Maintaining Exercise After Cardiac Rehabilitation

Maintaining exercise participation among patients who have completed cardiac rehabilitation
is integral to secondary prevention of coronary events and cardiac re-hospitalization.
Patients in Phase II cardiac rehabilitation programs, a majority being older adults,
participate in regular supervised exercise during the program; however, long-term adherence
to exercise is poor, with only 30% reporting regular exercise at 12 month follow-ups. To
promote exercise maintenance after completion of a 12 week Phase II rehabilitation program,
we propose to offer a theoretically-based intervention that we have used successfully to
promote exercise among older, primary-care patients. This program (Maintenance Counseling)
includes brief advice from the Cardiac Rehabilitation case manager at Phase II program
discharge followed by telephone-counseling based on the Transtheoretical Model of Behavior
Change and Social Cognitive Theory. Health educators will provide the telephone-based
intervention over 6 months. Using a randomized controlled design, 180 patients will be
assigned to Maintenance Counseling or Brief Advice plus Contact Control. Outcome assessments
will include an exercise tolerance test (baseline/post-rehabilitation and 6 months),
self-reported exercise participation, motivational readiness for exercise, and objective
activity monitoring at baseline, 6, 12 and 18 months. These data will help to identify
whether telephone-based exercise counseling is an effective strategy for sustaining regular
exercise and fitness among cardiac rehabilitation patients thereby contributing to secondary
prevention of coronary heart disease.

Inclusion Criteria:: 1) men and women aged >40 years participating in supervised Phase II
CR. The CR population tends to be older (mean age: 64.5+11.9, range 38-83 years,
Preliminary Studies C.6.) and by including adults as young as 40 years, we expect to offer
the program to the majority of Phase II CR patients. (2) scheduled to complete Phase II CR
in the next 4 weeks, 3) able to read and speak English, 4) provide consent for medical
chart review to extract disease and treatment variables, 5) able to walk unassisted. 6) We
plan to include patients who participated in Phase II CR due to a diagnosis of coronary
heart disease (e.g., post- MI, CABG, chronic angina pectoris) or chronic heart failure.

Exclusion Criteria:1) Prior neurological brain disorder (e.g., Seizure Disorder, Traumatic
Brain Injury. Patients with prior neurological disease, including large vessel stroke and
Alzheimer’s Disease will be excluded. 2) An arbitrary Mini-Mental Status Examination
(MMSE) cutoff score of >10 will be set to exclude patients whose scores suggest dementia
or cognitive impairments that will interfere with ability to provide informed consent and
complete research demands.