Despite the numerous physical and psychosocial benefits of exercise for coronary heart disease survivors, non-adherence to cardiac rehabilitation (CR) exercise is a major problem. Adherence to the lifestyle behavior change associated with CR involves both physical and self-regulatory skills. While self-regulatory efficacy is clearly linked to exercise adherence and adjustment, the literature on the relationship between self-efficacy and exercise among CR participants has not been systematically reviewed. A search of relevant databases identified 41 CR studies. Few studies measured self-regulatory efficacy for actions that facilitate adherence. Most studies examined self-efficacy during the intensive center-based phase of CR, with little attention to long-term maintenance. The CR literature could benefit by examining (a) self-efficacy as a major rehabilitation outcome, (b) measurement of self-regulatory efficacy for behavior change, (c) suspected moderators of self-efficacy (i.e. gender, age), and (d) self-efficacy relative to maintenance.
Ades, P.A. , Waldmann, M.L. , Polk, D.M. , & Coflesky, J.T. (1992). Referral patterns and exercise response in the rehabilitation of female coronary patients aged greater than or equal to 62 years . American Journal of Cardiology, 69, 1422-1425.
2.
* Allison, M.J. , & Keller, C. (1992). Physical activity maintenance in elders with cardiac problems . Geriatric Nursing, 21, 200-203.
3.
American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). (1999). Guidelines for cardiac rehabilitation and secondary prevention programs, 3rd edn. Champaign, IL: Human Kinetics.
4.
American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). (2004). Guidelines for cardiac rehabilitation and Secondary prevention programs, 4th edn. Champaign, IL: Human Kinetics.
5.
American Heart Association (AHA). (2005). Heart disease and stroke statistics-2005 update. Dallas, TX: American Heart Association.
6.
Bandura, A. (1995). On rectifying conceptual ecumenism. In J. E. Maddux (Ed.), Self-efficacy, adaptation, and adjustment: Theory, research, and application (pp. 347-375). New York: Plenum Press.
7.
Bandura, A. (1997). Self-efficacy: The exercise of control. New York: Freeman.
8.
Bandura, A. (2001). Social cognitive theory: An agentic perspective . Annual Review of Psychology, 52, 1-26.
9.
Bandura, A. (2004). Health promotion by social cognitive means . Health Education & Behavior, 31, 143-164.
10.
Baranowski, T. , Anderson, C. , & Carmack, D. (1998). Mediating variable framework in physical activity interventions. How are we doing ? How might we do better? American Journal of Preventive Medicine, 15, 266-297.
11.
* Beniamini, Y. , Rubenstein, J.J. , Zaichkowsky, L.D. , & Crim, M.C. (1997). Effects of high-intensity strength training on quality-of-life parameters in cardiac rehabilitation . American Journal of Cardiology, 80, 841-846.
12.
* Bennett, P. , Mayfield, T. , Norman, P. , Lowe, R. , & Morgan, M. (1999). Affective and social-cognitive predictors of behavioral change following first myocardial infarction . British Journal of Health Psychology, 4, 247-256.
13.
* Berkhuysen, M.A. , Nieuwland, W. , Buunk, B.P. , Sanderman, R. , & Rispens, P. (1999). Change in self-efficacy during cardiac rehabilitation and the role of perceived overprotectiveness . Patient Education and Counseling, 38, 21-32.
14.
* Blanchard, C. , Rodgers, W. , Courneya, K. , Daub, B. , & Knapik, G. (2002). Does barrier efficacy mediate the gender-exercise adherence relationship during phase II cardiac rehabilitation ? Rehabilitation Psychology, 47, 106-121.
15.
* Bock, B.C. , Albrecht, A.E. , Traficante, R.M. , Clark, M.M. , Pinto, B.M. , Tilkemeier, P. , & Marcus, B.H. (1997). Predictors of exercise adherence following participation in a cardiac rehabilitation program . International Journal of Behavioral Medicine, 4, 60-75.
16.
Brawley, L.R. , Rejeski, W.J. , Angove, J. , & Fox, L. (2003). Process-outcome relationships in a physical activity intervention: The cardiovascular health and maintenance program (CHAMP)Annals of Behavioral Medicine, p. 111 .
17.
Brawley, L.R. , Rejeski, W.J. , & King, A. (2003). Promoting physical activity for older adults: The challenges for changing behavior . American Journal of Preventive Medicine, 25, 172-183.
18.
* Bray, S.R. , & Cowan, H. (2004). Proxy efficacy: Implications for self-efficacy and exercise intentions in cardiac rehabilitation . Rehabilitation Psychology, 49, 71-75.
19.
Brezinka, V. , & Kittel, F. (1995). Psychosocial factors of coronary heart disease in women: A review . Social Science and Medicine, 42, 1351-1365.
20.
British Heart Foundation. (2005). Coronary heart disease statistics: 2005 editionhttp://www.heartstats.org/temp/CHD_2005_whole_spdocument.pdf (accessed 21 November 2005).
21.
* Brown, A. , Laschinger, S. , Hains, S. , & Parry, M. (1992). Discharge functional capacity and self-efficacy of men after coronary artery bypass graft surgery . Canadian Journal of Cardiovascular Nursing, 3, 18-24.
22.
* Burns, K.J. , Camaione, D.N. , Froman, R.D. , & Clark, B.A. (1998). Predictors of referral to cardiac rehabilitation and cardiac exercise self-efficacy . Clinical Nursing Research , 7, 147-163.
23.
* Carlson, J.J. , Norman, G.J. , Feltz, D.R. , Franklin, B.A. , Johnson, J.A. , & Locke, S.K. (2001). Self-efficacy, psychosocial factors, and exercise behavior in traditional versus modified cardiac rehabilitation . Journal of Cardiopulmonary Rehabilitation, 21, 363-373.
24.
* Carroll, D.L. (1995). The importance of self-efficacy expectations in elderly patients recovering from coronary artery bypass surgery . Heart & Lung, 24, 50-59.
25.
* Cheng, T.Y. , & Boey, K.W. (2002). The effectiveness of a cardiac rehabilitation program on self-efficacy and exercise tolerance . Clinical Nursing Research, 11, 10-21.
26.
Clark, N.M. (2003). Management of chronic disease by patients . Annual Review of Public Health, 24, 289-313.
27.
* Evon, D.M. , & Burns, J.W. (2004). Process and outcome in cardiac rehabilitation: An examination of cross-lagged effects . Journal of Consulting and Clinical Psychology, 72, 605-616.
28.
Ewart, C.K. (1995). Self-efficacy and recovery from heart attack: Implication for a social cognitive analysis of exercise and emotion. In J. E. Maddux (Ed.), Self-efficacy, adaptation, and adjustment: Theory, research, and application (pp. 203-226). New York: Plenum Press.
29.
* Ewart, C.K. , Stewart, K.J. , Gillilan, R.E. , & Kelemen, M.H. (1986a). Self-efficacy mediates strength gains during circuit weight training in men with coronary artery disease . Medicine and Science in Sports and Exercise, 18, 531-540.
30.
* Ewart, C.K. , Stewart, K.J. , Gillilan, R.E. , Kelemen, M.H. , Valenti, S.A. , Manley, J.D. , & Kelemen, M.D. (1986b). Usefulness of self-efficacy in predicting overexertion during programmed exercise in coronary artery disease . American Journal of Cardiology, 57, 557-561.
31.
* Ewart, C.K. , Taylor, C.B. , Reese, L.B. , & DeBusk, R.F. (1983). Effects of early postmyocardial infarction exercise testing on self-perception and subsequent physical activity . American Journal of Cardiology, 51, 1076-1080.
32.
Focht, B.C. , Brawley, L.R. , Rejeski, W.J. , & Ambrosius, W.T. (2004). Group-mediated activity counseling and traditional exercise therapy programs: Effects upon health-related quality of life among older adults in cardiac rehabilitation . Annals of Behavioral Medicine, 28, 52-61.
33.
* Foster, C. , Oldridge, N.B. , Dion, W. , Forsyth, G. , Grevenow, P. , Hansen, M. et al. (1995). Time course of recovery during cardiac rehabilitation . Journal of Cardiopulmonary Rehabilitation , 15, 209-215.
34.
* Gardner, J.K. , McConnell, T.R. , Klinger, T.A. , Herman, C.P. , Hauck, C.A. , & Laubach, C.A. (2003). Quality of life and self-efficacy: Gender and diagnoses considerations for management during cardiac rehabilitation . Journal of Cardiopulmonary Rehabilitation, 23, 299-306.
35.
* Gilliss, C.L. , Gortner, S.R. , Hauck, W.W. , Shinn, J.A. , Sparacino, P.A. , & Tompkins, C. (1993). A randomized clinical trial of nursing care for recovery from cardiac surgery . Heart & Lung, 22, 125-133.
36.
* Gortner, S.R. , & Jenkins, L.S. (1990). Self-efficacy and activity following cardiac surgery . Journal of Advanced Nursing, 15, 1132-1138.
37.
* Gulanick, M. (1991). Is phase 2 cardiac rehabilitation necessary for early recovery of patients with cardiac disease? A randomized, controlled study . Heart & Lung, 20, 9-15.
38.
* Jeng, C. , & Braun, L. (1995). Instrument development and measurement of exercise self-efficacy in cardiac rehabilitation patients . Progress in Cardiovascular Nursing, 10, 28-35.
39.
* Jeng, C. , & Braun, L. (1997). The influence of self-efficacy on exercise intensity, compliance rate and cardiac rehabilitation outcomes among coronary artery disease patients . Progress in Cardiovascular Nursing, 12, 13-24.
40.
* Jenkins, L.S. , & Gortner, S.R. (1998). Correlates of self-efficacy expectation and prediction of walking behavior in cardiac surgery elders . Annals of Behavioral Medicine, 20, 99-103.
Lemanksi, K.M. (1990). The use of self-efficacy in cardiac rehabilitation . Progress in Cardiovascular Nursing, 5, 114-117.
43.
* Maddison, R. , & Prapavessis, H. (2004). Using self-efficacy and intention to predict exercise compliance among patients with ischemic heart disease . Journal of Sport & Exercise Psychology, 26, 511-524.
44.
Maddux, J.E. (1995). Looking for common ground: A comment on Kirsch and Bandura. In J. E. Maddux (Ed.), Self-efficacy, adaptation, and adjustment: Theory, research, and application (pp. 377-385). New York: Plenum Press.
45.
Maddux, J.E. (1997). Habit, health, and happiness . Journal of Sport and Exercise Psychology, 19, 331-346.
46.
Maddux, J.E. , & Gosselin, J.T. (2003). Self-efficacy. In M. R. Leary & J. Price Tangney (Eds.), Handbook of self and identity (pp. 218-238). New York: Guilford Press.
Marks, R. , Allegrante, J.P. , & Lorig, K. (2005). A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: Implications for health education practice (Part I) . Health Promotion Practice , 6, 37-43.
49.
McAuley, E. , & Blissmer, B. (2000). Self-efficacy determinants and consequences of physical activity . Exercise and Sport Sciences Reviews, 28, 85-88.
50.
McAuley, E. , & Katula, J. (1998). Physical activity interventions in the elderly: Influence on physical health and psychological function. In R. Schulz , G. Maddox , & M. P. Lawton (Eds.), Annual review of gerontology and geriatrics, 18 (pp. 111-154). New York: Springer Publishing.
51.
McAuley, E. , & Mihalko, S.L. (1998). Measuring exercise-related self-efficacy. In J. L. Duda (Ed.), Advances in sport and exercise psychology measurement (pp. 371-381). USA: Fitness Information .
52.
McAuley, E. , Pena, M.M. , & Jerome, G. (2001). Self-efficacy as a determinant and an outcome of exercise. In G. C. Roberts (Ed.), Advances in motivation in sport and exercise (pp. 235-261). Champaign, IL: Human Kinetics Publishers.
53.
Meichenbaum, D. , & Turk, D.C. (1987). Facilitating treatment adherence: A practitioner's guidebook. New York: Plenum Press .
54.
* Moore, S.M. , Dolansky, M.A. , Ruland, C.M. , Pashkow, F.J. , & Blackburn, G.G. (2003). Predictors of women's exercise maintenance after cardiac rehabilitation . Journal of Cardiopulmonary Rehabilitation, 23, 40-49.
55.
Mullinax, C.H. (1995). Cardiac rehabilitation programs and the problem of patient dropout . Rehabilitation Nursing, 20, 90-92, 101 .
56.
Newman, S. , Steed, L. , & Mulligan, K. (2004). Self management interventions for chronic illness . The Lancet, 364, 1523-1537.
57.
* Oka, R.K. , Gortner, S.R. , Stotts, N.A. , & Haskell, W.L. (1996). Predictors of physical activity in patients with chronic heart failure secondary top either ischemic or idiopathic dilated cardiomyopathy . American Journal of Cardiology, 77, 159-163.
58.
* Oldridge, N.B. , & Rogowski, B.L. (1990). Self-efficacy and in-patient cardiac rehabilitation . American Journal of Cardiology, 66, 362-365.
59.
* Parent, N. , & Fortin, F. (2000). A randomized, controlled trial of vicarious experience through peer support for male first-time cardiac surgery patients: Impact on anxiety, self-efficacy expectation, and self-reported activity . Heart & Lung, 29, 389-400.
60.
* Rejeski, W.J. , Brawley, L.R. , Ambrosius, W.T. , Brubaker, P.H. , Focht, B.C. , Foy C. G., & Fox, L.D. (2003). Older adults with chronic disease: The benefits of group mediated counselling in the promotion of physically active lifestyles . Health Psychology, 22, 414-423.
61.
Rejeski, W.J. , Brawley, L.R. , McAuley, E. , & Rapp, S. (2000). An examination of theory and behavior change in randomized clinical trials . Controlled Clinical Trials, 21, 164S-170S.
62.
Rejeski, W.J. , Foy, C.G. , Brawley, L.R. , Brubaker, P.H. , Focht, B.C. , Norris, J.L. , & Smith, M.L. (2002). Older adults in cardiac rehabilitation: A new strategy for enhancing physical function . Medicine and Science in Sports and Exercise, 34, 1705-1713.
63.
* Robertson, D. , & Keller, C. (1992). Relationships among health beliefs, self-efficacy, and exercise adherence in patients with coronary artery disease . Heart & Lung, 21, 56-63.
64.
Rothman, A.J. (2000). Toward a theory-based analysis of behavioral maintenance . Health Psychology, 19, 64-69.
65.
* Ruiz, B.A. , Dibble, S.L. , Gilliss, C.L. , & Gortner, S.R. (1992). Predictors of general activity eight weeks after cardiac surgery . Applied Nursing Research, 5, 59-65.
66.
Schneiderman, N. , Antoni, M.H. , Saab, P.G. , & Ironson, G. (2001). Health psychology: Psychosocial and biobehavioral aspects of chronic disease management . Annual Review of Psychology , 52, 555-580.
67.
* Scholz, U. , Sniehotta, F.F. , & Schwarzer, R. (2005). Predicting physical exercise in cardiac rehabilitation: The role of phase-specific self-efficacy beliefs . Journal of Sport & Exercise Psychology, 27, 135-151.
68.
* Schuster, P.M. , & Waldron, J. (1991). Gender differences in cardiac rehabilitation patients . Rehabilitation Nursing, 16, 248-253.
69.
Statistics Canada. (2004). Causes of death 2002http://ww2.heartandstroke.ca/Page.asp?PageID=33&ArticleID=1077&Src=news&From=SubCategory (accessed 6 July 2006).
70.
* Stewart, K.J. , Kelemen, M.H. , & Ewart, C.K. (1994). Relationships between self-efficacy and mood before and after exercise training . Journal of Cardiopulmonary Rehabilitation , 14, 35-42.
71.
* Stewart, K.J. , Mason, M. , & Kelemen, M.H. (1988). Three-year participation in circuit weight training improves muscular strength and self-efficacy in cardiac patients . Journal of Cardiopulmonary Rehabilitation, 8, 292-296.
72.
Strachan, S.M. , Woodgate, J. , Brawley, L.R. , & Tse, A. (2005). Long-term exercise maintenance: Relationships to social cognitions and self-identity . Journal of Applied Biobehavioral Research, 10, 98-112.
73.
* Taylor, C.B. , Bandura, A. , Ewart, C.K. , Miller, N.H. , & DeBusk, R.F. (1985). Exercise testing to enhance wive's confidence in their husband's cardiac capability soon after clinically uncomplicated acute myocardial infarction . American Journal of Cardiology, 55, 636-638.
74.
* Vidmar, P. , & Rubison, L. (1994). The relationship between self-efficacy and exercise compliance in a cardiac population . Journal of Cardiopulmonary Rehabilitation, 14, 246-255.
75.
Williams, D.M. , Anderson, E.S. , & Winett, R.A. (2005). A review of the outcome expectancy construct in physical activity research . Annals of Behavioral Medicine , 29, 70-79.
76.
Wing, R.R. (2000). Cross-cutting themes in maintenance of behavior change . Health Psychology, 19, 84-88.
77.
* Woodgate, J. , Brawley, L.R. , & Weston, Z.J. (2005). Maintenance cardiac rehabilitation exercise adherence: Effects of task and self-regulatory self-efficacy . Journal of Applied Social Psychology, 35, 183-197.
78.
* Yates, B.C. , Price-Fowlkes, T. , & Agrawal, S. (2003). Barriers and facilitators of self-reported physical activity in cardiac patients . Research in Nursing & Health , 26, 459-469.
