Cardiovascular disease is the leading cause of death for U.S. adults. It adds greater than $100 billion to U.S. health care costs annually. Rates of morbidity, mortality, and economic burden of the disease could be dramatically reduced with improvements in sedentary behaviors among adults with coronary artery disease (CAD). A regular commitment to moderate physical activity can reduce ischemic heart events up to 50%. Although the benefits of physical activity are well-known for individuals with coronary artery disease, an estimated 70% of this population remains relatively sedentary. Hospital-based cardiac rehabilitation programs are the single secondary prevention option offered to improve physical activity habits in persons with CAD. Although effective, cardiac rehabilitation is inaccessible for the majority of CAD sufferers and is offered only after an acute cardiac event. Different from rehabilitation, prehabilitation (prehab) programs use physical activity as a means to deter a worsening condition or prevent injury before an acute event occurs. These programs have proved successful in other areas of medicine but there are currently no such secondary prevention programs available for stable persons with CAD in the U.S. A home-based prehab program could help adults with CAD establish improved physical activity habits and circumvent many of the barriers associated with admission and attendance of a hospital-based cardiac rehabilitation program. Researchers have indicated that self-efficacy is key to initiation and sustentation of a regular physical activity habit, regardless of the physical activity program that one attends. These habits are more likely to last when participants receive self-efficacy based support for an average of 66 days. The purpose of this study was to determine if a nurse-practitioner-led, home-based, prehab program could assist adults with CAD to improve and maintain increased physical activity habits and levels of self-efficacy for physical activity. The five primary facilitators of self-efficacy were used to devise a 10-week prehab program. A convenience sample of 54 adults with diagnosed CAD was recruited from cardiology practices in St. Johns County, Florida. The research population was 68.5% (n=37) male, 88.9% (n=48) Caucasian, and 74% (n=40) married with a mean age of 68.57 years. Participants attended a 90-minute prehab class which offered health education and group discussion of barriers and goals for regular physical activity. Following the class, participants were contacted weekly for 10-weeks to discuss goal progress, assist in circumventing barriers, and revise physical activity goals as needed. After the 10-week call period, participants were contacted 30-days later to assess for physical activity habit maintenance and any sustained benefit in self-efficacy for physical activity. Self-efficacy for exercise was measured before the prehab class, after the prehab class, and after the 10-week intervention period using the Short Self-Efficacy Expectations scale (SSEE), Multidimensional Outcomes Expectations for Exercise Scale (MOEES), and the Barriers Self-Efficacy Scale (BARSE). All baseline measures of self-efficacy (MOEES, BARSE, SSEE) improved significantly immediately following the prehab class. Baseline physical outcome expectations of the MOEES (m=21.87, sd=4.67), self-evaluative outcome expectations of the MOEES (m=16.70, sd=4.15) and SSEE (m=12.75, sd=4.02) remained significantly improved after the 10-week intervention period (p<.05). At the 10-week assessment, mean significant self-efficacy scores were 24.39 (sd=1.26, p<.01) for physical outcome expectations, 18.39 (sd=2.27, p<.02) for self-evaluative outcome expectations, and 15.06, (sd=3.25, p<.001) for SSEE. The SSEE was reassessed 30-days after the study and remained significantly improved compared to baseline (m=15.65, sd=3.42, p<.01). Qualitative data collection coincided with the quantitative self-efficacy findings. Participants reported satisfaction with physical activity goal attainment and increased confidence to continue with a regular physical activity plan. The Godin Leisure-Time Exercise Questionnaire (GLTEQ) was used to assess activity levels at baseline, during each weekly phone call, at the end of 10-weeks, and 30-days after the study. Repeated-measures ANOVA (F (2,90) = 21.86, p<.001) revealed that participant's baseline physical activity volume measured by GLTEQ (m=18.39, sd= 16.93) improved significantly after 10 weeks in the prehab study (m=41.10, sd=24.11, p<.001) and remained significantly improved when re-measured 30-days after the study (m=39.02, sd=21.87, p<.001). Qualitative data concurred with quantitative data with participants reporting physical activity habit formation and maintenance of self-regulatory skills. Qualitative data also demonstrated that participants in prehab experienced very similar facilitators and barriers compared to other adults with CAD attempting an exercise program. In summary, the prehab study findings coincided with other research findings in this area. Self-efficacy based support can assist individuals with CAD to improve and maintain physical activity habits. The ease of the intervention likely contributed to lower cost and attrition rates (7%) compared to hospital-based cardiac rehabilitation programs. Although more research is needed, study findings suggest that a nurse-practitioner-led, home-based program could be a viable secondary prevention strategy for stable adults with CAD. This should be considered for the future given that even modest improvements in physical activity can substantially reduce all-cause mortality in this population.
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Sole, Mary Lou
Doctor of Philosophy (Ph.D.)
College of Nursing
Length of Campus-only Access
Doctoral Dissertation (Open Access)
Russell, Billie, "Prehabilitation (Prehab): Prevention in Motion" (2016). Electronic Theses and Dissertations, 2004-2019. 5188.