Enhancing physical activity in cardiac patients who report hopelessness: Feasibility testing of an intervention

Abstract

Objective:

Hopelessness is present in 27% of patients with ischaemic heart disease (IHD), can persist for 12 months and is associated with lack of physical activity (PA). No interventions have been tested to increase PA in IHD patients who report hopelessness. This study evaluated the feasibility of conducting a randomised controlled trial to investigate the effectiveness of the Heart Up! intervention, designed to reduce hopelessness through enhanced PA in IHD patients. It was hypothesised that increased PA would be identified in the intervention group.

Setting:

Patients were recruited from a large teaching hospital in the Midwestern USA. Data collection occurred in the patient’s home at 1 and 8 weeks after hospital discharge.

Methods:

A three-group design was used. Eligible patients were randomised to (1) motivational social support (MSS) from a nurse, (2) MSS from a nurse with social support from a significant other support (SOS) or (3) control. MSS-only and MSS-SOS recipients received motivational interviewing followed by 6 weeks of social support text messages from a nurse. MSS-SOS participants additionally received social support text messages from a significant other. Control participants received the usual care. Feasibility outcomes included recruitment and retention rates, patient acceptability and patient satisfaction. An accelerometer measured PA.

Results:

Of the 156 patients screened for the study, 43 met the inclusion criteria. Of eligible patients, 69.8% (n = 30) enrolled and 67% (n = 20) completed the study. Patients in the MSS and MSS-SOS groups expressed satisfaction with the intervention components (86% with motivational interviewing, 77% with nurse texts and 100% with significant other texts). Although differences were not statistically significant, a medium effect size for change in PA was identified in the MSS-SOS group compared to the other two groups.

Conclusion:

Study findings demonstrate the feasibility of the Heart Up! intervention and support testing its efficacy in a randomised controlled trial.

Keywords

Feasibility heart disease hopelessness motivation physical activity social support

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References

Abramson

Alloy

Metalsky

(1989) Hopelessness depression: A theory-based subtype of depression. Psychological Review 96: 358–372.

ActiGraph LLC (2018) ActiGraph research database. Available at: http://www.actigraphcorp.com/resources/research-database (accessed 23 August 2018).

Anderson

Thompson

Oldridge

et al . (2016) Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. Journal of the American College of Cardiology 67(1): 1–12.

Artinian

Fletcher

Mozaffarian

et al . (2010) Interventions to promote PA and dietary lifestyle changes for cardiovascular risk factor reduction in adults a scientific statement from the American Heart Association. Circulation 122(4): 406–441.

Beckie

Beckstead

(2010) Predicting cardiac rehabilitation attendance in a gender-tailored randomized clinical trial. Journal of Cardiopulmonary Rehabilitation and Prevention 30(3): 147–156.

Burke

Azar

et al . (2015) Current science on consumer use of mobile health for cardiovascular disease prevention: A scientific statement from the American Heart Association. Circulation 132: 1157–1213.

Carney

Freedland

Eisen

et al . (1995) Major depression and medication adherence in elderly patients with coronary artery disease. Health Psychology 14(1): 88–90.

Chow

Redfern

Hillis

et al . (2015) Effect of lifestyle-focused text messaging on risk factor modifications in patients with coronary heart disease: A randomized clinical trial. Journal of the American Medical Association 314(12): 1255–1263.

Cohen

Gottlieb

Underwood

(2001) Social Relationships and Health: Challenges for Measurement and Intervention. New York: Oxford University Press.

10.

Dalal

Zawada

Jolly

et al . (2010) Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis. British Medical Journal 340(7740): 249–264.

11.

Davies

Taylor

Beswick

et al . (2014) Promoting patient uptake and adherence in cardiac rehabilitation. Cochrane Database of Systematic Reviews 6: CD007131.

12.

Davis

Brennan

Vish

et al . (2013) Lesson learned from study of depression in cardiovascular patients in an acute-care and vascular hospital. Proceedings (Baylor University Medical Center) 26(1): 6–9.

13.

Deci

Ryan

(2008) Self-determination theory: A macrotheory of human motivation, development, and health. Canadian Psychology 49(3): 182–185.

14.

Dunn

Rieth

et al . (2017) Impact of home- and hospital-based exercise in cardiac rehabilitation on hopelessness in patients with coronary heart disease. Journal of Cardiopulmonary Rehabilitation and Prevention 37(1): 39–48.

15.

Dunn

Olamijulo

Fuglseth

et al . (2014) The state-trait hopelessness scale: Development and testing. Western Journal of Nursing Research 36(4): 552–570.

16.

Dunn

Stommel

Corser

et al . (2009) Hopelessness and its effect on cardiac rehabilitation exercise participation following hospitalization for acute coronary syndrome. Journal of Cardiopulmonary Rehabilitation and Prevention 29(1): 32–39.

17.

Dzewaltowski

Estabrooks

Klesges

et al . (2004) Behavior change intervention research in community settings: How generalizable are the results? Health Promotion International 19(2): 235–245.

18.

Freedland

Skala

Carney

et al . (2009) Treatment of depression after coronary artery bypass surgery: A randomized controlled trial. Archives of General Psychiatry 66(4): 387–396.

19.

Gaalema

Higgins

Shepard

et al . (2014) State-by-state variations in cardiac rehabilitation participation are associated with educational attainment, income, and program availability. Journal of Cardiopulmonary Rehabilitation and Prevention 34(4): 248–254.

20.

Janssen

De Gucht

van Exel

et al . (2013) Beyond resolutions? A randomized controlled trial of a self-regulation lifestyle programme for post-cardiac rehabilitation patients. European Journal of Preventive Cardiology 20(3): 431–441.

21.

Kangelaris

Vittinghoff

Otte

et al . (2010) Association between a serotonin transporter gene variant and hopelessness among men in the heart and soul study. Journal of General Internal Medicine 25: 1030–1037.

22.

Lee

Chong

et al . (2008) Patient satisfaction and its relationship with quality and outcomes of care after acute myocardial infarction. Circulation 118: 1938–1945.

23.

McCusker

Cole

Yaffe

et al . (2016) Adherence to depression self-care intervention among primary care patients with chronic physical conditions: A randomized controlled trial. Health Education Journal 75(7): 767–779.

24.

Marklund

Ryan

Tobin

et al . (2005) Motivational interviewing and self-determination theory. Journal of Social and Clinical Psychology 24(6): 811–831.

25.

Miller

Rollnick

(2013) Motivational Interviewing: Helping People Change. 3rd ed. New York: Guilford Press.

26.

Murphy

Worcester

Higgins

et al . (2013) Reduction in 2-year recurrent risk score and improved behavioral outcomes after participation in the ‘beating heart problems’ self-management program: Results of a randomized controlled trial. Journal of Cardiopulmonary Rehabilitation and Prevention 33(4): 220–228.

27.

Orsmond

Cohn

(2015) The distinctive features of a feasibility study: Objectives and guiding questions. OTJR: Occupation, Participation and Health 35(3): 169–177.

28.

Pederson

Denollet

Daemen

et al . (2007) Fatigue, depressive symptoms, and hopelessness as predictors of adverse research events following percutaneous coronary intervention with paclitaxel-eluting stents. Journal of Psychosomatic Research 62: 455–461.

29.

Pew Research Center (2016) Smartphone ownership rates skyrocket in many emerging economies, but digital divide remains. Available at: http://www.pewglobal.org/2016/02/22/smartphone-ownership-rates-skyrocket-in-many-emerging-economies-but-digital-divide-remains/ (accessed 15 March 2018).

30.

Pew Research Center (2018) Pew Research Center mobile technology fact sheet. Available at: http://www.pewinternet.org/fact-sheets/mobile-technology-fact-sheet/ (accessed 15 March 2018).

31.

Ross

Blair

Arena

et al . (2016) Importance of assessing cardiorespiratory fitness in research practice: A case for fitness as a research vital sign: A scientific statement from the American Heart Association. Circulation 134(24): e653–e699.

32.

Ryan

Deci

(2017) Self-Determination Theory: Basic Psychological Needs in Motivation, Development, and Wellness. New York: Guilford Press.

33.

Schulz

Altman

Moher

et al . (2010) CONSORT 2010 statement: Updated guidelines for reporting parallel group randomized trials. Annuals of Internal Medicine 152(11): 726–732.

34.

Smith

Emelia

Benjamin

et al . (2011) AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. Journal of the American College of Cardiology 58(23): 2432–2446.

35.

Taliaferro

Rienzo

Pigg

et al . (2009) Associations between physical activity and reduced rates of hopelessness, depression, and suicidal behavior among college students. Journal of the American College Health 57(4): 427–435.

36.

Voltonen

Laaksonen

Laukkanen

et al . (2009) Leisure-time physical activity, cardiorespiratory fitness and feelings of hopelessness in men. BMC Public Health 9: 204.

37.

Win

Parakh

Eze-Nliam

et al . (2011) Depressive symptoms, physical inactivity and risk of cardiovascular mortality in older adults: The cardiovascular health study. Heart 97(6): 500–505.

38.

Muntner

Shimbo

et al . (2013) Behavioral mechanisms, elevated depressive symptoms, and the risk for myocardial infarction or death in individuals with coronary heart disease: The regards (reason for geographic and racial differences in stroke) study. Journal of the American College of Cardiology 61(6): 622–630.