What Motivational Factors Influence Exercise in Cardiac Patients? A Literature Review
European Journal of Preventive Medicine
Volume 1, Issue 1, July 2013, Pages: 1-19
Received: May 16, 2013; Published: Jun. 10, 2013
Views 4513      Downloads 269
Núria Santaularia, Department of Rehabilitation, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain;Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
Tiny Jaarsma, Department of Social and Welfare Studies, Faculty of Health Sciences Linköping University, Norrköping, Sweden
Article Tools
Follow on us
Objective: To review factors related to regular exercise in patients diagnosed with myocardial ischemia, heart failure, and other heart diseases. Review methods: Literature review of studies published from 1969 to January 2013. Results: Of the studies included (n=27), 18 describe factors related to the performance of exercise. The other 9 articles describe barriers to exercise and/or propose options for overcoming the barriers posed by social and economic factors, the health care system, the patient’s condition, the therapy and the patient related factors. The literature specifically describes different barriers and motives for men and women. Conclusions: To increase exercise among cardiac patients, the factors that influence participation need to be examined. Alternative formats for exercise programs are needed. Programs need to be better tailored to patients’ needs so as to enhance participation among those who are not attracted by the choice of programs currently offered.
Myocardial Ischemia, Heart Disease, Motivation, Barriers, Exercise, Literature Review
To cite this article
Núria Santaularia, Tiny Jaarsma, What Motivational Factors Influence Exercise in Cardiac Patients? A Literature Review, European Journal of Preventive Medicine. Vol. 1, No. 1, 2013, pp. 1-19. doi: 10.11648/j.ejpm.20130101.11
Clark A, Harting L, Vandermeer B, McAlister F. Meta-Analysis: Secondary Prevention Programs for Patients with Coronary Artery Disease. Ann Intern Med 2005; 9 (143): 659-672.
Dickstein K, Cohen-Solal A, Filippatos G, McMurray J, Ponikowski P, Poole-Wilson Pea. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail 2008; 10(10): 933-989.
Taylor R, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees Kea. Exercise-Based Rehabilitation for Patients with Coronary Heart Disease:Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Med 2004; 116(10): 682-692.
Carlson JJ, Johnson JA, Franklin BA, VanderLaan RL. Program participation, exercise adherence, cardiovascular outcomes, and program cost of traditional versus modified cardiac rehabilitation. Am J Cardiol 2000; 86: 17-23.
Arthur HM, Smith KM, Kodis J, Mckelvie R. A Controlled trial of hospital versus home-based exercise in cardiac patients. Med Sci Sports Exer 2002; 34: 1544-1550.
Moore SM. Women's views of cardiac rehabilitation programs. J Cardiopulm Rehabil 1996; 16: 123-129.
Bock B, Albrecht A, Traficante R, Clark M, Pinto B, Marcus B, et al. Predictors of exercise adherence following participation in a cardiac rehabilitation program. Journal of Behavioral Medicine 1997; 4(1): 60-75.
Brubaker PH, Warner JG Jr, Rejeski WJ, Edwards DG, Matrazzo BA, Ribisl PM et al. Comparison of standard- and extended-lenght participation in cardiac rehabilitation on body composition, functional capacity, and blood lipids. Am J Cardiol 1996; 78: 769-773.
Ades PA, Huang D, Weaver SO. Cardiac rehabilitation participation predicts lower rehospitalization costs. Am Heart J 1992; 123(4 Pt 1): 916-21.
Dusseldorp E, Van Elderen T, Maes S, Meulman J, Kraaij V. A meta-analysis of psychoeducational programs for coronary heart disease patients. Health Psychology 1999;18:506-519.
van der Wal MH, van Veldhuisen DJ, Veeger NJ, Rutten FH, Jaarsma T. Compliance with non-pharmacological recommendations and outcome in heart failure patients. Eur Heart J 2010; 31(12): 1486-93.
World Health Organization. WHO | Adherence to long-term therapies: evidence for action. WHO 2003: 10/11/2010.
Mosleh SM, Kiger A, Campbell N. Improving uptake of cardiac rehabilitation: using theoretical modelling to design an intervention. Eur J Cardiovasc Nurs 2009; 8(3): 161-8.
MeSH. 2010; Available at: http://www.ncbi.nlm.nih.gov/mesh.
Jovell AJ NM. Evaluation of scientific evidence. Med Clin 1995; 105: 740-743.
Dorn J, Naughton J, Imamura D, Trevisan M. Correlates of compliance in a randomized exercise trial in myocardial infarction patients. Med Sci Sports Exerc 2001; 33(7): 1081-1089.
Jolly K, Taylor R, Lip GY, Greenfield S, Raftery J, Mant J, et al. The Birmingham Rehabilitation Uptake Maximisation Study (BRUM). Home-based compared with hospital-based cardiac rehabilitation in a multi-ethnic population: cost-effectiveness and patient adherence. Health Technol Assess 2007; 11(35): 1-118.
Beckie TM, Beckstead JW. Predicting cardiac rehabilitation attendance in a gender-tailored randomized clinical trial. J Cardiopulm Rehabil Prev 2010; 30(3): 147-56.
Andrew GM PJ. Factors related to dropout of post myocardial infarction patients from exercise programs. Med Sci Sports 1979; 11(4): 376-378.
Farley RL, Wade TD, Birchmore L. Factors influencing attendance at cardiac rehabilitation among coronary heart disease patients. Eur J Cardiovasc Nurs 2003; 2(3): 205-12.
Corvera-Tindel T, Doering LV, Gomez T, Dracup K. Predictors of noncompliance to exercise training in heart failure. J Cardiovasc Nurs 2004; 19(4): 269-77.
Kärner A, Tingström P, Abrandt-Dahlgren M, Bergdahl B. Incentives for lifestyle changes in patients with coronary heart disease. J Adv Nurs 2005; 51(3): 261-75.
Evenson KR, Johnson A, Aytur SA. Five-year changes in north carolina outpatient cardiac rehabilitation. J Cardiopulm Rehabil 2006; 26(6): 366-376.
Leung YW, Ceccato N, Steward DE, Grace SL. A prospective examination of patterns and correlates of exercise maintenance in coronary artery disease patients. J Behav Med 2007; 30: 411-421.
Sharp J FC. Patterns and predictors of uptake and adherence to cardiac rehabilitation. J Cardiopulm Rehabil Prev 2009;29(4):241-7.
Dohnke B, Nowossadeck E, Müller-Fahrnow W. Motivation and participation in a phase III cardiac rehabilitation programme: an application of the health action process approach. Res Sports Med 2010; 18(4): 219-235.
Sweet SN, Tulloch H, Fortier MS, Pipe AL, Reid RD. Patterns of motivation and ongoing exercise activity in cardiac rehabilitation settings: A 24-month exploration from the TEACH study. Ann Behav Med 2011; 42: 55-63.
Caulin-Glaser T, Maciejewski PK, Snow R, LaLonde M, Mazure C. Depressive symptoms and sex affect completion rates and clinical outcomes in cardiac rehabilitation. Prev Cardiol 2007; 10(1): 15-21.
Marzolini S, Brooks D, Oh PI. Sex differences in completion of a 12-month cardiac rehabilitation programme: An analysis of 5922 women and men. Eur J Cardiovas Prev Rehabil 2008; 15(6): 698-703.
Godin G, Valois P, Jobin J, Ross A. Prediction of intention to exercise of individuals who have suffered from coronary heart disease. J Clin Psychol 1991; 47(6): 762-72.
Lieberman L, Meana M, Stewart D. Cardiac rehabilitation: gender differences in factors influencing participation. J Womens Health 1998; 7(6): 717-723.
Jones LW, Farrell JM, Jamieson J and Dorsch DD. Factors Influencing Enrollment in a Cardiac Rehabilitation Exercise Program. Can J Cardiovasc Nurs 2003; 13(1): 11-15.
Kärner A, Dahlgren MA, Bergdahl B. Coronary heart disease: causes and drug treatment--spouses' conceptions. J Clin Nurs 2004; 13(2): 167-76.
Clark AM, Barbour RS, White M, MacIntyre PD. Promoting participation in cardiac rehabilitation: patient choices and experiences. J Adv Nurs 2004; 47(1): 5-14.
Hong TB, Franks MM, Gonzalez R, Keteyian SJ, Franklin BA, Artinian NT. A dyadic investigation of exercise support between cardiac patients and their spouses. Health Psychol 2005; 24(4): 430-434.
Dolansky MA, Moore SM, Visovsky C. Older adults’ views of cardiac rehabilitation program: is it time to reinvent? J Gerontol Nurs 2006; 32: 37-44.
Wingham J, Dalal HM, Sweeney KG, Evans PH. Listening to patients: choice in cardiac rehabilitation. Eur J Cardiovasc Nurs 2006; 5(4): 289-94.
Rivett MJ, Tsakirides C, Pringle A, Carroll S, Ingle L, Dudfield M. Physical activity readiness in patient withdrawals from cardiac rehabilitation. Br J Nurs 2009; 18(3): 188-91.
Thow M, Rafferty D, Kelly H. Exercise motives of long-term phase IV cardiac rehabilitation participants. Physiotherapy 2008; 94(4): 281-285.
Jones MI, Greenfield S, Jolly K, BRUM Trial Steering Committee. Patients' experience of home and hospital based cardiac rehabilitation: a focus group study. Eur J Cardiovasc Nurs 2009; 8(1): 9-17.
Marzolini S, Mertens DJ, Oh PI, Plyley MJ. Self-reported compliance to home-based resistance training in cardiac patients. Eur J Cardiovasc Prev Rehabil 2010;17(1):35-41.
Martin AM WC. What Sustains Long-Term Adherence to Structured Physical Activity After a Cardiac Event? J Aging Phys Act 2012; 20(2): 135-147.
Wyer S., Joseph S. & Earll L. Predicting attendance at cardiac rehabilitation: a review and recommendations. Coronary Health Care 2001; 5: 171-177.
Luszczynska A. An implementation intentions intervention, the use of a planning strategy, and physical activity after myocardial infarction. Soc Sci Med 2006; 62(4): 900-8.
Bjarnason-Wehrens B, Grande G, Loewel H, Völler H, Mittag O. Gender-specific issues in cardiac rehabilitation: do women with ischaemic heart disease need specially tailored programmes? Eur J Cardiovac Prev Rehabil 2007; 14(2): 163-71.
van der Wal M, Jaarsma T. Adherence in heart failure in the elderly: Problem and possible solutions. Inter 2008; 125: 203-208.
Johnston DW, Johnston M, Pollard B, Kinmonth AL, Mant D. Motivation is not enough: prediction of risk behavior following diagnosis of coronary heart disease from the theory of planned behavior. Health Psychol 2004; 23(5): 533-8.
Allison MJ, Keller C. Physical activity maintenance in elders with cardiac problems. Geriatr Nurs 2000; 21(4): 200-203.
D'Angelo MS, Reid RD, Pelletier LG. A model for exercise behavior change regulation in patients with heart disease. J Sport Exerc Psychol 2007; 29(2): 208-24.
Jones M, Jolly K, Raftery J, Lip GYH and Greenfield S, on behalf of BRUM Steering Committee. ‘DNA’ may not mean ‘did not participate’: a qualitative study of reasons for non-adherence at home- and centre-based cardiac rehabilitation. Family Practice 2007; 24: 343-357.
Parkosewich JA. Cardiac rehabilitation barriers and opportunities among women with cardiovascular disease. Cardiol Rev 2008; 16(1): 36-52.
Perry CK, Bennett JA. Heart disease prevention in women: promoting exercise. J Am Acad Nurse Pract 2006; 18(12): 568-73.
Jones MI, Greenfield S, Jolly K, BRUM Trial Steering Committee. Patients' experience of home and hospital based cardiac rehabilitation: a focus group study. Eur J Cardiovasc Nurs 2009; 8(1): 9-17.
Barlow JH, Turner AP, Gilchrist M. A randomised controlled trial of lay-led self-management for myocardial infarction patients who have completed cardiac rehabilitation. Eur J Cardiovasc Nurs 2009; 8(4): 293-301.
Coghill N, Cooper A. Motivators and de-motivators for adherence to a program of sustained walking. Preventive Medicine 2009;49:24-27.
Fleury J, Kimbrell LC, Kruszewski MA. Life after a cardiac event- Womens experience in healing. Heart & Lung 1995; 24(6): 474-482.
Wyer S, Earll L, Joseph S, Harrison J, Giles M, Johnston M. Increasing attendance at cardiac rehabilitation: an intervention study using the Theory of Planned Behaviour. Coronary Health Care 2001; 5(3): 154-159.
Rozanski A. Integrating psychologic approaches into the behavioral management of cardiac patients. Psychosom Med 2005; 67(Suppl 1): 567-73.
Leon A. Exercise Following Myocardial Infraction: Current Recommendations. Sports Medicine and International Journal of applied medicine and science in sport and exercise 2000; 29 (5): 301-311.
Salvetti XM, Oliveira JA, Servantes DM, Vincenzo de Paola AA. How much do the benefits cost? Effects of a home-based training programme on cardiovascular fitness, quality of life, programme cost and adherence for patients with coronary disease. Clin Rehabil 2008; 22(10-11): 987-996.
Sniehotta FF, Scholz U, Schwarzer R, Fuhrmann B, Kiwus U, Völler H. Long-term effects of two psychological interventions on physical exercise and self-regulation following coronary rehabilitation. Int J Behav Med 2005; 12(4): 244-55.
Plotnikoff RC, Higginbotham N. Protection Motivation Theory and exercise behaviour change for the prevention of coronary heart disease in a high-risk, Australian representative community sample of adults. Psychology, Health & Medicine 2002; 7(1): 87-98.
Blanchard CM, Reid RD, Morrin LI, McDonnell L, McGannon K, Rhodes RE, Spence JC, Edwards N. Does protection motivation theory explain exercise intentions and behavior during home-based cardiac rehabilitation? J Cardiopulm Rehabil Prev 2009; 29(3): 188-92.
Brodie DA, Inoue A, Shaw DG. Motivational interviewing to change quality of life for people with chronic heart failure: a randomised controlled trial. Int J Nurs Stud 2008; 45(4): 489-500.
Timmins F. A review of the information needs of patients with acute coronary syndromes. Nurs Crit Care 2005; 10(4): 174-83.
Baigi A, Bering C, Hildingh C, Almerud S. Non-attendees' attitudes to the design of a cardiac rehabilitation programme focused on information of risk factors and professional involvement. Eur J Cardiovasc Nurs 2009; 8(1): 62-6.
Luttik ML, Jaarsma T, Moser D, Sanderman R, van Veldhuisen DJ. The importance and impact of social support on outcomes in patients with heart failure: an overview of the literature. J Cardiovasc Nurs 2005; 20(3): 162-9.
Daly J, Sindone AP, Thompson DR, Hancock K, Chang E, Davidson P. Barriers to participation in and adherence to cardiac rehabilitation programs: a critical literature review. Prog Cardiovasc Nurs 2002; 17(1): 8-17.
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
Tel: (001)347-983-5186