ABSTRACT
Background: Building confidence to exercise regularly (exercise self-efficacy) in the face of constraints is a key goal of cardiac rehabilitation (CR) because these beliefs are predictors of sustained exercise behaviours. This study identifies patient subgroups at risk of poor self-efficacy to enable targeting and tailoring of CR interventions. Methods: Patients with coronary heart disease at four CR sites in Australia completed the Exercise Self-Efficacy Scale at CR entry and completion (6-8 weeks). A General Linear Model was used to identify independent predictors of least change in exercise self-efficacy. Data collection included COVID-19 pandemic time, so delivery mode (in-person versus remote) was included in the analyses. Results: Patients (n=194) had a mean age of 65.9 (SD 10.5) years, 81% were males. The majority (80%) were married/partnered, 76% were White, and 24% were from an ethnic minority background. Patients received CR in-person (47%) or remote-delivered (54%). At CR entry, the mean exercise self-efficacy score was 24.9 (SD 6.0) of potential 30 points, which improved significantly by completion (p=0.027). Independent predictors of least improvements in exercise self-efficacy were being an ethnic minority (β= -2.96, 95%CI -4.90, -1.02), not having a spouse/partner (β=-2.42, 95% CI -4.49, -0.35), attending in-person CR (β= -1.75, 95%CI -3.39, -0.12), and having higher exercise self-efficacy at entry (β= -0.37, 95%CI -0.51, -0.23). Conclusions: Confidence to exercise improves in CR programs. Assessing exercise self-efficacy at CR entry is recommended to ensure interventions can be tailored for patients’ needs. The relative lesser increase in confidence in ethnic minorities and solo patients should be explored.
ABSTRACT
Background/Introduction: Building confidence to exercise regularly (exercise self-efficacy (ESE)) in the face of constraints and barriers, is a key goal of cardiac rehabilitation (CR) because such self-efficacy beliefs are predictors of sustained exercise behaviours. Therefore, identifying patient subgroups at risk of poor ESE enables tailoring of CR and appropriate targeting of support interventions. Purpose: To identify independent predictors of poor ESE and poor improvements in ESE in CR participants. Methods: The study used a prospective observational cohort design and recruited patients with coronary heart disease at CR entry across four sites in Metropolitan Sydney, Australia (2019-2020). Data were also compared for traditional in-person and remote-delivered CR during COVID-19 pandemic restrictions. The Exercise Self Efficacy Scale was used to measure ESE at CR entry and completion, and General Linear Models were used for analyses. Results: Participants (n=194) had a mean age of 65.94 (SD 10.46) years, with 80.9% males;and 80.0% were married or partnered, with 23.6% from an ethnic minority background. Referral diagnosis included elective percutaneous coronary intervention (PCI) (40.2%), coronary artery bypass surgery (26.3%), and myocardial infarction with or without PCI (33.5%). At CR entry, the mean ESE score was 24.93 (SD 5.99) points, which improved significantly by completion (p=.027). The GLM of ESE change (Adjusted R2=.247) identified that predictors of less change in ESE scores by CR completion included ethnic minorities (β=2.96, p=.003), not having a spouse or an intimate partner (β=-2.42, p=.023), and attending in-person CR (β=1.75, p=.036). Having higher ESE scores at entry was also associated with less ESE change on completion, such that for every point increase in ESE at entry, there was a reduction of .37 points in change (p<.001). These variables were also the same predictors of poor ESE at CR completion. Conclusions: Confidence to exercise improves in CR, and screening for ESE at CR entry enables identification of patients at-risk of poor improvements. Tailoring of interventions to provide appropriate support such as extending CR should be considered for patients from ethnic minorities and those who are single/widowed. Exploring the reasons for differences in outcomes from in-person and remote-delivered CR using appropriate methods should be the focus of future research.