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)     

Assisted implantation: direct intraendometrial embryo transfer

LVAD use in the heart failure population is increasing and allows severely impaired patients an opportunity for exercise rehabilitation before cardiac transplantation. Although the LVAD provides nearly all of the cardiac output at rest, the native left ventricle contributes a modest amount during exercise, with the LVAD capable of providing a mechanical cardiac output of 10 L/min or greater. Given the parameters of the LVAD, exercise training responses should yield greater changes in submaximal exercise tolerance rather than changes in peak oxygen consumption. Heart rate and LVAD rate are driven by separate mechanisms but increase similarly during exercise. Blood pressure responses are somewhat variable early post LVAD implantation but normalize. Ratings of perceived exertion appear to be reliable and useful in this population. Evidence to date suggests that early mobilization and progressive exercise training in this population is safe and improves the transplantation experience. Although central contributions to oxygen consumption are limited by the inherent mechanical parameters of the LVAD, adequate cardiac output is provided for routine physical activities and moderate exercise training while the patient awaits transplantation.     

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)     

Proxy Efficacy: Implications for Self-Efficacy and Exercise Intentions in Cardiac Rehabilitation.

Objective: To examine relations among proxy efficacy, exercise self-efficacy, and exercise in cardiac rehabilitation. Participants and Study Design: Twenty-nine cardiac rehabilitation outpatients (24 men and 5 women) enrolled in a 12-week hospital-based program. Measures of proxy efficacy and exercise self-efficacy, obtained in Week 3, were used to predict program attendance and exercise self-efficacy at Week 10. Late program (i.e.. Week 10) exercise self-efficacy and proxy efficacy were also used to predict postprogram exercise intentions. Results: Early program proxy efficacy and attendance predicted late program exercise self-efficacy (adjusted K2 = .71, p     

The impact of self-efficacy on behavior change and weight change among overweight participants in a weight loss trial.

Despite considerable clinical interest, attempts to link perceived self-efficacy with successful weight control have had mixed success. Definitive data on prospective associations between self-efficacy and weight loss are particularly sparse. This study examined relationships between self-efficacy beliefs, weight control behaviors, and weight change among individuals participating in a weight loss trial (N = 349, 87% women). Cross-sectionally, eating and exercise self-efficacy beliefs were strongly associated with corresponding weight loss behaviors. Self-efficacy beliefs prospectively predicted weight control behavior and weight change during active treatment but not during follow-up. Mediational models indicate that people's weight control behaviors mediate the impact of self-efficacy on weight change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between self-efficacy, attributions, and weight loss in a weight rehabilitation program.

Assessed the relationship between self-efficacy, attributions, and weight loss in the context of a weight rehabilitation program. Pretreatment, posttreatment, and followup assessments of self-efficacy, weight loss, and success–failure attributions were obtained from 38 volunteer overweight women (aged 21–65 yrs) participating in the program. Self-efficacy was significantly enhanced as a result of treatment, although it was not significantly related to weight loss during treatment. However, changes in efficacy expectations during follow-up did coincide with weight change during those intervals. In addition, efficacy expectations alone at treatment termination were found to be a significant predictor of weight loss following a 6-wk and 6-mo follow-up. Success–failure attributions contributed significantly to the prediction of efficacy expectations during treatment and during the 6-wk follow-up. Weight loss during treatment was not a significant determinant of treatment-induced self-efficacy enhancement. Results are interpreted in light of the reciprocal interaction between actual behavior change and cognitive factors in the context of a rehabilitation program. (18 ref) (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.     

Risk factor reduction behaviours in coronary angioplasty and myocardial infarction patients

A recent study asked percutaneous transluminal coronary angioplasty (PTCA) patients in Saskatchewan (n = 210) to identify specific information surrounding their rehabilitation behaviours and motivation to change lifestyle. The scale used to elicit this information was developed and previously used to determine patient risk factor knowledge and lifestyle change behaviours among myocardial infarction (MI) patients during rehabilitation phases. The purpose of this article is to discuss the results of PTCA patients' responses and compare these findings to previously obtained data from MI patients. Risk factors most frequently reported by both PTCA and MI patients as causative factors of their heart problems included diet, job stress, low levels of exercise, and other patient-perceived factors. When asked about lifestyle restrictions post-hospitalization, PTCA patients reported more lifestyle restrictions in activities of daily living (recreation, job, social life, sexual activity and driving) following hospitalization than MI patients. Both groups of patients reported high levels of dietary changes made post-hospitalization but findings reflected that MI patients had initiated more modifiable risk factor changes overall than PTCA patients. Comparative results showed that MI patients were more likely to initiate risk factor reduction behaviours for modifiable factors such as smoking, weight reduction, job/family stress, and exercise than PTCA patients. These findings offer insight into differences between PTCA and MI patients with respect to cardiac rehabilitation behaviours and may suggest the need for different teaching-learning approaches and/or more focused patient education for PTCA patients. A goal of cardiac rehabilitation is to encourage patient initiation and maintenance of lifestyle modification behaviours based on identified risk factors.(ABSTRACT TRUNCATED AT 250 WORDS)     

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)     

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)     

Occult ectopic ACTH secretion due to recurrent lung carcinoid: long-term control of hypercortisolism by continuous subcutaneous infusion of octreotide

OBJECTIVES: Patients with chronic fatigue syndrome complain of physical and mental fatigue that is worsened by exertion. It was predicted that the cognitive and motor responses to vigorous exercise in patients with chronic fatigue syndrome would differ from those in depressed and healthy controls. METHODS: Ten patients with chronic fatigue syndrome, 10 with depressive illness, and 10 healthy controls completed cognitive and muscle strength testing before and after a treadmill exercise test. Measures of cardiovascular functioning and perceived effort, fatigue, and mood were taken during each stage of testing. RESULTS: Depressed patients performed worst on cognitive tests at baseline. During the treadmill test, patients with chronic fatigue syndrome had higher ratings of perceived effort and fatigue than both control groups, whereas patients with depression reported lower mood. After exertion, patients with chronic fatigue syndrome showed a greater decrease than healthy controls on everyday tests of focused (p=0.02) and sustained (p=0.001) attention, as well as greater deterioration than depressed patients on the focused attention task (p=0.03). No between group differences were found in cardiovascular or symptom measures taken during the cognitive testing. CONCLUSIONS: Patients with chronic fatigue syndrome show a specific sensitivity to the effects of exertion on effortful cognitive functioning. This occurs despite subjective and objective evidence of effort allocation in chronic fatigue syndrome, suggesting that patients have reduced working memory capacity, or a greater demand to monitor cognitive processes, or both. Further insight into the pathophysiology of the core complaints in chronic fatigue syndrome is likely to be realised by studying the effects of exercise on other aspects of everyday functioning.     

Do Psychosocial and Study Skill Factors Predict College Outcomes? A Meta-Analysis.

This study examines the relationship between psychosocial and study skill factors (PSFs) and college outcomes by meta-analyzing 109 studies. On the basis of educational persistence and motivational theory models, the PSFs were categorized into 9 broad constructs: achievement motivation, academic goals, institutional commitment, perceived social support, social involvement, academic self-efficacy, general self-concept, academic-related skills, and contextual influences. Two college outcomes were targeted: performance (cumulative grade point average; GPA) and persistence (retention). Meta-analyses indicate moderate relationships between retention and academic goals, academic self-efficacy, and academic-related skills (ps = .340, .359, and .366, respectively). The best predictors for GPA were academic self-efficacy and achievement motivation (ps = .496 and .303, respectively). Supplementary regression analyses confirmed the incremental contributions of the PSF over and above those of socioeconomic status, standardized achievement, and high school GPA in predicting college outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy and safety of exercise programs in cardiac rehabilitation

Physical activity performed by patients with coronary heart disease is a two-edged sword. A number of biological changes produced by regular exercise may reduce the risk of future cardiac events, while the increase in cardiac work produced by this same exercise can predispose the patient to sudden cardiac death. Data from observational studies as well as randomized clinical trials demonstrate a lower cardiac mortality rate for men participating in exercise rehabilitation programs vs nonparticipants. Overall, exercise program participants appear to experience a reduction of approximately 25% in cardiac and all-cause mortality, but no single study has provided definitive results. During medically supervised exercise, the risk of cardiac death based on reports of programs in the United States is approximately one event in every 60,000 participant-hours of exercise. At this rate, a typical rehabilitation program that has 95 patients exercising 3 h.wk-1 could expect a sudden cardiac death during an exercise session once every 4 yr. No data have been published on the morbidity or mortality benefits or risks of home-based exercise or for women participants. Also, the contribution of continuous electrocardiographic monitoring to the safety of exercise training of cardiac patients is yet to be defined.     

The effects of body composition changes to observed improvements in cardiopulmonary parameters after exercise training with cardiac rehabilitation

STUDY OBJECTIVE: To discriminate the effects of body fat reduction on improvements in peak aerobic capacity made following exercise training during cardiac rehabilitation. DESIGN: Observational, prospective study. SETTING: Outpatient cardiovascular health center at regional academic center. PATIENT INTERVENTIONS: Peak oxygen uptake (pkVO2), percent body fat, lean body mass (LBM), and other anthropometric measures were assessed before and after a 3-month program of cardiac rehabilitation and exercise training in 500 consecutive cardiac patients following a major coronary event. Baseline pkVO2 was corrected for LBM (pk/VO2 lean) and compared with posttraining values. RESULTS: Following exercise training, percent body fat decreased 5% from 26.2+/-8.0 to 24.8+/-7.5 (p<0.0001), and LBM increased 1% from 61.3+/-12.5 to 61.7+/-11.8 kg (p=0.02). pk/VO2 increased 16% from 16.0+/-4.1 to 18.5+/-4.8 mL/kg/min (p<0.0001), and pkVO2 lean increased 13% from 21.7+/-5.3 to 24.6+/-6.0 mL/kg/min (p<0.0001). Isolating the effects of reduction in body fat, we discern that these changes contributed to 0.3 of the 2.5 mL/kg/min increase in pkVO2 or 12% of the increase in pkVO2 observed. CONCLUSIONS: Changes in body composition, as a consequence of dietary and exercise modification, contribute to 12% of the "observed" improvement noted in weight-adjusted peak aerobic capacity following cardiac rehabilitation and exercise training. Changes in pkVO2 lean should be used by investigators to assess the singular effects of exercise conditioning alone.     

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)     

Prospective evaluation of the effects of stress on exercise adherence in community-residing women.

The effects of stress on exercise behavior in community-residing women exercising on their own were assessed. Participants (N?=?82) completed a background questionnaire and kept exercise diaries and Weekly Stress Inventories (P. J. Brantley, G. N. Jones, E. Boudreax, & S. L. Catz, 1997) for 8 consecutive weeks. During weeks with a high frequency of stressful events, participants exercised for less time and reported lower self-efficacy for meeting upcoming exercise goals. During weeks of high perceived stress, participants exercised significantly fewer days, omitted more planned exercise sessions, were less satisfied with their exercise, and had lower self-efficacy for meeting exercise goals. Findings suggest that perceptions of stressful events and cognitive reactions to missed exercise may play a significant role in mediating exercise behavior and support the view of exercise relapse as an ongoing process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

First total synthesis of ganglioside GT1a alpha

Controversy still exists concerning the potential ergogenic benefit of caffeine (CAF) for exercise performance. The purpose of this study was to compare the effects of CAF ingestion on endurance performance during exercise on a bicycle ergometer at two different intensities, i.e., approximately 10% below and 10% above the anaerobic threshold (AT). Eight untrained males, non-regular consumers of CAF, participated in this study. AT, defined as the intensity (watts) corresponding to a lactate concentration of 4 mM, was determined during an incremental exercise test from rest to exhaustion on an electrically braked cycle ergometer. On the basis of these measurements, the subjects were asked to cycle until exhaustion at two different intensities, i.e., approximately 10% below and 10% above AT. Each intensity was performed twice in a double-blind randomized order by ingesting either CAF (5 mg/kg) or a placebo (PLA) 60 min prior to the test. Venous blood was analyzed for free fatty acid, glucose, and lactate, before, during, and immediately after exercise. Rating of perceived exertion and time to exhaustion were also measured during each trial. There were no differences in free fatty acids or lactate levels between CAF and PLA during and immediately after exercise for either intensity. Immediately after exercise glucose increased in the CAF trial at both intensities. Rating of perceived exertion was significantly lower (CAF = 14.1 +/- 2.5 vs PLA = 16.6 +/- 2.4) and time to exhaustion was significantly higher (CAF = 46.54 +/- 8.05) min vs PLA = 32.42 +/- 14.81 min) during exercise below AT with CAF. However, there was no effect of CAF treatment on rating of perceived exertion (CAF = 18.0 +/- 2.7 vs PLA = 17.6 +/- 2.3) and time to exhaustion (CAF = 18.45 +/- 7.28 min vs PLA = 19.17 +/- 4.37 min) during exercise above AT. We conclude that in untrained subjects caffeine can improve endurance performance during prolonged exercise performed below AT and that the decrease of perceived exertion can be involved in this process.     

Using motivational interviewing as a supplement to obesity treatment: A stepped-care approach.

Objective: This investigation was designed to improve behavioral weight loss program (BWLP) treatment outcomes by providing stepped care (SC) to individuals experiencing difficulties with weight loss during treatment. SC entails transition to more intensive treatments when less intensive treatments fail to meet treatment goals. In a BWLP, motivational interviewing (MI) may increase participants' motivation toward behavioral change and thus complement the acquisition of behavioral change skills. It was hypothesized that BWLP + SC (MI) participants (i.e., participants who failed to meet weight loss goals and received MI) would demonstrate superior treatment outcomes when compared with BWLP (SC matched) participants (i.e., participants who failed to meet weight loss goals but did not receive MI). Design: Fifty-five obese, sedentary adults were randomly assigned to a BWLP + SC or a BWLP. Main outcome measures: Changes in weight, cardiorespiratory fitness, self-reported physical activity, and diet (i.e., calories, percentage daily intake of fat, protein, and carbohydrates) in response to treatment were assessed. Results: Participants significantly decreased their weight, increased physical activity/fitness, and improved dietary intake (ps