Background and objectives:

Regular exercise is associated with decreased mortality and improved quality of life in individuals living with coronary artery disease (CAD). It has been suggested that individuals progress through stages of change in adopting regular exercise. In this study, we examined the influence of variables from the Social Ecological Model in predicting stage progression over 2 time periods following hospitalization in patients with CAD.

Methods:

801 patients, hospitalized with CAD were recruited from 3 hospitals in Eastern Ontario. Patients' completed measures of exercise stage of change, demographics, social ecological variables (perceived seriousness of heart disease, perceived risk of future event, exercise intentions, self efficacy, barriers to exercise, availability of home exercise equipment, availability of community exercise facilities, and participation in cardiac rehabilitation), smoking status, and BMI at hospital discharge (baseline) and 6 months and 1 year later. Exercise stage progression was measured over 2 consecutive time periods: baseline to six months (time 1-2) and six months to one year (time 2-3). Individuals in the maintenance stage were excluded from the analysis as they could not progress to a higher stage. At each time point participants were categorized as: 1) Regressors and Stables (moved back at least one stage or no change) or 2) Progressors (moved forward at least one stage). Univariate and multivariate analyses were conducted to identify predictors of stage progression over each time period.

Results:

For time 1-2, there were 242 Regressors and Stables compared to 359 Progressors. Univariate analyses revealed that education, BMI, availability of community exercise resources, and participation in cardiac rehabilitation were significant (P < .001) predictors of stage progression. A multivariate analysis revealed that only participation in cardiac rehabilitation ([beta] = 0.86; P < .001) was a significant independent predictor of stage progression. For time 2-3, there were 345 Regressors and Stables compared to 222 Progressors. Univariate analyses revealed that age, BMI, smoking status, exercise intentions, self-efficacy, barriers to exercise and participation in cardiac rehabilitation were significant (P < .001) predictors of stage progression. In the multivariate analysis, there were three independent predictors of stage progression: participation in cardiac rehabilitation ([beta] = 0.51; P = .018), BMI ([beta] = - 0.05; P = .020), and age ([beta] = .02; P = .048).

Conclusions:

Progression in exercise stages occurred following hospitalization for CAD. Progression was predicted by variables from different categories including social ecological, demographic, behavioural and biological. Participation in cardiac rehabilitation was an independent predictor of early and late exercise stage progression. These findings have implications for the design of interventions to promote physical activity in patients with CAD.

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For more information, contact Marilyn Thomas (204) 488-5854