Self-Efficacy and Adherence to Exercise During and as a Follow-Up to Cardiac Rehabilitation

We examined self-efficacy (task, in-class, and barrier) and physical activity during transition from hospital-based cardiac rehabilitation. Participants ( N  = 50) completed measures of self-efficacy at the midpoint and end of the program. Cardiac rehabilitation adherence was monitored and physical activity assessed by telephone interview 6 and 12 weeks post-program. Mid-program barrier self-efficacy predicted adherence ( R ²_adj. = .15, p  < .05). Barrier self-efficacy at the end of the program predicted physical activity 6 weeks later ( R ² = .11, p  < .05). Task self-efficacy at the end of the program predicted home-based exercise at the 12-week follow-up ( R ² = .10, p  < .05). Results have implications for intervention efforts to ease transition from supervised to independent home-based exercise.     

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.     

Temporal relationships of self-efficacy and social support as predictors of adherence in a 6-month strength-training program for older women.

The present study investigated how self-efficacy and social support predicted adherence to a strength training program for elderly women over two time periods in the initial 6 mo. of the program. Participants were 30 elderly women volunteers aged 75 to 80 who completed measures of barrier self-efficacy and general social support at baseline and 3 mo. later. Social support from the program was also measured at 3 mo. Adherence to the program was measured by attendance. Hierarchical regression equations were utilized to identify the contributions of self-efficacy and social support for adherence at 0 to 3 mo. and 4 to 6 mo. For prediction of the first 3 mo. of adherence, both self-efficacy and social support contributed significant unique variance towards the total explained variance of 36%. For the 4- to 6-mo. period, self-efficacy explained significant (12%) variance in adherence even when controlling for the previous 3-mo. adherence. Inclusion of general social support and social support from the program, however, did not account for significant variance. Researchers must continue to examine self-efficacy and social support in exercise adherence within various time periods among older adults to develop effective intervention strategies.     

Dynamics in Self-Regulation: Plan Execution Self-Efficacy and Mastery of Action Plans

This study investigated whether an individual's plan execution self-efficacy precedes mastery of the respective action plan or vice versa. Study participants were 122 cardiac rehabilitation patients. Plan execution self-efficacy and mastery of a personal action plan on physical activity were assessed each week for 6 weeks after discharge from rehabilitation. Physical exercise was assessed 2 months after discharge. Multilevel cross-lagged panel analyses resulted in a positive effect of mastery on subsequent self-efficacy, whereas self-efficacy did not predict subsequent mastery at the within-person level. At the between-person level, however, self-efficacy predicted following physical exercise. Thus, the predictive power of self-efficacy was developed in relation to mastery of personal action plans over time. Implications for behavior change interventions are discussed.     

Social networks and partner stress as predictors of adherence to medication, rehabilitation attendance, and quality of life following acute coronary syndrome.

OBJECTIVE: This study examined whether social network size and partner stress predicted medication adherence, cardiac rehabilitation attendance, and quality of life 12 months following hospitalization for an acute coronary syndrome (ACS). DESIGN: ACS patients (N = 193, M age = 60.6 years, SD = 11.4 years, 23% female) were recruited shortly following admission to 4 local hospitals. A prospective design was employed with follow-up data collected 12 months following hospital admission. MAIN OUTCOME MEASURES: Data were gathered on social network size and partner stress. The main outcomes assessed at 12 months were medication adherence, cardiac rehabilitation attendance, and quality of life (Short Form 36). RESULTS: Partner stress predicted medication nonadherence, odds ratio: 2.89, (95% CI = 1.21, 6.95). ACS patients with large social networks were more likely to attend rehabilitation, odds ratio: 3.42, (95% CI = 1.42, 8.25). Analyses were adjusted for age, gender, clinical risk scores, readmission/recurrence, and negative affectivity. Both partner stress and smaller social network size were associated with poorer quality of life. CONCLUSION: Social network size and partner stress may partly exert their influence on coronary heart disease morbidity and mortality through recovery behaviors and maintenance of quality of life.     

Attributions for recovery and adherence to rehabilitation following anterior cruciate ligament reconstruction: A prospective analysis

Abstract

The relationship between causal attributions for recovery and adherence was examined in a sample of 80 individuals (25 females and 55 males) undergoing rehabilitation following anterior cruciate ligament reconstruction. Participants estimated their speed of recovery and then rated their open-ended attributions for recovery on the Revised Causal Dimension Scale (McAuley, Duncan and Russell, 1992). Adherence was assessed in terms of attendance at rehabilitation sessions and practitioner ratings for the remainder of the rehabilitation period. Participants who perceived themselves as recovering rapidly attributed their recovery to more stable and personally controllable factors than participants who perceived themselves as recovering slowly. Causal dimension ratings predicted attendance at rehabilitation sessions, but not practitioner ratings of adherence. The results, which further demonstrate the relevance of causal attributions to health behavior, are compared with previous cross-sectional findings.     

Bridging the intention–behaviour gap: Planning,self-efficacy,and action control in the adoption and maintenance of physical exercise

Although some people may develop an intention to change their health behaviour, they might not take any action. This discrepancy has been labelled the “intention–behaviour gap.” Detailed action planning, perceived self-efficacy, and self-regulatory strategies (action control) may mediate between intentions and behaviour. This was examined in a longitudinal sample of 307 cardiac rehabilitation patients who were encouraged to adopt or maintain regular exercise. At the first time point, the predictors of intention and intention itself were assessed. Two months and four months later, the mediators and outcomes were measured. Results confirmed that all the three factors (planning, maintenance self-efficacy, and action control) served to mediate between earlier exercise intentions and later physical activity, each of them making a unique contribution. The results have implications for research on the “intention–behaviour gap,” and indicate that planning, maintenance self-efficacy and action control may be important volitional variables.     

Predicting short and long-term exercise intentions and behaviour in patients with coronary artery disease: A test of protection motivation theory

The purpose of this study was to examine the utility of protection motivation theory (PMT) in the prediction of exercise intentions and behaviour in the year following hospitalisation for coronary artery disease (CAD). Patients with documented CAD (n?=?787), recruited at hospital discharge, completed questionnaires measuring PMT's threat (i.e. perceived severity and vulnerability) and coping (i.e. self-efficacy, response efficacy) appraisal constructs at baseline, 2 and 6 months, and exercise behaviour at baseline, 6 and 12 months post-hospitalisation. Structural equation modelling showed that the PMT model of exercise at 6 months had a good fit with the empirical data. Self-efficacy, response efficacy, and perceived severity predicted exercise intentions, which, in turn predicted exercise behaviour. Overall, the PMT variables accounted for a moderate amount of variance in exercise intentions (23%) and behaviour (20%). In contrast, the PMT model was not reliable for predicting exercise behaviour at 12 months post-hospitalisation. The data provided support for PMT applied to short-term, but not long-term, exercise behaviour among patients with CAD. Health education should concentrate on providing positive coping messages to enhance patients’ confidence regarding exercise and their belief that exercise provides health benefits, as well as realistic information about disease severity.     

Correlates of exercise adherence in an African American church community

This study identified correlates of attendance to a community-based exercise program in an African American church congregation. After medical clearance, 48 participants completed measures of social support, health-related quality of life, depression, exercise self-efficacy, and exercise motivation and then participated in an exercise program for 6 months (attendance rate = 27%). Age, a sense of affiliation as a motivator to exercise, and weekly caloric expenditure derived from yard work were positively associated with program attendance, and full- or part-time employment was negatively associated with attendance. The authors concluded that exercise adherence is a complicated phenomenon that is influenced by a variety of environmental, personal, and social factors. Social factors, in particular, may be important in promoting adherence to an exercise program in African Americans.     

Common and specific process factors in cardiac rehabilitation: independent and interactive effects of the working alliance and self-efficacy.

OBJECTIVE: Therapeutic processes in cardiac rehabilitation programs are virtually unexamined. Models were tested by which changes in the working alliance between patient and staff (agreement on goals/tasks; emotional bond) may affect outcomes in conjunction with changes in patient self-efficacy to change their diets and increase exercise. DESIGN: Cardiac patients (n = 79) participated in a 12-week program, and completed assessments at early, mid, and late treatment. MAIN OUTCOME MEASURES: Changes in cardiac depression, physical health, perceived exertion during exercise, rate/pressure product at submaximal exercise tolerance, weight loss, return to work, total fat intake. RESULTS: Early-treatment changes in agreement on goals/tasks were related to changes in psychosocial factors and perceived exertion during exercise independent of effects of changes in self-efficacy. Early-treatment changes in goals/tasks and self-efficacy interacted to predict changes in cardiorespiratory fitness, weight loss, and return to work such that patients high on both goals/tasks and self-efficacy showed the most gains. CONCLUSION: Sound therapeutic relationships between patients and staff may play an important role in facilitating the achievement of a wide-range of salutary outcomes during cardiac rehabilitation.     

Goal-setting protocol in adherence to exercise by Italian adults

A goal-setting protocol, based on research in goal setting and performance and personal construct theory, was tested for its effect on adherence to a new exercise program. The Goal-setting group (n = 50) had significantly less dropout (30%) than the control group (n = 50) (74%). The Goal-setting group also had significantly better attendance (p<.0001). Suggestions for increasing confidence in findings through further research and practical implications of using the protocol to improve exercise maintenance across settings were discussed.     

Serial Fluctuations in Exercise Behavior as a Function of Social Support and Efficacy Cognitions1

The present study investigated the role of social support provisions and efficacy cognitions in adherence to a prescribed exercise regimen. A generalized estimating equations approach was employed to estimate regression coefficients via an iterative weighted least squares algorithm. Findings indicated that when employed as time-varying covariates, the social provisions of reassurance of worth, attachment, and, to a lesser extent, guidance were significantly associated with intraindividual fluctuations in program adherence. Specifically, individuals with a greater sense of self-worth were more likely to adhere throughout the program, whereas the effects of subject's perceptions of greater attachment, although generally related to sustained adherence, fluctuated over time. Findings also suggest that individuals perceiving higher levels of guidance were less likely to adhere during the early and concluding stages of the exercise program. Although synchronous covariation existed between efficacy cognitions and attendance, self-efficacy was not predictive of intraindividual change in attendance over time. Results are discussed in regard to the importance of self-referent processes and social provisions in exercise adherence, and the utility of the proposed generalized estimating equations approach to the analysis of longitudinal data.     

Self-efficacy and affect responses to Sprint Interval Training

ObjectivesTo examine the influence of efficacious beliefs on affective states, enjoyment, and satisfaction after performing a maximal intensity exercise task (i.e. Sprint Interval Training (SIT).DesignAn experimental design was utilized and participants were randomized to a high self-efficacy feedback (HE), low self-efficacy feedback (LE), or no feedback control condition.MethodsCollege-aged men and women (n = 74) performed four 30-second maximal sprints, interspersed with 4-min breaks. Following each sprint interval, participants received either positive, negative or no feedback and SIT self-efficacy, affective states (i.e., positive well-being, psychological distress, fatigue), heart rate (HR), and ratings of perceived exertion (RPE) were assessed. Upon terminating the exercise session, enjoyment and satisfaction were assessed.ResultsThere was group equivalency in HR and RPE among participants of each group. The HE group had significantly less of a decline in SIT self-efficacy from pre to post SIT than both the LE and control groups, and reported significantly higher levels of exercise enjoyment than the other two groups. In addition, the HE and control groups reported significantly higher satisfaction than the LE group.ConclusionsWe recommend that exercisers receive positive feedback statements while performing SIT to minimize the decrease in SIT self-efficacy and to bolster feelings of enjoyment and satisfaction.     

De l’efficacité d’un « exergame » sur le stress perçu et le sentiment d’auto-efficacité chez un patient atteint de la maladie de Parkinson : résultats d’un protocole à cas unique de type ABAB

IntroductionRehabilitation is of paramount importance in Parkinson's disease because it compensates for deficiencies in the body's structures and functions and preserves relative autonomy for as long as possible. Nevertheless, people with this disease report low adherence to physical activity.ObjectiveThe purpose of this research is to examine the potential psychological benefits of using an “exergame”, a “serious game” based on physical exercise in the functional rehabilitation of Parkinson's disease, including stress and self-efficacy.MethodA single case ABAB protocol (n = 1) over 4 weeks, 1 week per phase, 3 observation points per phase, was developed. Our variables were measured by questionnaires and we used visual and statistical analysis to interpret changes in scores between Phases A and B.OutcomesThe “exergame” intervention appears to improve perceived stress and self-efficacy. The results are accompanied by an exploratory interview, reporting qualitative changes.ConclusionThe use of “exergame” in Parkinson's disease seems promising, and does not harm the person. But the methodology used is not sufficient to conclude on its real effectiveness. Further studies are needed.     

Relationship between sleep disturbance,depression and anxiety in the 12 months following a cardiac event

We aimed to assess the prevalence of sleep disturbance in a cardiac patient population over a 12-month period and assess its relationship with treatment adherence, self-efficacy, anxiety and depression. A total of 134 patients consecutively admitted to two Australian hospitals after acute myocardial infarction (31%), or to undergo bypass surgery (29%) or percutaneous coronary intervention (40%) were interviewed at six weeks and four and 12 months. Sleep disturbance was measured using a recode of the Beck Depression Inventory (v.2) item 16. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale. Sleep disturbance was highly prevalent (69%) at 6 weeks but was not associated with 12-month psychological outcomes. Path analysis revealed that sleep disturbance at 4 months was, however, associated with reduced treatment adherence and self-efficacy, and higher anxiety and depression scores at 12 months. The high prevalence of sleep disturbance in this study and its association with psychological outcomes may have adverse prognostic implications and possibly impede cardiac rehabilitation efforts.     

Acute Exercise Thoughts, Coping, and Exercise Intention in Older Adults

Two purposes of this study were to identify the types of acute thoughts older adults experienced when making exercise decisions and the strategies used to cope with negative thoughts. The third purpose was to examine the relationships between acute thoughts, coping self-efficacy, and the outcomes of decisional struggle and exercise intention. Participants were 117 exercising older adults (M_age= 72 years). Acute thoughts, coping strategies and self-efficacy, decisional struggle, and intention measures were taken concurrently. Results indicate that older adults experienced both acute positive and negative thoughts. To cope with negative thoughts, participants used cognitive and behavioral strategies. Further, coping self-efficacy significantly predicted decisional struggle and intention.     

General self-efficacy and control in relation to anxiety and cognitive performance

The present investigation employed a general measure of self-efficacy, a measure of perceived control, and items relating to expectation and evaluation (pre and post). The purpose was to determine whether general self-efficacy or perceived control best predicted the criterion variables of state anxiety and performance on a stressful cognitive task (solving anagrams) under conditions of high versus low control. These relationships were tested under the experimental conditions of high and low objective control (i.e., the actual control afforded by the situation). Results showed that general self-efficacy, relative to perceived control was a better predictor of state anxiety in the high and low control conditions but neither predicted actual performance. Participants’ expectations of task difficulty, their own performance, and their performance relative to the performance of others taken before the task were compared with their evaluations of difficulty and performance after completing the task. Participants indicated that the task was easier than anticipated, but rated their own performance more poorly after completion of the task. The study reported in this article was supported, in part, by Social Sciences and Humanities Research Council Grant No. 410-94-1473 to Norman S. Endler.     

General self-efficacy and control in relation to anxiety and cognitive performance

The present investigation employed a general measure of self-efficacy, a measure of perceived control, and items relating to expectation and evaluation (pre and post). The purpose was to determine whether general self-efficacy or perceived control best predicted the criterion variables of state anxiety and performance on a stressful cognitive task (solving anagrams) under conditions of high versus low control. These relationships were tested under the experimental conditions of high and low objective control (i.e., the actual control afforded by the situation). Results showed that general self-efficacy, relative to perceived control was a better predictor of state anxiety in the high and low control conditions but neither predicted actual performance. Participants’ expectations of task difficulty, their own performance, and their performance relative to the performance of others taken before the task were compared with their evaluations of difficulty and performance after completing the task. Participants indicated that the task was easier than anticipated, but rated their own performance more poorly after completion of the task. The study reported in this article was supported, in part, by Social Sciences and Humanities Research Council Grant No. 410-94-1473 to Norman S. Endler.     

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.