Persons older than 60 now comprise 60% of patients who have cardiac events. Unfortunately, the positive evidence of exercise to reduce mortality, morbidity, and future cardiac events following an acute cardiac event in persons of all ages is not enough to motivate people to maintain long-term exercise. At 6 months after a cardiac event only 15-40% of people exercise at levels consistent with recommended guidelines.
The CHANGE Study (2000–2005), tested an intervention to increase individuals’ exercise maintenance after cardiac rehabilitation. The CHANGE intervention successfully reduced the number of people who stopped exercising, although the effect was greater in the maintenance phase than the adoption phase. Analysis of data from the study, combined with a review of emerging theory in the behavior change field, indicated that we needed to improve the change program. Thus, we have modified the CHANGE intervention for the current study: Improving Long-term Exercise in Older Cardiac Patients.
The original CHANGE intervention has been modified in two ways. First, the cognitive-behavioral framework that underlies the small group education sessions has been retained, and telephone boosters have been added, to increase the effectiveness of the intervention. This intervention is called CHANGE+. The second modification replaces the cognitive-behavioral framework with a Systems Improvement framework. The focus of the intervention shifts from the individual to a more comprehensive model targeting the person’s immediate environment surrounding the performance of habitual exercise. This intervention is called SystemCHANGE.
This study will use a randomized clinical trial with 3 groups to conduct a head-to-head evaluation of the two different interventions, SystemCHANGE and CHANGE+, as compared to Usual Care, to improve the adoption and maintenance of exercise in older cardiac patients.
Study questions are: (1) Is there a difference between SystemCHANGE, CHANGE+, and Usual Care in exercise adoption when controlling for covariates ( age, race, functional capacity, body fat, co-morbidity, muscle or joint pain, exercise experience, home and neighborhood environment, and depression), for individuals following a cardiac rehabilitation program (CRP)? (2) Is there a difference between SystemCHANGE, CHANGE+, and Usual Care in exercise maintenance when controlling for covariates? (3) Do system changes, social support for exercise, problem-solving skills, motivation, health beliefs, and exercise self-efficacy mediate the effects of SystemCHANGE, CHANGE+, or Usual Care on exercise adoption? (4) Do system changes, social support for exercise, problem-solving skills, motivation, health beliefs, and exercise self-efficacy mediate the effects of SystemCHANGE, CHANGE+, or Usual Care on exercise maintenance? (5) What are the economic impacts of the SystemCHANGE and CHANGE+ interventions in terms of health care spending, labor force participation and earnings, and household productivity?
Older persons (N=420) recovering from cardiac events will be randomly assigned to the three groups. Measures of exercise adoption and maintenance (# of hours exercised, # of hours exercised in target heart rate zone, # of exercise sessions, # of metabolic equivalents {METS} expended, and whether or not a subject remains exercising) will be taken for 1 year after completion of a Cardiac Rehabilitation Program using heart rate wristwatch monitors, exercise diaries, and a 7-Day Recall Survey. The effect of covariates also will be assessed. Mechanisms by which the interventions achieve their effects will be determined. Multivariate analyses will examine and compare the effects of the interventions over time. A cost-effectiveness analysis also will be conducted.
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