Promoting adherence to physical activity among individuals with cardiovascular disease using behavioral counseling: A theory and research-based primer for health care professionals

Facilitators and barriers of initiation and maintenance of physical activity among people with coronary heart disease: a qualitative study

PURPOSE

We aimed to describe the facilitators and barriers of physical activity for patients with coronary heart disease.

METHODS

A qualitative descriptive study using semi-structured interviews was conducted with 15 participants with coronary heart disease. The interview guide was developed based on a multi-theory model. Interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis.

RESULTS

Two main themes were identified: facilitators of initiation and maintenance of physical activity (behavioral motivation, perceived benefits, behavioral confidence, supportive physical environment, positive emotional experience, self-regulation, supportive social environment, illness perception, and excellent self-control), barriers of initiation and maintenance of physical activity (perceived barriers, restricted physical environment, psychological distress, insufficient social support, and poor self-control).

CONCLUSIONS

This study presents an in-depth theory-based exploration of facilitators and barriers to initiating and maintaining physical activity among people with coronary heart disease. Relevant factors should be taken into account to increase their effectiveness when designing the target interventions to encourage a physically active lifestyle in this population.

Making it transparent: A worked example of articulating programme theory for a digital health application using Intervention Mapping

Objective

Digital health interventions for behaviour change are usually complex interventions, and intervention developers should 'articulate programme theory', that is, they should offer detailed descriptions of individual intervention components and their proposed mechanisms of action. However, such detailed descriptions often remain lacking. The objective of this work was to provide a conceptual case study with an applied example of 'articulating programme theory' for a newly developed digital health intervention.

Methods

Intervention Mapping methodology was applied to arrive at a detailed description of programme theory for a newly developed digital health intervention that aims to support cardiac rehabilitation patients in establishing heart-healthy physical activity habits. Based on a Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) logic model of the problem, a logic model of change was developed. The proposed mechanisms of action were visualised in an acyclic behaviour change diagram.

Results

Programme theory for this digital health intervention includes 4 sub-behaviours of the main target behaviour (i.e. habitual heart-healthy physical activity), 8 personal determinants and 12 change objectives (i.e. changes needed at the determinant level to achieve the sub-behaviours). These are linked to 12 distinct features of the digital health intervention and 12 underlying behaviour change methods.

Conclusions

This case study offers a worked example of articulating programme theory for a digital health intervention using Intervention Mapping. Intervention developers and researchers may draw on this example to replicate the method, or to reflect on most suitable approaches for their own behaviour change interventions.

The effect of a multi-component behavior change technique intervention on medication adherence among individuals on primary prevention statin therapy: a dose-finding protocol

BACKGROUND

In the USA, the primary cause of death and morbidity continues to be cardiovascular disease (CVD). Numerous trials have shown that statin medication reduces the likelihood of CVD events; it is a cornerstone of CVD prevention. However, studies have also indicated that up to 60% of the estimated 26.8 million Americans prescribed primary prevention statin treatment are nonadherent during the first year. Multi-component behavioral change technique (BCT) therapies have shown moderate promise in improving medication adherence as well as other positive health behaviors (such as physical activity). However, no research has looked at the duration of multi-component BCT intervention needed to result in a clinically significant improvement in statin adherence behaviors. This study aims to determine the necessary dose of a multi-component BCT intervention (defined as duration in weeks) to promote adherence to statin medication among those on primary prevention statin treatment by utilizing the modified time-to-event continuous reassessment method (TiTE-CRM).

METHODS AND DESIGN

The study will utilize the modified TiTE-CRM in 42 participants, recruited in 14 cohorts of 3 participants each. The goal of this analysis is to identify the minimum effective dose (MED) of a multi-behavior change technique (BCT) intervention required to increase adherence to statins by 20% between baseline and follow-up periods. Using the TiTE-CRM method, the dose of the behavior intervention in weeks will be assigned to each cohort based on the performance of the prior cohort. At the end of the study, the intervention dose that has been found to be associated with a 20% increase in statin adherence among 80% of participants assigned to that dose will be identified as the MED.

DISCUSSION

If successful, the current trial will provide additional guidance to researchers and clinicians seeking to increase statin medication adherence using a BCT intervention by identifying the dose (i.e., the duration) of an intervention required to meaningfully increase adherence.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05273736. Registered on March 10, 2022. https://www.

CLINICALTRIALS

gov/ct2/show/NCT05273736.

The impact of patient education on knowledge, attitudes, and cardiac rehabilitation attendance among patients with coronary artery disease

OBJECTIVE

Patient education (PE) delivered during exercise-based cardiac rehabilitation (CR) aims to promote health behaviour change, including attendance at CR exercise sessions, by imparting knowledge about coronary artery disease (CAD) and improving CR-related attitudes. This study evaluated the impact of PE on aspects of patient motivation (i.e., CAD-related knowledge, attitudes towards CR) and exercise session attendance.

METHODS

Adults with CAD referred to a 12-week CR program were recruited. CAD knowledge, perceived necessity/suitability of CR, exercise concerns, and barriers to CR were assessed pre/post-PE, and at 12-week follow-up. CR exercise attendance was obtained by chart review.

RESULTS

Among 90 patients (60 ± 10 years; 88% men), CAD knowledge and perceived necessity of CR improved pre- to post-PE; gains persisted at 12-weeks. Stronger pre-CR intentions to attend exercise sessions predicted greater attendance. Greater knowledge gains did not predict improvements in CR attitudes or exercise attendance.

CONCLUSION

Whereas PE may be useful for improving knowledge and attitudes regarding CAD self-management, more formative research is needed to determine whether PE can promote CR attendance.

PRACTICE IMPLICATIONS

Cardiac PE programs may be more successful in promoting exercise attendance if they target patients' behavioural intentions to attend and attitudes toward CR, rather than focussing exclusively on imparting knowledge.

Monitoring of risk factors of cardiovascular diseases in adult men

The study aims to evaluate the monitoring of risk factors of cardiovascular diseases in the young population, which significantly contribute to the origin and development of cardiovascular diseases, such as peripheral artery diseases, atherosclerosis, stroke, and others. We focused on a group of young adult men (n = 110) in the age range of 30 to 50 years, which we selected from the database of 800 patients hospitalized in the Cardio Center in Nitra during 2010 – 2020. When evaluating the influence of meat products consumption frequency on biochemical parameters and BMI, we recorded a statistically significant effect at the level of p <0.05 in the evaluation of meat products such as salami, brawn, and sausages. When consuming sausages, BMI values also increased with increasing frequency of consumption. The effect on BMI was also observed when eating salami, between consuming 1 – 2 times a week and not at all. We recorded a statistically significant effect (p <0.05) in frequent consumption of brawn (1 – 2 weeks) on the level of HDL cholesterol. The most frequent fish consumption was 1 – 2 times a month for freshwater (51.8%) and marine fish (56.3%). Daily consumption of fruit was reported in 64.6% of men, while daily consumption of vegetables was recorded in only 44.6% of men. In the lifestyle assessment, we focused on probands' time spent on physical activity. Only 35.5% of men stated that they spend more than an hour a day on physical activity. 40% of men from the surveyed respondents were active smokers. Another risk factor for cardiovascular diseases is stress, which significantly affected up to 42.7% of respondents. Nutrition and lifestyle play an important role in the prevention of cardiovascular diseases, which significantly affect blood lipid parameters, vascular endothelial elasticity, and factors determining the etiopathogenesis of cardiovascular diseases.

A Critical Review on New Approaches for Chronic Disease Prevention in Brazil and Canada: From Wholistic Dietary Guidelines to Physical Activity Security

In light of new evidence on the prevention of chronic diseases and the elevated rates of overweight and obesity in Brazil and Canada, this critical review aims to interpret and synthesize current aspects regarding dietary and physical activity initiatives in both countries and make future recommendations. The pioneering work presented in the last Brazilian dietary guidelines has been called a model that can be applied globally, given its conceptualization of healthy eating that translates easily to practical guidance. The new Canadian Food Guide has incorporated similar aspects, also putting the country as a leader in dietary guidance. With these new recommendations, citizens in both Brazil and Canada have access to impactful evidence-informed nutritional guidelines. Both documents propose eating patterns that focus not only on health benefits, such as chronic disease prevention, but also incorporate well-being concerning cultural, economic, sociodemographic, biological, and ecological dimensions. A similar approach is required for physical activity to allow individuals to have attainable health and life goals and thereby fully enjoy their lives, regardless of geographical location, health status, and socioeconomic condition, a concept recently described as physical activity security. The wholistic dietary guidelines from both countries represent a change in paradigm in public health. Likewise, national evidence-based policies are warranted to reduce disparities in physical activity, allowing healthier and more active lifestyles for everyone.