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Effects of Exercise Testing and Cardiac Rehabilitation in Patients with Coronary Heart Disease on Fear and Self-Efficacy of Exercise: A Pilot Study

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Abstract

Background

Exercise fear and low exercise self-efficacy are common in patients attending cardiac rehabilitation (CR). This study tested whether exercise prescription methods influence exercise fear and exercise self-efficacy. We hypothesized that the use of graded exercise testing (GXT) with a target heart rate range exercise prescription, relative to standard exercise prescription using rating of perceived exertion (RPE), would produce greater reductions in exercise fear and increase self-efficacy during CR.

Method

Patients in CR (N = 32) were randomized to an exercise prescription using either RPE or a target heart rate range. Exercise fear and self-efficacy were assessed with questionnaires at three time points: baseline; after the GXT in target heart rate range group; and at session 6 for the RPE group and CR completion. Items were scored on a five-point Likert-type scale with higher mean scores reflecting higher fear of exercise and higher self-efficacy. To analyze mean differences, a mixed effects analysis was run.

Results

There were no significant changes in exercise self-efficacy between baseline and discharge from CR; these were not statistically significant (mean differences baseline − 0.63; end − 0.27 (p = 0.13)). Similarly, there was no change in fear between groups (baseline 0.30; end 0.51 (p = 0.37)).

Conclusion

Patients in the RPE and target heart rate groups had non-significant changes in exercise self-efficacy over the course of CR. Contrary to our hypothesis, the use of GXT and target heart rate range did not reduce fear, and we noted sustained or increases in fear of exercise among patients with elevated baseline fear. A more targeted psychological intervention seems warranted to reduce exercise fear and self-efficacy in CR.

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Data Availability

Data can be made available upon request.

References

  1. Lapier TK, Cleary K, Kidd J. Exercise self-efficacy, habitual physical activity, and fear of falling in patients with coronary heart disease. Cardiopulm Phys Ther J. 2009;20(4):5–11.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Farris SG, Thomas JG, Abrantes AM, et al. Anxiety sensitivity and intentional avoidance of physical activity in women with probable migraine. Cephalalgia Int J Headache. 2019;39(11):1465–9. https://doi.org/10.1177/0333102419861712.

    Article  Google Scholar 

  3. Joo KC, Brubaker PH, MacDougall A, Saikin AM, Ross JH, Whaley MH. Exercise prescription using resting heart rate plus 20 or perceived exertion in cardiac rehabilitation. J Cardpulm Rehabil. 2004;24(3):178–184; quiz 185–186. https://doi.org/10.1097/00008483-200405000-00008.

  4. Reed JL, Blais AZ, Keast ML, Pipe AL, Reid RD. Performance of fixed heart rate increment targets of 20 vs 30 beats per minute for exercise rehabilitation prescription in outpatients with heart failure. Can J Cardiol. 2017;33(6):777–84. https://doi.org/10.1016/j.cjca.2017.01.022.

    Article  PubMed  Google Scholar 

  5. American Association of Cardiovascular & Pulmonary Rehabilitation, ed. Guidelines for Cardiac Rehabilitation Programs. Sixth edition. Human Kinetics; 2021.

  6. Slovinec D’Angelo ME, Pelletier LG, Reid RD, Huta V. The roles of self-efficacy and motivation in the prediction of short- and long-term adherence to exercise among patients with coronary heart disease. Health Psychol. 2014;33(11):1344–53. https://doi.org/10.1037/hea0000094.

    Article  PubMed  Google Scholar 

  7. Stathokostas L, Petrella AFM, Blunt W, Petrella RJ. Perceptions of exercise screening among older adults. Appl Physiol Nutr Metab Physiol Appl Nutr Metab. 2018;43(6):580–6. https://doi.org/10.1139/apnm-2017-0488.

    Article  Google Scholar 

  8. Ruano-Ravina A, Pena-Gil C, Abu-Assi E, et al. Participation and adherence to cardiac rehabilitation programs. A systematic review Int J Cardiol. 2016;223:436–43. https://doi.org/10.1016/j.ijcard.2016.08.120.

    Article  PubMed  Google Scholar 

  9. Fletcher JS, Banasik JL. Exercise self-efficacy. Clin Excell Nurse Pract. 2001;5(3):134–43. https://doi.org/10.1054/xc.2001.24203.

    Article  CAS  PubMed  Google Scholar 

  10. Keessen P, den Uijl I, Visser B, et al. Fear of movement in patients attending cardiac rehabilitation: a validation study. J Rehabil Med. 2020;52(2):jrm00021. https://doi.org/10.2340/16501977-2653.

  11. Hoffmann JM, Hellwig S, Brandenburg VM, Spaderna H. Measuring fear of physical activity in patients with heart failure. Int J Behav Med. 2018;25(3):294–303. https://doi.org/10.1007/s12529-017-9704-x.

    Article  PubMed  Google Scholar 

  12. Åhlund K, Bäck M, Sernert N. Fear-avoidance beliefs and cardiac rehabilitation in patients with first-time myocardial infarction. J Rehabil Med. 2013;45(10):1028–33. https://doi.org/10.2340/16501977-1219.

    Article  PubMed  Google Scholar 

  13. Farris SG, Abrantes AM, Bond DS, Stabile LM, Wu WC. Anxiety and fear of exercise in cardiopulmonary rehabilitation: patient and practitioner perspectives. J Cardiopulm Rehabil Prev. 2019;39(2):E9–13. https://doi.org/10.1097/HCR.0000000000000401.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Barnason S, Zimmerman L, Atwood J, Nieveen J, Schmaderer M. Development of a self-efficacy instrument for coronary artery bypass graft patients. J Nurs Meas. 2002;10(2):123–33. https://doi.org/10.1891/jnum.10.2.123.52553.

    Article  PubMed  Google Scholar 

  15. Woodgate J, Brawley LR. Self-efficacy for exercise in cardiac rehabilitation: review and recommendations. J Health Psychol. 2008;13(3):366–87. https://doi.org/10.1177/1359105307088141.

    Article  PubMed  Google Scholar 

  16. Bäck M, Cider Å, Herlitz J, Lundberg M, Jansson B. Kinesiophobia mediates the influences on attendance at exercise-based cardiac rehabilitation in patients with coronary artery disease. Physiother Theory Pract. 2016;32(8):571–80. https://doi.org/10.1080/09593985.2016.1229828.

    Article  PubMed  Google Scholar 

  17. Rogerson MC, Murphy BM, Bird S, Morris T. “I don’t have the heart”: a qualitative study of barriers to and facilitators of physical activity for people with coronary heart disease and depressive symptoms. Int J Behav Nutr Phys Act. 2012;9(1):140. https://doi.org/10.1186/1479-5868-9-140.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Daniali SS, Darani FM, Eslami AA, Mazaheri M. Relationship between self-efficacy and physical activity, medication adherence in chronic disease patients. Adv Biomed Res. 2017;6:63. https://doi.org/10.4103/2277-9175.190997.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Brawner CA, Abdul-Nour K, Lewis B, et al. Relationship between exercise workload during cardiac rehabilitation and outcomes in patients with coronary heart disease. Am J Cardiol. 2016;117(8):1236–41. https://doi.org/10.1016/j.amjcard.2016.01.018.

    Article  PubMed  Google Scholar 

  20. Franklin BA, Lavie CJ, Squires RW, Milani RV. Exercise-based cardiac rehabilitation and improvements in cardiorespiratory fitness: implications regarding patient benefit. Mayo Clin Proc. 2013;88(5):431–7. https://doi.org/10.1016/j.mayocp.2013.03.009.

    Article  PubMed  Google Scholar 

  21. Heran BS, Chen JM, Ebrahim S, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2011;(7):CD001800. https://doi.org/10.1002/14651858.CD001800.pub2.

  22. Martin BJ, Arena R, Haykowsky M, et al. Cardiovascular fitness and mortality after contemporary cardiac rehabilitation. Mayo Clin Proc. 2013;88(5):455–63. https://doi.org/10.1016/j.mayocp.2013.02.013.

    Article  PubMed  Google Scholar 

  23. Squires RW, Kaminsky LA, Porcari JP, Ruff JE, Savage PD, Williams MA. Progression of Exercise training in early outpatient cardiac rehabilitation: an official statement from the American Association of Cardiovascular and Pulmonary Rehabilitation. J Cardiopulm Rehabil Prev. 2018;38(3):139–46. https://doi.org/10.1097/HCR.0000000000000337.

    Article  PubMed  Google Scholar 

  24. Shea MG, Headley S, Mullin EM, Brawner CA, Schilling P, Pack QR. Comparison of ratings of perceived exertion and target heart rate-based exercise prescription in cardiac rehabilitation: a randomized controlled pilot study. J Cardiopulm Rehabil Prev. 2022;42(5):352–8. https://doi.org/10.1097/HCR.0000000000000682.

    Article  PubMed  Google Scholar 

  25. Pack QR, Visintainer P, Farah M, et al. Development of a simple clinical tool for predicting early dropout in cardiac rehabilitation: a single-center risk model. J Cardiopulm Rehabil Prev. 2020;Publish Ahead of Print. https://doi.org/10.1097/HCR.0000000000000541.

  26. Ha FJ, Hare DL, Cameron JD, Toukhsati SR. Heart failure and exercise: a narrative review of the role of self-efficacy. Heart Lung Circ. 2018;27(1):22–7. https://doi.org/10.1016/j.hlc.2017.08.012.

    Article  PubMed  Google Scholar 

  27. Warner RM. Applied statistics: from bivariate through multivariate techniques. 2nd ed. SAGE Publications; 2013.

  28. Fischer D, Stewart AL, Bloch DA, Lorig K, Laurent D, Holman H. Capturing the patient’s view of change as a clinical outcome measure. JAMA. 1999;282(12):1157–62. https://doi.org/10.1001/jama.282.12.1157.

    Article  CAS  PubMed  Google Scholar 

  29. Baykal Şahin H, Kalaycıoğlu E, Şahin M. The effect of cardiac rehabilitation on kinesiophobia in patients with coronary artery disease. Turk J Phys Med Rehabil. 2021;67(2):203–10. https://doi.org/10.5606/tftrd.2021.5164.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Bray SR, Cowan H. Proxy efficacy: implications for self-efficacy and exercise intentions in cardiac rehabilitation. Rehabil Psychol. 2004;49(1):71–5. https://doi.org/10.1037/0090-5550.49.1.71.

    Article  Google Scholar 

  31. Knapik A, Saulicz E, Gnat R. Kinesiophobia - introducing a new diagnostic tool. J Hum Kinet. 2011;28:25–31. https://doi.org/10.2478/v10078-011-0019-8.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Farris SG, Kibbey MM. Be brave, BE-FIT! A pilot investigation of an ACT-informed exposure intervention to reduce exercise fear-avoidance in older adults. Cogn Behav Ther. 2022;51(4):273–94. https://doi.org/10.1080/16506073.2022.2037017.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Petrie KJ, Müller JT, Schirmbeck F, et al. Effect of providing information about normal test results on patients’ reassurance: randomised controlled trial. BMJ. 2007;334(7589):352. https://doi.org/10.1136/bmj.39093.464190.55.

    Article  PubMed  PubMed Central  Google Scholar 

  34. van Ravesteijn H, van Dijk I, Darmon D, et al. The reassuring value of diagnostic tests: a systematic review. Patient Educ Couns. 2012;86(1):3–8. https://doi.org/10.1016/j.pec.2011.02.003.

    Article  PubMed  Google Scholar 

  35. Hamilton DM, Haennel RG. The relationship of self-efficacy to selected outcomes. Can J Cardiovasc Nurs J Can En Soins Infirm Cardio-Vasc. 2004;14(2):23–32.

    Google Scholar 

  36. Peers C, Issartel J, Behan S, O’Connor N, Belton S. Movement competence: association with physical self-efficacy and physical activity. Hum Mov Sci. 2020;70:102582. https://doi.org/10.1016/j.humov.2020.102582.

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Funding

This study was funded by internal funds through Baystate Medical Center’s Researcher Pilot Award Program (RPAP), a K23 grant (1K23HL135440) from NHLBI awarded to Dr. Quinn Pack, and by RedCap (UL1RR025752, UL1TR000073, UL1TR001064, and UL1TR002544) through Tufts. Dr. Meredith Shea’s time was partially funded by T32HL155020.

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Authors and Affiliations

  1. Department of Exercise Science and Athletic Training, Springfield College, Springfield, USA

    Meredith G. Shea, Jasmin Hutchinson & Samuel Headley

  2. Beth Israel Deaconess Medical Center, Boston, USA

    Meredith G. Shea

  3. Department of Psychology, Rutgers University, New Brunswick, USA

    Samantha G. Farris

  4. Department of Healthcare Delivery and Population Science, University of Massachusetts Medical School - Baystate, Springfield, MA, USA

    Patrick Schilling & Quinn R. Pack

  5. Center for Resuscitation Science, Beth Israel Deaconess Medical Center, 1 Deaconess Road, MA, 02215, Boston, USA

    Meredith G. Shea

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  1. Meredith G. Shea
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Correspondence to Meredith G. Shea.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Shea, M.G., Farris, S.G., Hutchinson, J. et al. Effects of Exercise Testing and Cardiac Rehabilitation in Patients with Coronary Heart Disease on Fear and Self-Efficacy of Exercise: A Pilot Study. Int.J. Behav. Med. (2023). https://doi.org/10.1007/s12529-023-10207-9

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