to Maintain Function Scale. The authors also performed a cardiac assessment, including an exercise treadmill test with stress echocardiography. Main Outcome Measures: Hospitalizations for HF, as determined by blinded review of medical records, and all-cause mortality, with adjustment for demographics, medical history, medication use, depressive symptoms, and social support. Results: Of the 1,024 predominately male, older CHD patients, 1013 (99%) were available for follow-up, 124 (12%) were hospitalized for HF, and 235 (23%) died during 4.3 years of follow-up. Mean cardiac self-efficacy score was 9.7 (SD 4.5, range 0–20), corresponding to responses between “not at all confident” and “somewhat confident” for ability to maintain function. Lower self-efficacy predicted subsequent HF hospitalization (OR per SD decrease = 1.4, p = .0006), and all-cause mortality (OR per SD decrease = 1.4, p Conclusion: Among patients with CHD, self-efficacy was a reasonable proxy for predicting HF hospitalizations. The increased risk of HF associated with lower baseline self-efficacy was explained by worse cardiac function. These findings indicate that measuring cardiac self-efficacy provides a rapid and potentially useful assessment of cardiac function among outpatients with CHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Examining the relationship between perceived autonomy support and age in the context of rehabilitation adherence in sport.

Objective: To investigate the relationship between perceived autonomy support, age, and rehabilitation adherence among sports-related injuries. Design: A prospective design measuring adherence over the entire rehabilitation period (8-10 weeks) was employed. Participants: 44 men and 26 women aged between 18 and 55 years took part in this study (M = 32.5 years, SD = 10.2). Method: Adherence was monitored via an observational measure of clinic-based adherence, a self-report measure of home-based adherence, and monitoring of attendance at rehabilitation sessions. Perceived autonomy support of participants was assessed during the last week of their rehabilitation. Results: High autonomy support provided by the physical therapist was related to better clinic-based adherence and attendance but not to home-based adherence. Age was related to all adherence indices and moderated the relationship between perceived autonomy support and clinic-based rehabilitation adherence. Conclusion: Findings indicate the importance of physical therapists providing an autonomous-supportive rehabilitation environment, particularly among older individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stages of Change Among Chinese People With Mental Illness: A Preliminary Study.

Objective: To determine the effect of self-efficacy and outcome expectancy on the readiness for rehabilitation among Chinese people with mental illness. Participants: Fifty-eight men and 62 women with chronic mental illness. Outcome Measures: Change Assessment Questionnaire for People With Severe and Persistent Mental Illness, Task-Specific Self-Efficacy Scale for People With Mental Illness, and Outcome-Expectancy Scale for People With Mental Illness. Results: Chinese people with mental illness can be meaningfully classified into 4 stages of change (SOC) groups: precontemplation, contemplation, ambivalent-conforming, and action-maintenance. SOCs are related to self-efficacy in interpersonal, symptoms management, and help-seeking skills as well as expectations about the benefit of social and coping skills. Conclusion: The SOC concept is useful for tailoring culturally sensitive psychiatric rehabilitation interventions for Chinese people with mental illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Barrier self-efficacy and physical activity over a 12-month period in men and women who do and do not attend cardiac rehabilitation.

Objectives: Two primary objectives were to examine (a) changes in physical activity (PA) over a 12-month period in people living with cardiac disease who did not attend cardiac rehabilitation (CR), and (b) the role of barrier self-efficacy in explaining these changes from a gender perspective. A secondary objective was to examine whether attending CR (or not) moderated the gender-barrier self-efficacy relationship with PA. Design and Setting: Participants (N=801) completed a questionnaire in the hospital and at 2, 6, and 12 months after hospitalization, as well as a telephone-administered 7-day PA recall at 2, 6, and 12 months. Main Outcome Measures: PA and barrier self-efficacy. Results: Hierarchical linear modeling showed significant declines in PA over time, which were especially pronounced for women. Moreover, the association between barrier self-efficacy and PA became significantly weaker over time, especially for women. This trend was similar for participants who did and did not attend CR. Conclusion: Interventions that focus on increasing barrier self-efficacy in people living with heart disease after hospitalization will likely equally benefit men and women in the short term but may disproportionately benefit men in the longer term regardless of participation in CR. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-determined motivation predicts independent, home-based exercise following cardiac rehabilitation.

Objective: To investigate self-determined motivation as a predictor of exercise behavior 3 and 6 weeks following completion of cardiac rehabilitation (CR) as well as the relationship between psychological need satisfaction and self-determined motivation to exercise. Participants and Design: CR outpatients (n = 68; Mage = 64.90 ± 8.86 years). The design was correlational (cross-sectional and prospective), with psychological need satisfaction predicting self-determined motivation at the completion of CR and self-determined motivation predicting exercise behavior at 3- and 6-week follow-ups. Results: Psychological need satisfaction for competence predicted self-determined motivation to exercise (β = .32, p pr2 = .08). Self-determined motivation at the end of CR was correlated with exercise behavior at 3-week follow-up (r(68) = .22, p R2adjusted = .11; β = .35, p Conclusion: CR participants who report higher levels of psychological need satisfaction regarding exercise report greater self-determined motivation. Greater self-determined motivation to exercise, in turn, relates to higher levels of subsequent independent exercise behavior. Nurturing psychological needs and self-determined motivation during CR may assist participants in maintaining exercise following CR. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Readiness to adopt a self-management approach to cardiac health: Predicting outcomes from cardiac rehabilitation.

Purpose/Objective: To examine whether initial attitudes toward a self-management approach to cardiac health and early-treatment changes in those attitudes predict outcomes in cardiac rehabilitation. Research Method/Design: One hundred eighteen participants took part in a 12-week Phase II cardiac rehabilitation program. Questionnaires to assess readiness to engage in a self-management approach, mood, activity level, and diet were completed at pretreatment and at Weeks 3, 6, 9, and 12. Results: Repeated-measures regressions showed that participants with higher pretreatment levels of readiness to engage in a self-management approach showed more pronounced improvements in mood, activity level, and diet than did those with lower levels of readiness. Those who reported significant shifts in self-management attitudes during the first 3 weeks of the program finished treatment with greater improvements on measures of mood, cardiorespiratory fitness, activity level, and weight than did participants who reported smaller shifts. Conclusions/Implications: Results suggest that pretreatment acceptance of a self-management orientation, as well as early shifts toward such a stance, predicted treatment gains. This information may be used to improve outcomes from cardiac rehabilitation by intervening to enhance readiness in those that start at low levels or fail to engage in the initial stages of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does similarity make a difference? Predicting cohesion and attendance behaviors within exercise group settings.

In this study, we assessed the ability of perceptual surface-level (i.e., observable qualities such as age and physical condition) and deep-level (i.e., nonobservable qualities such as attitudes and values) similarity to predict cohesion and attendance within exercise groups. Following the 2nd class of their respective programs, participants (N = 273) from 46 registered group-based exercise programs completed perceptual measures of surface-level similarity, deep-level similarity, social cohesion, and task cohesion. Following the 8th class of these programs, attendance data were collected. Perceptions of deep-level similarity were found to predict task cohesion. In contrast, perceptions of surface-level similarity were found to predict social cohesion and program attendance. Taken together, these results suggest that perceptions of surface-level and deep-level similarity may have noteworthy implications for involvement within group-based exercise programs. (PsycINFO Database Record (c) 2011 APA, all rights reserved)