Maintenance Cardiac Rehabilitation Exercise Adherence: Effects of Task and Self-Regulatory Self-Efficacy

The purpose of this study was to examine whether self-efficacy functions as a determinant and outcome of maintenance cardiac rehabilitation exercise adherence. Specifically, the purpose of this prospective observational study was to examine which types of self-efficacy–task or self-regulatory–predicted maintenance exercise attendance. In addition, the relative contribution of self-efficacy to the prediction of perceived exercise intensity was examined. Self-regulatory self-efficacy was operationalized as confidence to schedule and manage exercise sessions, while task self-efficacy concerned confidence to perform aspects of the exercise session and to walk for increasing durations. Sixty-four maintenance cardiac rehabilitation participants completed social cognitive measures and provided attendance data for 4 weeks prior to and 4 weeks following assessment. Results indicated that scheduling and walking self-efficacy significantly predicted cardiac rehabilitation exercise attendance. Task self-efficacy was the best predictor of perceived exercise intensity. Past exercise attendance significantly predicted all 3 dimensions of self-efficacy. Findings are discussed with respect to self-efficacy theory and applications to the maintenance of cardiac rehabilitation exercise adherence.     

Self-Efficacy as a Mediator of the Relationship Between Causal Attributions and Exercise Behavior

The primary purposes of this study were to examine whether the attribution–intention link was mediated by self-efficacy and whether the attribution–behavior link was mediated by self-efficacy. As a secondary purpose, we examined whether the attribution–behavior link was mediated by exercise intentions. These relationships were tested prospectively at multiple time points. Participants were 260 adult exercisers ( M age=32 years) enrolled in 12 weeks of structured exercise classes. Social cognitive measures were assessed at early and midprogram; attendance was tracked for the first and second half of the program. Hierarchical multiple regression procedures indicated support for self-efficacy as a mediator of the relationship between attributions and behavior. Secondary analyses revealed support for intention as a mediator of the attribution–behavior relationship. Finally, additive relationships in support of social cognitive theory also were detected. The attribution/self-efficacy/behavior link is important for adherence interventions and should be investigated further in both asymptomatic and symptomatic populations.     

Self-Efficacy Relationships With Affective and Exertion Responses to Exercise1

This study examined the relationship of preexisting efficacy for exercise with perceptions of effort expenditure and in-task affect during exercise testing. Subjects comprised sedentary, middle-aged adults participating in a submaxi-mal cycle ergometer-graded exercise test. Perceptions of efficacy were assessed prior to and following exercise testing while perceptions of effort expenditure and in-task affect were assessed at 70% of predicted maxim heart rate. Highly efficacious subjects had lower perceptions of effort expenditure and reported more positive affect during exercise than did their less efficacious counterparts. Affective responses during exercise were in turn significant predictors of posttest self-efficacy. These results are discussed in regard to the importance of examining the role of personal efficacy in the formation of exercise-related affect and affective responses as sources of efficacy or competence information in exercise.     

Pet Ownership Predicts Adherence to Cardiovascular Rehabilitation1

This experiment examined the effects of pet ownership and potential mediating (e.g., social support) and moderating variables (e.g., gender, personality, pet attachment) on completion of a 12‐week cardiac rehabilitation program. This experiment assessed pet ownership, personality, and psychosocial variables at the beginning of the program and followed participants through to completion. Results showed that pet owners (96.5%) were significantly more likely to complete cardiac rehabilitation compared with non‐owners (79.2%). Covariance analyses ruled out several alternative explanations for the results, including social support, personality variables, personal efficacy, and pet attachment. Results suggest that having a pet may facilitate rehabilitation and that further research is needed to understand how having a pet or being a pet owner improves health outcomes.     

The Relationship Between Goal Orientation and Self-Efficacy for Exercise

This study examined exercisers' motivational profiles and investigated whether different combinations of task and ego orientation would reflect different levels of coping and task self-efficacy. Male ( n = 106) and female ( n = 174) exercisers were administered an exercise version of the Task and Ego Orientation in Sport Questionnaire (Duda & Nicholls, 1992) and an instrument measuring coping and task self-efficacy. The results of a K-means cluster analysis on the questionnaire scores resulted in a 5-cluster solution that maximized between-group differences and minimized within-group differences. A MANOVA indicated that the different cluster groups could be distinguished by their coping and task self-efficacy. More specifically, exercisers with high levels of task orientation, regardless of their corresponding levels of ego orientation, were characterized by having higher levels of self-efficacy than exercisers with low levels of task orientation combined with low to high levels of ego orientation.     

Motivational Readiness,Self-Efficacy and Decision-Making for Exercise1

Exercise has important health benefits, but a large proportion of the population is physically inactive. We examined the prevalence of stages of readiness to exercise and their relationship to self-efficacy and to the costs and benefits of exercising in samples of 1093 employees in and around Providence, Rhode Island, and 801 employees in Adelaide, Australia. In both samples, 40.6% of respondents had not yet begun to take action (not thinking about starting to exercise or thinking about it but not doing it), while 59.4% were at some phase of action (exercising some, starting to exercise regularly, exercising regularly). Scores on self-efficacy items and cost-and-benefit items significantly differentiated employees at extreme stages. In contrast with those who exercised regularly, employees who had not yet begun to exercise had little confidence in their ability to exercise and saw exercising as having nearly as many costs as it had benefits. There is the potential to enhance the impact of exercise interventions by targeting them so as to address factors related to these different stages of readiness to exercise.     

Relation of Self-Efficacy to Reported Pain and Pain Medication Usage During Labor

We studied the relationship of self-efficacy to reported labor pain and pain medication usage among 43 women. Self-efficacy ratings were judgments of confidence regarding successful completion of tasks involved in labor and delivery (e.g., doing breathing exercises) and in overcoming barriers (e.g., nonsupportive partner). Multiple regression analyses revealed that self-efficacy significantly contributed to predicting labor pain beyond other relevant variables (e.g., age, amount of menstrual pain), with barrier self-efficacy the strongest predictor. Results are discussed in the context of increasing women's confidence in overcoming barriers by incorporating relevant interventions in childbirth education.     

The Influence of General and Exercise Specific Social Support on Self‐Efficacy for Overcoming Barriers to Cardiac Rehabilitation1

Self‐efficacy (SE) for overcoming barriers to exercise is key to continued exercise behavior in cardiac rehabilitation (CR). This study examined factors influencing patients' SE for overcoming barriers to exercise in CR. It was hypothesized that stress after a cardiac event would have a negative impact on SE, but that social support would be related to less stress and more SE. Measures of SE for overcoming barriers to exercise in CR, perceived stress, general forms of social support, and sources of support for exercise were completed by 459 men and 138 women upon entry into CR. Structural equation modeling revealed that general support was related to less stress and more support for exercise, which were both related to increased SE.     

Self-Efficacy,Perceptions of Success,and Intrinsic Motivation for Exercise1

A number of investigators have attempted to identify the determinants of continued participation in exercise regimens. Within a social cognitive framework, the present study examined the relationships among self-efficacy cognitions, perceptions of success, and multidimensional intrinsic motivation in the exercise domain. Multivariate analyses of variance indicated that highly efficacious individuals were more intrinsically motivated toward aerobic dance than were their less efficacious counterparts. However, multiple regression analyses revealed both perceptions of success and self-efficacy to account for significant variance in intrinsic motivation at both the composite and dimensional levels. Moreover, perceptions of success were considerably stronger predictors than were efficacy cognitions. The results are discussed in terms of the need for multiple measures of perceived success, the employment of longitudinal designs to determine the direction of causality among these variables, and possible implications for adherence issues.     

Effects of a Self-Efficacy Intervention on Exercise: The Moderating Role of Diabetes and Cardiovascular Diseases

The paper examines the influence of a brief tailored intervention on exercise levels and self-efficacy beliefs in the context of participants' health status. We hypothesised that the effects of a self-efficacy intervention targeting more frequent exercise would be larger among people with diabetes or cardiovascular diseases (CVD), compared to the effects of the intervention among individuals without such diseases. The treatment was tailored to participants' self-efficacy and was delivered by e-mail. Data from 187 adults were collected at two measurement points, with a 6-month follow-up. Participants reported their exercise frequency and self-efficacy scores, along with several social-cognitive variables, such as risk perception and intentions. Besides the influence of the intervention on exercise and self-efficacy, we found that the treatment effects were moderated by diabetes or CVD: Participants with those illnesses benefited from the intervention, compared to people without such diagnosis. Among participants with CVD or diabetes the effects of the intervention on behavior were mediated by changes in efficacy beliefs. The results indicated that a parsimonious treatment may contribute to change in exercise over the longer term, in particular among individuals with a disease related to the respective behavior. Changes in behavior may be explained by changes in respective beliefs.     

A Typology of Stages of Adherence to Exercise Behavior: A Cluster Analysis

The aim of the study was to report the results of a cluster analysis of current exercise behavior and of intention to exercise in the next year. A sample of 22,286 individuals was recruited over 4 successive 3-month periods. Each individual was asked to complete a self-administered questionnaire assessing exercise behavior in the last 3 months and intention, attitudes, perceived social norms, and perceived behavioral control with respect to exercising in the coming year. The Beale's pseudo F statistic clearly suggests that there are 4 stages of adherence to exercise: unconcerned, ambivalent, optimistic, and active. Finally, MANOVAs and univariate tests indicated that the 4 clusters differed in attitude, subjective norm, and perceived behavioral control ( p < 0001). These results support the appropriateness of combining intention and behavior to identify stages of adherence to exercise.     

Exercise Stage of Change and Self-Efficacy in Primary Care: Implications for Intervention

Multiple chronic diseases are caused or complicated by a sedentary lifestyle. Thus, an important and challenging application of psychology in clinical settings is changing the behavior of sedentary primary care patients. This study focused on exercise stage of change and self-efficacy in a sample of adult family practice patients recruited while waiting for their scheduled physician appointment. Regarding exercise stage of change, 15% of respondents were in the Precontemplation stage, 26% in the Contemplation stage, 50% in the Preparation stage, 7% in the Action stage, and 13% in the Maintenance stage. Mean self-efficacy scores for exercise were significantly higher among respondents in the Action and Maintenance stages of change. These cross-sectional data are consistent with the hypothesis that movement through the exercise stages of change could be encouraged by clinical interventions that increase exercise self-efficacy. The identification of multiple personal opportunities for increasing exercise self-efficacy may be clinically useful in this context. Recommendations for psychologists in primary care settings in their work with physicians are offered.     

Coping Self-Efficacy as a Mediator of Distress Following a Natural Disaster

Social-cognitive theory and conservation-of-resources theory were utilized to understand individual differences in psychological response to natural disaster. Coping self-efficacy, lost resources, social support, and optimism were assessed along with demographic variables in predicting distress following Hurricane Opal. Participants included 67 residents of Okaloosa County, Florida. Multiple regression analyses indicated that coping self-efficacy was the strongest predictor of general distress and trauma-related distress. Loss of resources and gender were also important predictors of general distress. Path analyses demonstrated that lost resources directly influenced general distress, social support, optimism, and coping self-efficacy. These analyses also indicated that coping self-efficacy perceptions mediated the relationships between loss of resources and trauma-related distress, social support and both trauma and general distress, and optimism and both types of distress. Theoretical implications are discussed.     

Decision Making Versus Decision Implementation: An Action Control Approach to Exercise Adoption and Adherence1

Two studies were conducted, one involving adoption of an exercise program and the other involving adherence to an aerobics exercise program. Consistent with action control theory, it was hypothesized that (a) subjective expected utility theory would predict exercise intentions but not exercise behavior in each study; (b) exercise adoption (Study 1) and attendance at an aerobics class (Study 2) would be predictable from the intentions regarding these behaviors expressed by action-oriented but not state-oriented subjects; and (c) subjects who had engaged in planning in regard to exercising would be more likely to adopt an exercise program (Study 1) and would exercise more frequently (Study 2). The findings provide some support for all three hypotheses. Implications of this research are discussed in regard to the distinction between decision making and decision implementation or action control; the relative usefulness of an action-control versus an expectancy-value approach for behavior involving complex decision implementation over a long period of time; the value of action orientation as a moderator of intention-behavior relationships; and the role of planning in exercise behavior.     

Self-Efficacy and Psychological Well-Being in Cardiac Patients: Moderated Mediation by Affect and Meaning-Making

Abstract

Prior research suggests a potential moderated mediation effect between self-efficacy and psychological well-being. Based on the Meaning Making Model and the Broaden-and-Build Theory, this study examines the relationship between self-efficacy and psychological well-being in the moderated mediation perspective of affect and meaning-making in coronary heart disease patients. The questionnaires measuring self-efficacy, psychological well-being, affect, and meaning-making were used to collect data from one hundred and fifty six patients (73 women and 83 men) who were suffering from coronary heart disease. The patients had a history of coronary heart disease in the previous .1?7.9?years and were aged 47?82. Findings demonstrated that meaning-making mediated the indirect relationship between self-efficacy and psychological well-being. In addition, the moderated mediation effect of positive affect, but not of negative affect was significant. Positive affect moderated the indirect effect between self-efficacy and psychological well-being through meaning-making; the indirect effect was stronger when positive affect was high as opposed to low. The results suggest the interplay of affective and meaning-making processes in the relationship between self-efficacy and well-being.     

Examination of the Relationship Between Self-Efficacy and Affect at Varying Levels of Aerobic Exercise Intensity

Although proposed as an explanation for increases in positive and decreases in negative affect, little evidence supports the notion of a stronger efficacy-affect relationship as acute aerobic exercise intensity increases. Relationships between self-efficacy (SE), positive affect (PA), and negative affect (NA) were examined with respect to 3 randomly assigned conditions: (a) no exercise (control), (b) cycling at 55% VO_2max, and (c) cycling at 70% VO_2max. Twenty subjects (age = 22.6 years; M VO_2max= 47.8 ml · kg⁻¹· min⁻¹) participated in each. Preexercise SE predicted in-task NA and postexercise PA in the 55% condition and postexercise PA in the 70% condition ( ps < .05). Although SE significantly increased from pre- to postexercise, in-task affect failed to predict these increases in SE. These data suggest that in a fit college-aged population, a stronger reciprocal relationship between preexercise SE, in-task affect, and postexercise SE does not exist with increasing levels of exercise intensity. Contrary to self-efficacy theory, no evidence was found for a reciprocal relationship. However, the relationship between efficacy and affect was such that when collapsed across conditions and time, subjects with higher SE scores reported lower NA ( p < .05).     

Social Support in Cardiac Rehabilitation Exercise Maintenance: Associations with Self‐Efficacy and Health‐Related Quality of Life1

This study examined whether cardiac rehabilitation (CR) maintenance exercise participants who were high and moderate in social support (SS) differed in their types of self‐efficacy and health‐related quality of life, and whether SS was related to self‐efficacy. Measures of SS, self‐efficacy (i.e., walking, scheduling, in‐class efficacy), and health‐related quality of life (HRQL) were administered to 64 CR maintenance exercise participants. A one‐way, between‐groups MANOVA was significant (p < .01), indicating that CR participants higher in SS reported significantly greater self‐efficacy and physical HRQL than did their moderate counterparts. In addition, social support predicted significant variance in task self‐efficacy. The findings suggest that differential perceptions of SS are related to differences in walking, in‐class and scheduling self‐efficacy, and the physical component of HRQL among CR exercise maintainers.     

Allegoria: Reading as a Spiritual Exercise

What I wish to argue for in this essay is the theological advantage of turning from the stasis of analogy and symbol (important categories for modernity according to Paul de Man) to the dynamism and semiosis of allegory. The move from static, atemporal discussions of analogy and symbol to allegory will lend itself to a rather different model for the hermeneutical task. It is one that is founded upon narrative, mimesis and participation, and one that presents a more dynamic view of the relationship between revelation (the event of Christ), disclosure (a participation in that event), representation and knowledge. I begin by examining a constellation of inter-related ideas—narrative, participation in an unfolding tradition, knowledge and discipleship—in what is often read as an appeal in the Lukan Preface to historical facts. I then return to Aristotle, to develop the rich association between mimesis and phronesis, rhetoric and knowledge, and to point out the ambiguous nature of analogy to ontology. The practice of living, for Aristotle, I suggest, is allegorical. It is with Gregory of Nyssa's work on allegory that I put together the Lukan emphasis upon participation and discipleship with an account of reading creation allegorically. With Gregory, we learn how to read the world in the light of its Christic watermark and in the power of a Trinitarian desire. In modernity such allegorical reading fell out of favour, and it is a recapitulation of that theologically informed, allegorical reading (rearticulated with the help of the new turn to allegory by poststructuralist thinkers) that this essay finally exhorts.