Bill Daub

Is the theory of planned behavior a useful framework for understanding exercise adherence during phase II cardiac rehabilitation

PURPOSE This study evaluated the theory of planned behavior (TPB) as a framework for understanding exercise adherence during phase II cardiac rehabilitation (CR). METHODS A total of 215 patients completed a baseline questionnaire that included the TPB constructs and past exercise. Exercise adherence was measured via program attendance during phase II CR. RESULTS Hierarchic regression analyses indicated that attitude, subjective norm, and perceived behavioral control (PBC) explained 30% of the variance in exercise intention, with attitude, subjective norm, and PBC each making significant unique contributions to intention. Furthermore, exercise intention explained 12% of the variance in exercise adherence. Finally, the behavioral, normative, and control beliefs provided novel information concerning why patients in phase II CR hold certain attitudes, subjective norms, PBC, and exercise intentions. CONCLUSION Results of the present study provide evidence that the TPB is a useful framework for understanding exercise intentions and adherence during phase II CR.

Effects of aerobic or aerobic and resistance training on cardiorespiratory and skeletal muscle function in heart failure: a randomized controlled pilot trial

Objective: To examined the effects of different training modalities on exercise capacity (Vo 2peak), systolic function, muscular strength and endurance and quality of life in heart failure patients. Design: Randomized controlled trial. Setting: Cardiac rehabilitation centre in Canada. Subjects: Forty-two individuals with heart failure (62 ± 12 years; New York Heart Association (NYHA) classes I—III). Interventions: Aerobic training (n = 14), combined aerobic and resistance training (n = 15) or usual care (n = 13) three times per week for 12 weeks. Main measures: (1) Vo 2peak measured by symptom-limited graded exercise test on cycle ergometer; (2) systolic function assessed by two-dimensional echocardiography; (3) muscular strength and muscular endurance measured by one-repetition maximum procedure; and (4) quality of life assessed by questionnaires. Results: In the intention-to-treat analysis, neither aerobic nor combined aerobic and resistance training significantly improved Vo2peak, systolic function or quality of life compared with usual care. However, combined aerobic and resistance training significantly improved upper extremity strength (40.7 (14.0)—48.5 (16.0) kg, P<0.05) and muscular endurance (5.7 (2.7)—11.6 (7.6) reps, P<0.05) compared with aerobic training or usual care. In compliant participants (exercise adherence 80%), Vo2peak increased in the aerobic group (16.9 (6.0)—19.0 (6.8), P= 0.026) and tended to increase in the combined training group (15.9 (5.0)—17.6 (5.6), P= 0.058) compared with usual care. Quality of life was improved in the aerobic group only. Conclusions: Both aerobic and combined aerobic and resistance training are effective interventions to improve Vo2peak in compliant heart failure patients. Combined training may be more effective in improving muscle strength and endurance.

Effects of a comprehensive cardiac rehabilitation program on quality of life and exercise tolerance in women: A retrospective analysis

BackgroundCurrently, there are a lack of investigations that have examined the effect of participating in a comprehensive cardiac rehabilitation program on quality of life and physiological measures in women of different ages. The purpose of this investigation was to examine the effect of participating in a comprehensive cardiac rehabilitation program on quality of life, exercise tolerance, blood pressure and lipids in women between 33 and 82 years of age.MethodsThe 126 women participated in a 14-week cardiac rehabilitation program that consisted of 7 weeks of formal supervised exercise training and 7 weeks of unsupervised exercise and lifestyle modification. Physiologic and quality of life outcome measures obtained at the outset and after 14 weeks included: 1) exercise treadmill time; 2) resting and peak systolic and diastolic blood pressure; 3) total cholesterol, low-density lipoprotein cholesterol, high density lipoprotein cholesterol and Triglycerides; 4) Cardiac Quality of Life Index questionnaire.ResultsSignificant improvements were found in the following quality of life measures after participating in the cardiac rehabilitation program: physical well being, psychosocial, worry, nutrition and symptoms. No significant differences were seen for any QOL variable between the different age groups. Significant improvements were seen in exercise tolerance (+21%) and high density lipoprotein (+5%).ConclusionCardiac rehabilitation may play an important role in improving quality of life, exercise tolerance and high density lipoprotein cholesterol levels in younger and older women with underlying cardiovascular disease.

The Enduring Impact of Social Factors on Exercise Tolerance in Men Attending Cardiac Rehabilitation

PURPOSE: This study explored the influence of social support on a prognostic indicator among cardiac patients, exercise tolerance. The relationship of sociodemographic factors to social support was examined, as well as the role of social support as a potential mediator between sociodemographic factors and exercise tolerance. METHODS: Archival data were collected from a sample of 254 men referred to cardiac rehabilitation. An exercise tolerance test was completed upon entry into cardiac rehabilitation, after 14 weeks, and after 9 months. RESULTS: Sociodemographic factors and social support reported upon entry into the cardiac rehabilitation program were related to initial and post-cardiac rehabilitation exercise tolerance, after controlling for admitting diagnoses, medical history, smoking, and perceived severity of illness. Overall, 28% of the variance in exercise tolerance was explained at baseline, 19% at 14 weeks, and 20% at 9 months. Specifically, older individuals had poorer exercise tolerance, whereas those with more income had better exercise tolerance. Social support was positively related to exercise tolerance at all 3 times. Older men reported less social support than younger men did, and those with more income reported more social support. However, social support did not mediate the relationship between sociodemographic factors and exercise tolerance. CONCLUSIONS: Results support the potential use of broad social factors in examining the determinants of prognostic factors for heart patients.