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Behavioral intervention helped increase physical activity after PCI
Peterson JC. Arch Intern Med. 2012;doi:10.1001/archinternmed.2011.1311.
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A behavioral intervention that focused on positive affirmation helped patients who underwent percutaneous coronary intervention improve their physical activity by 1 year.
A new study included 242 patients who underwent PCI between 2004 and 2006. All were randomly assigned to patient education or positive affect/self-affirmation behavioral intervention. The patient education group, which was used as a control group, received an educational workbook, pedometer and behavioral contract for physical activity goals. The intervention group received the three patient education components, besides additional workbooks, bimonthly induction of positive affect/self-affirmation by telephone and small mailed gifts. Researchers contacted all patients with standardized bimonthly telephone follow-up for the 12 months after PCI.
About two-thirds of patients chose walking as their physical activity.
By 12 months, the intervention group was more likely to reach the main outcome of at least a 336-kcal increase in expenditure per week as compared with the control group (54.9% vs. 37.4% P=.007); this trend persisted when the researchers controlled for demographic and psychosocial measures. Patients in the intervention group were 1.7 times more likely to reach the goal of a 336-kcal or more increase by 12 months, the researchers found. Multivariate analysis showed that improvement in weekly kilocalorie expenditure was nearly double in the intervention group vs. the control group at 12 months (602 kcal vs. 328 kcal; P=.03). According to the researchers, this difference in expenditure of kilocalories is equivalent to the intervention group walking 7.5 miles per week vs. the control group walking 4.1 miles per week.
Overall, attrition was 4.5%. During the course of the study, 2.1% of patients died. Patients in the intervention group had a lower rate of combined CV morbidity and all-cause mortality compared with the control group (12.3% vs. 19.1%; P=.15).
Behavioral intervention with positive affect/self-affirmation also improved depressive symptoms from baseline to 12 months, with patients in the intervention group more likely to recover from depressive symptoms than patients in the control group.
“This study presents an intervention that successfully motivated patients who received PCI, resulting in increased physical activity and decreased depressive symptoms at 12 months,” the researchers concluded. “The long-term goal is to implement the positive affect/self-affirmation intervention over an even longer time frame to document maintenance patterns of physical activity and the occurrence of improved longer-term clinical and psychosocial outcomes in patients who receive PCI.”
Disclosure: The researchers report no relevant financial disclosures.
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Giving patients positive affect/self-affirmation comments and encouragement can really help them increase physical activity. The long-term idea is that if we can help people increase their exercise we might be able to improve their CV outcomes because physical inactivity is a very strong risk factor for CV events. We can encourage our patients and give them statements of self-affirmation to help them feel confident about improving their physical activity and taking control over their own health. Self-affirmation may be a very inexpensive way to make a big difference. We spend tons of money on statins and other medications to decrease the risk for coronary events. This may help empower patients to take control of their own health.
– Mary A. Whooley, MD
Professor of
Medicine, Epidemiology and Biostatistics
University of California, San
Francisco
Disclosure: Dr. Whooley reports no relevant financial disclosures.
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