The Evaluation of a Brief Motivational Intervention to Promote Intention to Participate in Cardiac Rehabilitation: A Randomized Controlled Trial

Objectives Cardiac rehabilitation (CR) is an effective treatment for cardiovascular disease, yet many referred patients do not participate. Motivational interviewing could be beneficial in this context, but efficacy with prospective CR patients has not been examined. This study investigated the impact of motivational interviewing on intention to participate in CR. Methods Individuals recovering from acute coronary syndrome (n = 96) were randomized to motivational interviewing or usual care, following CR referral but before CR enrollment. The primary outcome was intention to attend CR. Secondary outcomes included CR beliefs, barriers, self-efficacy, illness perception, social support, intervention acceptability, and CR participation. Results Compared to those in usual care, patients who received the motivational intervention reported higher intention to attend CR (p = .001), viewed CR as more necessary (p = .036), had fewer concerns about exercise (p = .011), and attended more exercise sessions (p = .008). There was an indirect effect of the intervention on CR enrollment (b = 0.45, 95% CI 0.04–1.18) and CR adherence (b = 2.59, 95% CI 0.95–5.03) via higher levels of intention. Overall, patients reported high intention to attend CR (M = 6.20/7.00, SD = 1.67), most (85%) enrolled, and they attended an average of 65% of scheduled CR sessions. Conclusion A single collaborative conversation about CR can increase both intention to attend CR and actual program adherence. Practice Implications The findings will inform future efforts to optimize behavioral interventions to enhance CR participation

Assessing the Value of Moving More-The Integral Role of Qualified Health Professionals

Being physically active or, in a broader sense, simply moving more throughout each day is one of the most important components of an individual's health plan. In conjunction with regular exercise training, taking more steps in a day and sitting less are also important components of one's movement portfolio. Given this priority, health care professionals must develop enhanced skills for prescribing and guiding individualized movement programs for all their patients. An important component of a health care professional's ability to prescribe movement as medicine is competency in assessing an individual's risk for untoward events if physical exertion was increased. The ability to appropriately assess one's risk before advising an individual to move more is integral to clinical decision-making related to subsequent testing if needed, exercise prescription, and level of supervision with exercise training. At present, there is a lack of clarity pertaining to how a health care professional should go about assessing an individual's readiness to move more on a daily basis in a safe manner. Therefore, this perspectives article clarifies key issues related to prescribing movement as medicine and presents a new process for clinical assessment before prescribing an individualized movement program

Design and Evaluation of a Brief Motivational Intervention to Promote Enrolment in Outpatient Cardiac Rehabilitation: A Mixed-Methods Feasibility Study

Objective: Patients who are referred to exercise-based cardiac rehabilitation (CR) following an acute coronary syndrome (ACS) event stand to benefit from a range of positive CR-related outcomes, including reduced morbidity and mortality. Yet, only 19-34% of eligible patients participate in CR in the United States and Canada. Motivational interviewing could be useful for encouraging CR enrolment, but empirical support does not exist. Research that examines patients’ decision-making about CR enrolment is needed to inform effective motivational intervention in this context. Methods: A two-part study was conducted to design and evaluate a brief motivational intervention to enhance intention to attend a 12-week CR program. Part 1 involved a qualitative examination of decision-making about CR enrolment using semi-structured interviews with ACS patients following CR referral but prior to enrolment (n = 14). A brief motivational intervention was subsequently designed to target obstacles to CR identified by patients in Part 1. Part 2 involved a two-group randomized controlled trial to examine preliminary efficacy and mechanisms of the intervention, using a usual care control group (n = 96). The primary outcome was intention to attend CR. Secondary outcomes included CR beliefs, CR barriers, self-efficacy, illness perception, social support, CR enrolment/adherence, and intervention acceptability. Results: Thematic analysis of qualitative data in Part 1 suggested the intervention should aim to bolster anticipated benefits of CR; assist patients in overcoming concerns about exercise, transportation, finances, and scheduling; and address contextual variables such as emotional distress and knowledge gaps. Randomization to the motivational intervention was associated with greater intention to attend CR (p = .001), greater perceived necessity of CR (p = .036), lower exercise concerns (p = .011), and higher CR adherence (p = .008), compared to usual care. Conclusions: Results provide preliminary evidence for the efficacy of a brief motivational intervention to enhance intention to attend CR. Implementing strategies that enhance the perceived necessity of CR and reduce exercise concerns may help improve adherence to CR following an ACS event. This body of work will help optimize efforts to promote participation in an under-utilized, cost-effective program that significantly improves ACS outcomes

The impact of mindfulness-based interventions on symptom burden, positive psychological outcomes, and biomarkers in cancer patients

Research on the use of mindfulness-based stress reduction and related mindfulness-based interventions (MBIs) in cancer care has proliferated over the past decade. MBIs have aimed to facilitate physical and emotional adjustment to life with cancer through the cultivation and practice of mindfulness (ie, purposeful, nonjudgmental, moment-to-moment awareness). This descriptive review highlights three categories of outcomes that have been evaluated in MBI research with cancer patients - namely, symptom reduction, positive psychological growth, and biological outcomes. We also examine the clinical relevance of each targeted outcome, while describing recently published original studies to highlight novel applications of MBIs tailored to individuals with cancer. Accumulating evidence suggests that participation in a MBI contributes to reductions in psychological distress, sleep disturbance, and fatigue, and promotes personal growth in areas such as quality of life and spirituality. MBIs may also influence markers of immune function, hypothalamic-pituitary-adrenal axis regulation, and autonomic nervous system activity, though it remains unclear whether these biological changes translate to clinically important health benefits. We conclude by discussing methodological limitations of the extant literature, and implications of matching MBIs to the needs and preferences of cancer patients. Overall, the growing popularity of MBIs in cancer care must be balanced against scientific evidence for their impact on specific clinical outcomes

The role of maternal cardiac vagal control in the association between depressive symptoms and gestational hypertension.

Author's accepted manuscript deposited according to Elsevier sharing policies: http://www.elsevier.com/about/company-information/policies/policy-faq (December 1st, 2016)Reduced cardiac vagal control, indexed by relatively lower high-frequency heart rate variability (HF-HRV), is implicated in depressed mood and hypertensive disorders among non-pregnant adults whereas research in pregnancy is limited. This study examined whether maternal HF-HRV during pregnancy mediates the association between depressed mood and gestational hypertension. Depressive symptoms (Edinburgh Depression Scale) and HF-HRV were measured during early (M = 14.9 weeks) and late (M = 32.4 weeks) pregnancy in 287 women. Gestational hypertension was determined by chart review. Depressive symptoms were associated with less HF-HRV (b = -0.02, p =.001). There was an indirect effect of depressed mood on gestational hypertension through late pregnancy HF-HRV (b = 0.04, 95% CI 0.0038, 0.1028) after accounting for heart rate. These findings suggest cardiac vagal control is a possible pathway through which prenatal depressed mood is associated with gestational hypertension, though causal ordering remains uncertain.Ye

Factors Associated With Attendance at a 1-yr Post–Cardiac Rehabilitation Risk Factor Check

Purpose: Patients with coronary artery disease (CAD) often fail to maintain secondary prevention gains after completing cardiac rehabilitation (CR). Follow-up appointments aimed at assessing cardiac status and encouraging maintenance of health behaviors after CR completion are generally offered, but not well-attended. This study explored patient characteristics and barriers associated with non-attendance at a one-year follow-up visit following CR completion. Methods: Forty-five patients with CAD who completed a 12-week outpatient CR program but did not attend the one-year follow-up appointment were included. Participants responded to a survey consisting of open-ended questions about follow-up attendance, a modified version of the Cardiac Rehabilitation Barriers Scale, and self-report items regarding current health practices and perceived strength of recommendation to attend. Thematic analysis was used to derive categories from open-ended questionnaire responses. Linear regression was used to assess characteristics associated with appointment attendance barriers. Results: Barrier themes were: 1) lack of awareness, 2) perception of appointment as unnecessary, 3) practical or scheduling issues, 4) comorbid health issues, and 5) anticipated an unpleasant experience at the appointment. Greater self-reported barriers (M=1.97/5.00 ± 0.57) were significantly associated with lower perceived strength of recommendation to attend the follow-up appointment (M=2.82/5.00 ± 1.45), p=.005. Conclusions: Providing a stronger recommendation to attend, enhancing patient awareness, highlighting potential benefits, and supporting self-efficacy might increase one-year follow-up appointment attendance and, in turn, support long-term adherence to cardiovascular risk reduction behaviors

Applying Precision Medicine to Healthy Living for the Prevention and Treatment of Cardiovascular Disease

Healthy living medicine (HLM) is an emerging concept that recognizes the importance of: (1) Moving more and sitting less; (2) Consuming a healthy diet at the appropriate caloric load; (3) Maintaining a healthy body weight; and (4) Not smoking. Suffice to say, HLM should be practiced by all health professionals, prescribing a personalized healthy living polypill to individuals under their care while titrating the dosage for optimal adherence and therapeutic efficacy. Traditionally, HLM, particularly when practiced in the context of physical activity and diet, is commonly viewed as an all-or-none and one-size-fits-all paradigm. As an example, there has been a dichotomous perception to physical activity messaging, where achieving anything less than 150 minutes of moderate intensity physical activity per day is not beneficial. The same holds true for the all-or-none perception of 5 servings of fruits and vegetables per day; anything less is not beneficial. While these are certainly desirable targets, healthy living practices at levels below current guidelines portend significant health benefits. Precision medicine is defined as "an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person." Much of the focus in precision medicine has been directed toward genomics and only recently has the influence of environment and lifestyle been considered. This review will highlight the importance of HLM directed toward the prevention and treatment of chronic diseases in the context of precision medicine

An evaluation of the role of the exercise training dose for changes in exercise capacity following a standard cardiac rehabilitation program.

BACKGROUND To retrospectively characterize and compare the dose of exercise training (ET) within a large cohort of patients demonstrating different levels of improvement in exercise capacity following a cardiac rehabilitation (CR) program. METHODS A total of 2310 patients who completed a 12-week, center-based, guidelines-informed CR program between January 2018 and December 2019 were included in the analysis. Peak metabolic equivalents (METpeak) were determined pre- and post-CR during which total duration (ET time) and intensity [percent of heart rate peak (%HRpeak)] of supervised ET were also obtained. Training responsiveness was quantified on the basis of changes in METpeak from pre- to post-CR. A cluster analysis was performed to identity clusters demonstrating discrete levels of responsiveness (i.e., negative, low, moderate, high, and very-high). These were compared for several baseline and ET-derived variables which were also included in a multivariable linear regression model. RESULTS At pre-CR, baseline METpeak was progressively lower with greater training responsiveness (F(4,2305) = 44.2, P < 0.01, η2p = 0.71). Likewise, average training duration (F(4,2305) = 10.7 P < 0.01, η2p = 0.02) and %HRpeak (F(4,2305) = 25.1 P < 0.01, η2p = 0.042) quantified during onsite ET sessions were progressively greater with greater training responsiveness. The multivariable linear regression model confirmed that baseline METpeak, training duration and intensity during ET, BMI, and age (P < 0.001) were significant predictors of METpeak post-CR. CONCLUSIONS Along with baseline METpeak, delta BMI, and age, the dose of ET (i.e., training duration and intensity) predicts METpeak at the conclusion of CR. A re-evaluation of current approaches for exercise intensity prescription is recommended to extend the benefits of completing CR to all patients

sj-sav-3-hpq-10.1177_13591053221124748 – Supplemental material for Health psychology and behavioral medicine researchers in Canada: An environmental scan

Supplemental material, sj-sav-3-hpq-10.1177_13591053221124748 for Health psychology and behavioral medicine researchers in Canada: An environmental scan by Kharah M Ross, Ryan Hoggan, Tavis S Campbell, Jennifer Gordon, Vincent Gosselin Boucher, Eric Kim, Kim Lavoie, Wolfgang Linden, Joshua A Rash, Codie R Rouleau, Sherry H Stewart and Justin Presseau in Journal of Health Psychology</p