Exercise Science Cardiac Rehabilitation

CHAPTER I

Introduction

Exercise following an acute cardiac event (such as myocardial infarction or coronary artery bypass surgery) has been shown to reduce mortality and morbidity, increase cardiovascular functional capacity, decrease myocardial demand and improve blood pressure control, weight control, lipid levels and psychosocial functioning in men and women of all ages . Despite the proven effectiveness of exercise, an increasing drop-out rate from exercise in the first 3-6 months following a cardiac rehabilitation (CR) program has been found. Women appear to have even lower rates of participation in CR exercise than men, with women's initiation of CR exercise 10-25% below those of men. The downward trajectory of exercise performance during the year following an acute cardiac event results in a large number of cardiac patients who are not exercising at levels needed to achieve the health benefits of exercise. Clearly, evidence of the effectiveness of exercise and fear of another cardiac event in the future is not enough to motivate cardiac patients to maintain long-term exercise.

Exercise maintenance is a complex and demanding health behavior that usually entails complex lifestyle changes. There are few reports of interventions to increase exercise maintenance following acute cardiac events. However, studies of the effects of CR programs on exercise maintenance have shown conflicting results; some studies report significant differences in exercise habits up to 1 year following the CR program, while others indicate no differences in long-term exercise . While interventions to increase exercise in healthy individuals have shown some success , efforts to increase exercise maintenance in patients after cardiac events have not been particularly effective . Therefore, better methods to increase exercise maintenance are needed.

Researchers have focused increasingly on the influence of patients' underlying value systems on their health-related decisions. Eliciting patient preferences has been a successful strategy to assist patients to reach health-related decisions that are consistent with their underlying values. For example, interventions to increase patient involvement in health-related decisions have resulted in higher satisfaction with, and more active participation in, decision making better scores on general health perceptions and physical functioning, higher compliance, improved knowledge and reduced decisional conflict . If people can exercise in accordance with their preferences and life-styles, it may become easier to maintain exercise over time.

Surprisingly, studies investigating the role of preferences for health promotion behaviors are almost absent. Research on behavioral change, such as exercise have primarily built on theoretical frameworks such as the health belief model, social learning theory, or the social problem solving model, with a focus on self-efficacy, problem-solving skills, coping skills, social support, health beliefs, motivation, or other cognitive-behavioral aspects. Some frameworks acknowledge that preferences are motivators for behavioral change . The six stages of change transtheoretical model relates indirectly to patient preferences by incorporating decisional balance as contributing factor to produce change. However, the degree to which patient preferences can explain compliance with health promoting behavior, such as exercise has not been a focus of empirical investigations.

Patient preferences are usually viewed from the perspective of the desirability of ...