Exercise and the transtheoretical model: a longitudinal test of a population sample.

BACKGROUND: The purpose of this study was to test the ability of the Transtheoretical Model (TTM) to predict exercise stage transition of individuals in a large, untreated-population-based, random sample of Canadian adults (18-65 years of age) over two consecutive time periods. METHODS: Assessments of TTM's stage of exercise behavior change, self-efficacy, pros, cons, experiential processes, and behavioral processes were made at baseline (time 1), 6 months (time 2), and 1 year (time 3). Six hundred eighty-three men and women, identified through random-digit telephone dialing, completed all measures across the three time points. Within each time period (time 1-2; time 2-3) participants were categorized as having regressed (moved back at least on stage), remained (no stage change), or progressed (moved forward at least one stage). Baseline TTM constructs were analyzed for their ability to predict change transition across the two time periods. RESULTS: Of 40 possible predictions (20 for each time period) 18 (45%) were supported. CONCLUSIONS: Overall, the findings demonstrate partial support for the internal validation of TTM in the exercise domain. Implications of the findings are discussed and future directions for researchers, practitioners, and program planners are provided.

Predicting exercise stage transitions over two consecutive 6-month periods: a test of the theory of planned behaviour in a population-based sample.

OBJECTIVES: To predict exercise stage transitions over two consecutive 6-month periods using the theory of planned behaviour (TPB). It was hypothesized that different social cognitive constructs would predict different stage transitions. DESIGN: Prospective and longitudinal in order to predict multiple stage transitions over time. Assessments were made at baseline, 6 months and 1 year. METHOD: Participants were a randomly selected population-based sample of 683 adults who completed two telephone interviews (baseline and 6 months) that assessed exercise stage, intention, perceived behavioural control, attitude, subjective norm, and social support, and a mailed survey (1 year) that assessed exercise stage. RESULTS: Progression from pre-contemplation was predicted by intention, attitude and subjective norm; progression/regression from contemplation was predicted by intention, perceived behavioural control, attitude, and social support; progression/regression from preparation was predicted by intention and attitude; and regression from action/maintenance was predicted by intention, attitude and social support. CONCLUSIONS: Different social cognitive constructs predicted different stage transitions, which indicates that exercise behaviour change may be represented by a series of stage transitions. Moreover, the TPB may be a useful model for highlighting the key social cognitive constructs that are important for exercise stage transitions.

Psychologic distress among spouses of patients undergoing cardiac rehabilitation.

OBJECTIVE: The goal of this study was to identify common sources of distress in spouses of patients undergoing cardiac rehabilitation and to compare spouses classified as being in distress and those classified as nondistressed on demographic variables, their experiences of stress, coping strategies employed, marital intimacy, and level of family functioning. The study aimed to describe the needs of spouses with respect to possible interventions. DESIGN: A cross-sectional analysis was used. SETTING: The study was located at the University of Ottawa Heart Institute Prevention and Rehabilitation Centre's cardiac rehabilitation program. OUTCOME MEASURES: Scores on the Brief Symptom Inventory, Heart Disease Hassles Scale, Coping Strategies Inventory, Miller Intimacy Scale, and McMaster Family Assessment Device were used as outcome measures. RESULTS: Two hundred thirteen female spouses of patients undergoing cardiac rehabilitation participated in this study. Sixty-six percent of the spouses met the criteria for distress. This was more common in younger spouses (51.99 +/- 9.94 years) than in older spouses (55. 74 +/- 10.54 years) (t = -2.45; P =.013). Distressed spouses used disengagement coping strategies significantly more than the nondistressed spouses (t = 6.91; P =.0001). Distressed spouses also reported significantly less intimacy in their marriages (t = -3.99; P =.0001) and poorer family functioning (t = 5.86; P =.0001). The most prevalent symptoms of psychologic distress included feeling tense, having trouble falling asleep and feeling easily hurt. The most prevalent stressors were as follows: (1) worries about treatment, recovery, and prognosis (75.5%); (2) moodiness of the patient (66.7%); (3) worries about the patient returning to work and about money (38.8%); (4) sexual concerns (36.7%); and (5) helplessness or apathy on the part of the patient and increased spousal responsibility (36.1%). CONCLUSIONS: Spouses of patients undergoing cardiac rehabilitation should be screened for psychologic distress, and those in distress should be offered interventions focused on assisting them to deal with specific stressors related to their experience with a spouse with heart disease. Interventions indicated include stress-management techniques and encouraging the use of engagement coping strategies. In addition, marital and family concerns need to be directly addressed in support interventions.

Exercise behavior in a community sample with diabetes: understanding the determinants of exercise behavioral change.

PURPOSE: The purpose of this study was to investigate the factors associated with exercise behavior among adults with diabetes. METHODS: Exercise behavior (stage of exercise readiness and energy expenditure) and potential determinants were measured on a subsample (n = 46) of adults with type 1 or type 2 diabetes from a randomized population-based telephone survey. Participants were assessed at baseline and at a 6-month follow-up. RESULTS: Sociodemographic and biomedical characteristics did not significantly differ between the stages of exercise behavior. Scores on the psychosocial constructs of self-efficacy, behavioral processes, self-concept, and social support were significantly higher for those in the action stage than those in the preaction stage of exercise readiness. Self-efficacy and behavioral process of change were significantly associated with energy expenditure; self-efficacy was the strongest predictor in the longitudinal analysis. CONCLUSIONS: These findings may generate direction for theory development and guide health and medical practitioners when intervening on the specific constructs. Population- and community-based surveys have utility for assessing diabetes health-related behavior (e.g., exercise behavior).

Fat-related dietary behaviour: behavioural science concepts for public health practice.

Despite being central to Canadian health objectives, reduction in fat consumption remains a difficult health target to reach. Strong epidemiological data associate high dietary fat intake with cardiovascular disease (CVD). There has been considerable interest in applying concepts from psychosocial models of behaviour change to enhance the effectiveness of CVD prevention programs. This review suggests that the determinants of fat-related dietary behaviours can be integrated within a comprehensive model useful to public health practice. The Transtheoretical Model (TTM) is suggested as an organizing framework for variables empirically related to diet. The TTM holds that dietary change occurs through successive stages, defined according to people's readiness to adopt new behaviours. Furthermore, readiness to change can be explained by variables that are amenable to public health interventions. The integration of important variables within the TTM framework may prove helpful in designing, implementing and evaluating effective dietary change intervention programs in the community.

Stress and cardiovascular disease risk behaviours: implications for health behaviour change.

This brief paper presents an integrative framework helpful in understanding the relationships between stress and cardiovascular disease risk behaviours. Key concepts such as cardiovascular reactivity, type A behaviour and hostility, ways of coping with both life and illness-related stressors, and the challenges associated with changing risk behaviours can support a patient's behaviour change efforts if communicated in a personally salient manner. Assessing the determinants of health behaviour change facilitates tailoring of interventions and can more precisely identify a patient's needs for referral to a psychologist with expertise in health behaviour issues.

A self-efficacy scale for heart-healthy eating.

Self-efficacy is an important mediator of behaviour change. We have developed a brief measure of self-efficacy related to ability to make dietary changes to lower serum cholesterol. An initial pool of 37 items was tested on 85 third-year nursing students. Factor analysis revealed two primary factors ('self-efficacy for resistance to temptation' and 'self-efficacy for change') composed of 13 items. This instrument was validated in a sample of 125 blue collar workers. Analyses confirmed that the scale structure accounted for 37% of the variance. Evidence of discriminant validity was provided by moderate correlations between factors (r = 0.41). Item-scale correlations also supported the discriminant validity. Cronbach's alpha ranged between 0.7 and 0.79 for both factors. This short instrument might be useful as an adjunct tool to identify potential responders for cholesterol modification interventions, to help understand the determinants of dietary behaviour changes and to guide the tailoring of interventions toward specific client/population subgroup needs.

Adjustment to Heart Disease: Helping families cope.

Many cardiac patients experience compromised psychologic and social adjustment, which can persist for a significant period. Worsened marital and family functioning have also been reported. This paper reviews the literature, provides a framework to identify adjustment problems, and discusses strategies to facilitate recovery and enhance the well-being of the patient, couple, and family.

The prevalence and impact of pain after day-care tubal ligation surgery.

Empirical data from controlled studies using standardized, reliable measures on the amount and quality of pain after laparoscopic tubal ligation and the consequences of this pain on the activities of daily living are extremely scarce. In a study of 54 women admitted to a day-care unit for this procedure, validated measures were utilized to assess the incidence, intensity and duration of pain after tubal ligation (McGill Pain Questionnaire) and the impact of pain on the activities of daily living (Modified Functional Assessment Inventory). Psychological measures (Brief Symptom Inventory, Kranz Health Opinion Survey, and the State-Trait Anxiety Inventory) were employed to test their use as possible predictors for pain, analgesic usage and the time taken to resume a normal activity level after tubal ligation surgery. The results showed that pain is a significant problem after tubal ligation although pain rating scores over the 7-day study period were lower than those reported after major abdominal surgery. Eighty-five percent of our sample reported that pain and/or fatigue impacted on their recovery and contributed to an average delay of return to normal activity level of 4.4 days, not including the day of surgery. The psychological measures did not prove to be strong predictors of postoperative pain, time of return to normal activity level or analgesic usage. The most powerful predictor of return to normal activity was the total amount of pain experienced, as measured by the McGill Pain Questionnaire, during the 7 day post-operative period.