Exercise barriers and the relationship to self-efficacy for exercise over 12 months of a lifestyle-change program for people with heart disease and/or diabetes

Abstract

Background:

Barriers to exercise are common in people with coronary heart disease (CHD) and/or diabetes mellitus (DM), and may influence self-efficacy for exercise.

Purpose:

The purpose of this study was to describe the exercise barriers experienced by people who have CHD and/or DM participating in the Healthy Eating and Exercise Lifestyle Program and to determine whether these barriers influence self-efficacy.

Methods:

Participants (n = 134) identified their barriers to exercise and completed the self-efficacy for exercise survey at baseline, at 4 months (following structured and supervised exercise) and at 12 months (following home-based exercise with three follow-up calls).

Results:

The sample mean age was 63.6 years (SD 8.5) and 58% were male. Barriers to exercise were reported by 88% at baseline, 76% at 4 months, and 47% at 12 months. The most common barriers were lack of motivation (40.3%), lack of time overall (30.6%), and lack of time due to family commitments (17.2%). Only motivation changed significantly over time from baseline (40%) to 4 months (23%, p = 0.040). Lower self-efficacy for exercise was associated with lack of motivation at 12 months only, more depressive symptoms at baseline and 4 months, and a CHD diagnosis and higher body mass index at 12 months. In contrast, male gender and having higher self-efficacy at baseline were associated with higher self-efficacy for exercise at 4 and 12 months.

Conclusion:

Patients identified many exercise barriers despite participating in a lifestyle-change program. Lack of motivation negatively influenced self-efficacy for exercise at 12 months. Other factors needing attention include baseline self-efficacy, depressive symptoms, being female, being more overweight, and having CHD.

Keywords

Exercise intervention barriers self-efficacy coronary heart disease diabetes

Get full access to this article

View all access options for this article.

References

Deedwania

. Diabetes, cardiovascular disease, and ethnicity. J Am Coll Cardiol 2013; 61: 1787–1789.

Haskell

Lee

Pate

. Physical activity and public health: Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007; 39: 1423–1434.

Otterstad

. Influence on lifestyle measures and five-year coronary risk by a comprehensive lifestyle intervention programme in patients with coronary heart disease. Eur J Cardiovasc Prev Rehabil 2003; 10: 429–437.

Gallagher

Armari

White

. Multi-component weight-loss interventions for people with cardiovascular disease and/or type 2 diabetes mellitus: A systematic review. Eur J Cardiovasc Nurs 2013; 12: 320–329.

Alharbi

Gallagher

Kirkness

. Long-term outcomes from Healthy Eating and Exercise Lifestyle Program for overweight people with heart disease and diabetes. Eur J Cardiovasc Nurs 2014; 15: 91–99.

Bandura

. Self-Efficacy: The Exercise of Control. New York, USA: Freeman, 1997.

Bandura

. Social Foundations of Thought and Action: A Social Cognitive Theory. Upper Saddle River, NJ, USA: Prentice Hall, 1986.

Slovinec D’Angelo

Pelletier

Reid

. The roles of self-efficacy and motivation in the prediction of short-and long-term adherence to exercise among patients with coronary heart disease. Health Psychol 2014; 33: 1344–1353.

Luszczynska

Sutton

. Physical activity after cardiac rehabilitation: Evidence that different types of self-efficacy are important in maintainers and relapsers. Rehabil Psychol 2006; 51: 314–321.

10.

Sol

Graaf

Bijl

. Self-efficacy in patients with clinical manifestations of vascular diseases. Patient Educ Couns 2006; 61: 443–448.

11.

Grace

Barry-Bianchi

Stewart

. Physical activity behavior, motivational readiness and self-efficacy among Ontarians with cardiovascular disease and diabetes. J Behav Med 2007; 30: 21–29.

12.

Blanchard

Reid

Morrin

. Barrier self-efficacy and physical activity over a 12-month period in men and women who do and do not attend cardiac rehabilitation. Rehabil Psychol 2007; 52: 65–73.

13.

Barkley

Fahrenwald

. Evaluation of an intervention to increase self-efficacy for independent exercise in cardiac rehabilitation. Behav Med 2013; 39: 104–110.

14.

Bazargani

Besharat

Ehsan

. The efficacy of chronic disease self management program and Tele-health on adherence by increasing self efficacy in patients with CABG. Procedia Soc Behav Sci 2011; 30: 817–821.

15.

Mohebi

Azadbakht

Feizi

. Review the key role of self-efficacy in diabetes care. J Educ Health Promot 2013; 2: 36–43.

16.

Annesi

Gorjala

. Relations of self-regulation and self-efficacy for exercise and eating and BMI change: A field investigation. Biopsychosoc Med 2010; 4: 269–278.

17.

Blanchard

Arthur

Gunn

. Self-efficacy and outcome expectations in cardiac rehabilitation: Associations with women’s physical activity. Rehabil Psychol 2015; 60: 59–66.

18.

Blanchard

Rodgers

Courneya

. Does barrier efficacy mediate the gender–exercise adherence relationship during phase II cardiac rehabilitation? Rehabil Psychol 2002; 47: 106–120.

19.

Cherrington

Wallston

Rothman

. Exploring the relationship between diabetes self-efficacy, depressive symptoms, and glycemic control among men and women with type 2 diabetes. J Behav Med 2010; 33: 81–89.

20.

Heiss

Petosa

. Social cognitive theory correlates of moderate-intensity exercise among adults with type 2 diabetes. Psychol Health Med 2015; 21: 1–10.

21.

Ewart

. The role of physical self-efficacy in recovery from heart attack. In: Schwarzer

(ed.). Self-Efficacy: Thought Control of Action. Washington, DC, USA: Hemisphere, 1992, pp. 287–305.

22.

Feltz

Payment

. Self-efficacy beliefs related to movement and mobility. Quest 2005; 57: 24–36.

23.

Tulloch

Sweet

Fortier

. Exercise facilitators and barriers from adoption to maintenance in the diabetes aerobic and resistance exercise trial. Can J Diabetes 2013; 37: 367–374.

24.

Egan

Mahmood

Fenton

. Barriers to exercise in obese patients with type 2 diabetes. QJM 2013; 106: 635–638.

25.

Petter

Blanchard

Kemp

. Correlates of exercise among coronary heart disease patients: Review, implications and future directions. Eur J Cardiovasc Prev Rehabil 2009; 16: 515–526.

26.

Jason

McGannon

Blanchard

. A systematic gender-based review of physical activity correlates in coronary heart disease patients. Int Rev Sport Exerc Psychol 2014; 8: 1–23.

27.

Rogerson

Murphy

Bird

. “I don’t have the heart”: A qualitative study of barriers to and facilitators of physical activity for people with coronary heart disease and depressive symptoms. Int J Behav Nutr Phys Act 2012; 9: 140–149.

28.

Ferrier

Blanchard

Vallis

. Behavioural interventions to increase the physical activity of cardiac patients: A review. Eur J Cardiovasc Prev Rehabil 2011; 18: 15–32.

29.

Reid

Tulloch

Kocourek

. Who will be active? Predicting exercise stage transitions after hospitalization for coronary artery disease. Can J Physiol Pharmacol. 2007; 85: 17–23.

30.

Conraads

Deaton

Piotrowicz

. Adherence of heart failure patients to exercise: Barriers and possible solutions. Eur J Heart Fail 2012; 14: 451–458.

31.

British Heart Foundation. The national audit of cardiac rehabilitation annual statistical report 2014. http://www.cardiacrehabilitation.org.uk/nacr/docs/2014.pdf (2014, accessed 6 February 2016).

32.

Gallagher

Kirkness

Zelestis

. A randomised trial of a weight loss intervention for overweight and obese people diagnosed with coronary heart disease and/or type 2 diabetes. Ann Behav Med 2012; 44: 119–128.

33.

Linde

Rothman

Baldwin

. The impact of self-efficacy on behavior change and weight change among overweight participants in a weight loss trial. Health Psychol 2006; 25: 282–291.

34.

Zigmond

Snaith

. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983; 67: 361–370.

35.

Leung

Ceccato

Stewart

. A prospective examination of patterns and correlates of exercise maintenance in coronary artery disease patients. J Behav Med 2007; 30: 411–421.

36.

Ziv

Lidor

. Music, exercise performance, and adherence in clinical populations and in the elderly: A review. J Clin Sport Psychol 2011; 5: 1–23.

37.

Adam

Folds

. Depression, self-efficacy, and adherence in patients with type 2 diabetes. J Nurse Pract 2014; 10: 646–652.

38.

Dutton

Tan

Provost

. Relationship between self-efficacy and physical activity among patients with type 2 diabetes. J Behav Med 2009; 32: 270–277.

39.

Bandura

. Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev 1977; 84: 191–215.

40.

Chase

J-AD

. Systematic review of physical activity intervention studies after cardiac rehabilitation. J Cardiovasc Nurs 2011; 26: 351–358.

41.

Sniehotta

Scholz

Schwarzer

. Long-term effects of two psychological interventions on physical exercise and self-regulation following coronary rehabilitation. Int J Behav Med 2005; 12: 244–255.

42.

Janssen

De Gucht

van Exel

. A self-regulation lifestyle program for post-cardiac rehabilitation patients has long-term effects on exercise adherence. J Behav Med 2014; 37: 308–321.

43.

Chiauzzi

Rodarte

DasMahapatra

. Patient-centered activity monitoring in the self-management of chronic health conditions. BMC Med 2015; 13: 77–82.

44.

Bravata

Smith-Spangler

Sundaram

. Using pedometers to increase physical activity and improve health: A systematic review. JAMA 2007; 298: 2296–2304.

45.

Izawa

Watanabe

Omiya

. Effect of the self-monitoring approach on exercise maintenance during cardiac rehabilitation: A randomized, controlled trial. Am J Phys Med Rehabil 2005; 84: 313–321.

46.

Butler

Furber

Phongsavan

. Effects of a pedometer-based intervention on physical activity levels after cardiac rehabilitation: A randomized controlled trial. J Cardiopulm Rehabil Prev 2009; 29: 105–114.

47.

Furber

Butler

Phongsavan

. Randomised controlled trial of a pedometer-based telephone intervention to increase physical activity among cardiac patients not attending cardiac rehabilitation. Patient Educ Couns 2010; 80: 212–218.

48.

Pinto

Goldstein

Papandonatos

. Maintenance of exercise after phase II cardiac rehabilitation: A randomized controlled trial. Am J Prev Med 2011; 41: 274–283.

49.

Qiu

Cai

Chen

. Step counter use in type 2 diabetes: A meta-analysis of randomized controlled trials. BMC Med 2014; 12: 36–45.

50.

Kaminsky

Jones

Riggin

. A pedometer-based physical activity intervention for patients entering a maintenance cardiac rehabilitation program: A pilot study. Cardiovasc Diagn Ther 2013; 3: 73–79.