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A randomized controlled trial of positive-affect induction to promote physical activity after percutaneous coronary intervention.

ABSTRACT: BACKGROUND:Within 1 year after percutaneous coronary intervention, more than 20% of patients experience new adverse events. Physical activity confers a 25% reduction in mortality; however, physical activity is widely underused. Thus, there is a need for more powerful behavioral interventions to promote physical activity. Our objective was to motivate patients to achieve an increase in expenditure of 336 kcal/wk or more at 12 months as assessed by the Paffenbarger Physical Activity and Exercise Index. METHODS:Two hundred forty-two patients were recruited immediately after percutaneous coronary intervention between October 2004 and October 2006. Patients were randomized to 1 of 2 groups. The patient education (PE) control group (n = 118) (1) received an educational workbook, (2) received a pedometer, and (3) set a behavioral contract for a physical activity goal. The positive-affect/self-affirmation (PA) intervention group (n = 124) received the 3 PE control components plus (1) a PA workbook chapter, (2) bimonthly induction of PA by telephone, and (3) small mailed gifts. All patients were contacted with standardized bimonthly telephone follow-up for 12 months. RESULTS:Attrition was 4.5%, and 2.1% of patients died. Significantly more patients in the PA intervention group increased expenditure by 336 kcal/wk or more at 12 months, our main outcome, compared with the PE control group (54.9% vs 37.4%, P = .007). The PA intervention patients were 1.7 times more likely to reach the goal of a 336-kcal/wk or more increase by 12 months, controlling for demographic and psychosocial measures. In multivariate analysis, the PA intervention patients had nearly double the improvement in kilocalories per week at 12 months compared with the PE control patients (602 vs 328, P = .03). CONCLUSION:Patients who receive PA intervention after percutaneous coronary intervention are able to achieve a sustained and clinically significant increase in physical activity by 12 months. Trial Registration clinicaltrials.gov Identifier: NCT00248846.

SUBMITTER: Peterson JC

PROVIDER: S-EPMC3717982 | biostudies-literature | 2012 Feb

REPOSITORIES: biostudies-literature

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A randomized controlled trial of positive-affect induction to promote physical activity after percutaneous coronary intervention.

Peterson Janey C JC Charlson Mary E ME Hoffman Zachary Z Wells Martin T MT Wong Shing-Chiu SC Hollenberg James P JP Jobe Jared B JB Boschert Kathryn A KA Isen Alice M AM Allegrante John P JP

Archives of internal medicine 20120123 4

<h4>Background</h4>Within 1 year after percutaneous coronary intervention, more than 20% of patients experience new adverse events. Physical activity confers a 25% reduction in mortality; however, physical activity is widely underused. Thus, there is a need for more powerful behavioral interventions to promote physical activity. Our objective was to motivate patients to achieve an increase in expenditure of 336 kcal/wk or more at 12 months as assessed by the Paffenbarger Physical Activity and Ex ...[more]

PMID: 22269589

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Project description:ObjectivesTo explore the effectiveness of the mobile app-based multidisciplinary exercise management on patients who receive percutaneous coronary intervention (PCI).MethodsFrom January to October 2020, 54 patients after PCI were randomly assigned to the intervention group (n = 27) and the control group (n = 27). The intervention group received the mobile app-based multidisciplinary exercise management, whereas the control group received routine care. The patients after PCI began to take intervention one month after the operation, and the intervention lasted for two months. Before and after the intervention, 6-Minute Walking Distance was used to evaluate the patient's exercise tolerance, and the patient's exercise compliance was evaluated according to the patient's exercise status recorded by the mobile app. The cognitive questionnaire on knowledge about PCI treatment for Coronary Heart Disease, the Self-efficacy for Chronic Disease Scale and the Perceived Social Support Scale were used to evaluate patients' disease-related cognition, self-efficacy and perception of social support. This study was registered on Clinical Trials.gov with registration number ChiCTR2000028930.ResultsTotally 51 patients after PCI who completed this study (25 patients in the intervention group and 26 patients in the control group) were included in the analysis. After 2 months of intervention, the exercise compliance of patients in the intervention group was better than that in the control group. And 6-Minute Walking Distance (469.36 ± 57.48 vs. 432.81 ± 67.09), and the scores of knowledge of PCI treatment for coronary heart disease (52.64 ± 9.82 vs. 42.42 ± 8.54), Self-efficacy for Chronic Disease Scale (42.40 ± 8.04 vs. 36.88 ± 7.73) and Perceived Social Support Scale (74.04 ± 5.73 vs. 66.69 ± 6.86) in the intervention group were higher than those in the control group with statistical significance (P < 0.05).ConclusionsThe multidisciplinary exercise management based on the mobile app can effectively improve exercise tolerance, exercise compliance, disease-related cognition, self-efficacy, and perception of social support during exercise training for patients after PCI.

Project description:Inconsistent results exist regarding the treatment effectiveness of immediate versus deferred percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). This meta-analysis aimed to evaluate the efficacy and safety of immediate versus deferred PCI in ACS patients. PubMed, EMBASE, and Cochrane Library electronic databases were systematically searched from their inception up to August 2019. Random-effects models were employed to calculate pooled relative risks (RRs) and weight mean differences (WMDs) with 95% confidence intervals (CIs). A total of 10 randomized controlled trials (RCTs) that recruited 3350 patients were selected for inclusion in the final meta-analysis. Four trials included patients with non-ST elevation ACS (NSTEACS), whereas the remaining six trials included patients with ST elevation myocardial infarction (STEMI). There were no significant differences between immediate versus deferred PCI for the risk of major adverse cardiovascular events (NSTEACS patients: RR, 0.76, 95%CI, 0.33-1.75, P = 0.513; STEMI patients: RR, 1.24, 95%CI, 0.80-1.92, P = 0.335), myocardial infarction (NSTEACS patients: RR, 0.88, 95%CI, 0.27-2.81, P = 0.826; STEMI patients: RR, 0.86, 95%CI, 0.43-1.74, P = 0.678), all-cause mortality (NSTEACS patients: RR, 0.85, 95%CI, 0.38-1.88, P = 0.686; STEMI patients: RR, 1.16, 95%CI, 0.82-1.66, P = 0.407), target vessel revascularisation (NSTEACS patients: RR, 1.26, 95%CI, 0.29-5.43, P = 0.756; STEMI patients: RR, 1.01, 95%CI, 0.51-1.97, P = 0.988), or major bleeding (NSTEACS patients: RR, 0.99, 95%CI, 0.64-1.54, P = 0.972; STEMI patients: RR, 0.90, 95%CI, 0.45-1.77, P = 0.753). Although patients who underwent immediate PCI may experience increased incidences of cardiac death (RR, 1.19, 95%CI, 0.69-2.07, P = 0.525) and no or slow reflow (RR, 1.60, 95%CI, 0.91-2.84, P = 0.105), these increases were not statistically significant. We noted that immediate versus deferred PCI was associated with a reduced incidence of myocardial brush grade 3 (RR, 0.70, 95%CI, 0.56-0.88, P = 0.002); however, no significant differences were observed between immediate and deferred PCI for TIMI III flow (RR, 0.98, 95%CI, 0.93-1.03, P = 0.453), complete ST-segment resolution (RR, 0.93, 95%CI, 0.75-1.17, P = 0.548), and ejection fraction (WMD, -1.05, 95%CI, -2.58 to 0.49, P = 0.182). The findings of this study suggested that deferred PCI did not yield significant benefits for clinical endpoints. Further large-scale RCTs should be conducted to verify the findings of this study.

Project description:BackgroundPhysicians are expected to serve as role models for healthy lifestyles, but long work hours reduce time for healthy behaviors. A hospital-based physical activity intervention could improve physician health and increase counseling about exercise.MethodsWe conducted a two-phase intervention among 104 medical residents at a large hospital in Boston, Massachusetts. Phase 1 was a 6-week randomized controlled trial comparing daily steps of residents assigned to an activity monitor displaying feedback about steps and energy consumed (intervention) or to a blinded monitor (control). Phase 2 immediately followed and was a 6-week non-randomized team steps competition in which all participants wore monitors with feedback. Phase 1 outcomes were: 1) median steps/day and 2) proportion of days activity monitor worn. The Phase 2 outcome was mean steps/day on days monitor worn (≥500 steps/day). Physiologic measurements were collected at baseline and study end. Median steps/day were compared using Wilcoxon rank-sum tests. Mean steps were compared using repeated measures regression analyses.ResultsIn Phase 1, intervention and control groups had similar activity (6369 vs. 6063 steps/day, p = 0.16) and compliance with wearing the monitor (77% vs. 77% of days, p = 0.73). In Phase 2 (team competition), residents recorded more steps/day than during Phase 1 (CONTROL: 7,971 vs. 7,567, p = 0.002;Intervention7,832 vs. 7,739, p = 0.13). Mean compliance with wearing the activity monitor decreased for both groups during Phase 2 compared to Phase 1 (60% vs. 77%, p<0.001). Mean systolic blood pressure decreased (p = 0.004) and HDL cholesterol increased (p<0.001) among all participants at end of study compared to baseline.ConclusionsAlthough the activity monitor intervention did not have a major impact on activity or health, the high participation rates of busy residents and modest changes in steps, blood pressure, and HDL suggest that more intensive hospital-based wellness programs have potential for promoting healthier lifestyles among physicians.Trial registrationClinicaltrials.gov NCT01287208.

Dataset Information

A randomized controlled trial of positive-affect induction to promote physical activity after percutaneous coronary intervention.

Publications

A randomized controlled trial of positive-affect induction to promote physical activity after percutaneous coronary intervention.

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