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Case nursing researchers seek to get exercise-averse cardiac patients back on the treadmill

Photo: Getting back on the bike to save your heartA four-year study released last year by Case Western Reserve University’s Frances Payne Bolton School of Nursing showed that despite a concerted effort to teach the importance of exercise to patients who have survived severe heart attacks, 14 percent of study participants never exercised once. Researchers also found that only 30 to 60 percent of individuals are still exercising six months after the completion of a cardiac rehabilitation program.

Now, those same researchers are introducing into clinical trial a program to get those patients back on the treadmill or in the pool – and keep them moving.

Led by principal investigator Shirley M. Moore, a professor of nursing and associate dean of research at the Bolton School, the research team is involved in a second phase study to test an intervention to increase an individual’s exercise maintenance following a cardiac rehabilitation program. Moore also was lead investigator on the original study.

CHANGE LogoE-CHANGE Logo“Change Habits by Applying New Goals and Experiences” (CHANGE) is a health behavior change program to assist cardiac patients in implementing the lifestyle changes needed for long-term exercise. Moore is also testing an electronic version of CHANGE, called E-CHANGE, a computer-based intervention program.

Both projects are funded by the National Institute of Nursing Research of the National Institutes of Health.

CHANGE is a person-to-person intervention program that consists of five sessions with small groups of five to eight participants taught by an intervention nurse with a background in cardiac rehabilitation. The intervention incorporates counseling and behavior modification sessions in which participants are taught self-efficacy enhancement, problem-solving skills and relapse prevention strategies.

Image: E-CHANGE collaborationE-CHANGE, or Electronically Change Habits by Applying New Goals and Experiences, is a sequence of nurse-led activities designed to increase cardiac patients’ expectancy-value, self-efficacy, problem-solving and relapse prevention skills regarding exercise maintenance.

“E-CHANGE tests the intervention of our CHANGE program and puts it into electronic form,” said Moore. “This project is a collaboration to combine expertise in nursing informatics, human factors in computer applications, health behavior change and exercise science.”

Moore’s original study followed 90 patients who had experienced a cardiac event, had completed a 12-week cardiac rehabilitation exercise conditioning program, and had been given an exercise regimen to follow at least 30 minutes a day on most, if not all, days of the week for six months. Participants were monitored to determine the frequency of exercise, the number of minutes spent exercising each day, and the intensity (measured by heart rate) during their effort.

The results showed that 14 percent of individuals never exercised once following the initial rehabilitation program, and after six months, 28 percent were not exercising at all. Even more discouraging to Moore and her research team was the finding that those who did exercise, did so fewer than two times a week and at an intensity level lower than that required to achieve the desired cardio-protective effects. Also, the researchers found that women exercised significantly less often and at a less desired intensity than men.

With E-CHANGE, specially designed behavior change programs will be developed for patients to use on computer terminals in their homes. They will be tracked and Case researchers will provide feedback on their exercise behavior and provide a connection to a nurse “coach.”

Forty individuals who are recovering from a myocardial infarction, coronary artery bypass graft surgery, or angioplasty and participating in Phase II cardiac rehabilitation will be randomly assigned to the E-CHANGE intervention or the usual care rehabilitation program, says Moore.

Measures of exercise maintenance (number of minutes exercised over the study period, number of minutes exercised within the target heart rate zone and mean number of exercise sessions per week) will be taken for six months following completion of cardiac rehabilitation. Exercise will be measured using heart rate wristwatch monitors and exercise diaries. The effect of the patient’s age, body fat, angina, muscle or joint pain, depression, adherence to other cardiac risk factor modification behaviors and social support will be assessed. Problem-solving skills, motivation, health beliefs about exercise, and exercise self-efficacy will also be assessed. Measures will be taken at the beginning of the intervention, and then at two months and six months following cardiac rehabilitation.

“Men and women who have survived severe heart attacks and are in rehabilitation are taught that exercising in their target heart rate is safe and will reduce their chances of another cardiac event while improving their heart function,” Moore said. “Our goal is to make exercise second nature to them. Exercise is something they shouldn’t live without.”


About Case Western Reserve University

Case is among the nation's leading research institutions. Founded in 1826 and shaped by the unique merger of the Case Institute of Technology and Western Reserve University, Case is distinguished by its strengths in education, research, service, and experiential learning. Located in Cleveland, Case offers nationally recognized programs in the Arts and Sciences, Dental Medicine, Engineering, Law, Management, Medicine, Nursing, and Social Work.