Promoting and Enabling Adherence to Resistance Training Following Cardiac Rehabilitation

Abstract

The mortality/morbidity and quality of life benefits of exercise-based cardiac rehabilitation (CR) are well established, yet adherence to exercise is generally poor post-discharge. Recent trials have attempted to enhance adherence to aerobic activities during transition from CR to home-based exercise. However, these trials have not addressed resistance training, which is also an integral part of many participants' CR exercise routines. Because accessibility to familiar training equipment (e.g., weight machines) and instruction may be limited for many patients upon completion of CR, poor adherence to this beneficial form of exercise can be resultant. The purpose of this study was to examine the effects of a brief intervention involving the provision of a motivation-enhancing instructional manual and elastic Thera-Bands® on self-efficacy for, outcome expectancies for, and adherence to, upper body resistance exercise. It was hypothesized that participants receiving the intervention would report higher self-efficacy, outcome expectancies and greater adherence than those in a standard care control condition. The study was a randomized controlled trial involving informed and consenting CR participants recruited from an established outpatient CR programme at a major urban hospital (N = 40; n_males = 32; M_age= 61.20 ± 11.10). Participants in the intervention group (n=20) received an orientation to home-based upper body resistance training, a theory-based instructional manual designed to enhance self-efficacy and outcome expectations, and Thera-Bands®. The standard care control group received an orientation to home-based upper body resistance training and standard care CR follow-up (n=20). Participants completed baseline measures of self-efficacy for performing resistance training and activities of daily living as well as outcome expectancy measures one week prior to discharge from CR. The same measures were completed again one week later (i.e., at the end of the CR program), and at 4-weeks post-discharge. Participants logged their sets of upper-body resistance exercises continuously throughout the 4-week period following completion of the CR program. There were no differences between groups on any of the study variables at baseline. Participants in the intervention condition reported higher self-efficacy and outcome expectations for resistance training than controls at the 4-week follow-up assessment. Adherence to resistance training was significantly greater with the intervention group completing over twice as many (105%) sets over the four weeks than the control group. Maintaining or increasing upper body strength is an important outcome of CR as it relates to the performance of many activities of daily living. However, adherence to resistance exercises may be difficult upon completion of supervised, facility-based CR. This study illustrates that the provision of a motivation-enhancing instructional manual and low cost materials has a positive impact on self-efficacy, outcome expectations and adherence to resistance training, and may help participants make a successful transition to home-based resistance exercise.