Stages of Physical Activity in Patients after Coronary Artery Bypass ...

Health Education and Health Promotion (HEHP) (2016) Vol. 4 (3)

Stages of Physical Activity in Patients after Coronary Artery Bypass Graft Surgery: Application of Trans-Theoretical Model Zeinab Moazzami1 , Tahereh Rahimi2 *, Masoud Tarbiat3 , Alireza Soltanian4

Abstract Aim: Continuous physical activity is required after coronary artery bypass graft (CABG) surgery to prevent recurrence of the disease; however, its amount is not suitable in many patients. The present study aimed to investigate the stages of physical activity in patients after CABG using the Trans-Theoretical Model (TTM). Methods: In this cross-sectional research, 120 cardiac patients participated; they had CABG surgery and referred to Ekbatan Hospital of Hamadan. Sampling was conducted using a purpose-based approach. Data were collected using a researcher-made questionnaire based on the TTM and analyzed using the SPSS18 software. Descriptive statistics and statistical processes of one-way ANOVA, Tukey's post-hoc, and Chi-square tests were also conducted at a significant level of pp

5 ± 1.01

6.47 ± 1.28

10.50 ± 2.02

14.92 ± 2.78

18.13 ± 1.55

0.001>p

S tage of Change Variables

S elf-efficacy

Tukey's test PC< P,A,M C< A,M PC> C,P,A,M C> P,A,M P> A,M A> M PC< C,P,A,M C< P,A,M P< A,M A< M PC< C,P,A,M C< P,A,M P< A,M A< M

PC: Pre-contemplation, C: Contemplation, P: Preparation, A: Action, M : M aintenance

The mean scores and standard deviations of

contemplation and contemplation stages (p =

cognitive and behavioral processes based on the

0.2), and the highest difference was between the

stages of physical activity change in the patients

two

after CABG surgery are tabulated in Table 4.

maintenance (pp

Behavioral processes

25.20 ± 5.35

29.65 ± 6.18

33.14 ± 4.56

37.92 ± 3.12

40.60 ± 3.99

0.001>p

Change processes

60.80 ± 5.54

71.11 ± 11.06

78.55 ± 9.44

90.46 ± 8.82

99.26 ± 4.86

0.001>p

S tage of Change Variables

Tukey's test PC< P,A,M C< P,A,M P< A,M A< M PC< P,A,M C< P,A,M P< A,M PC< P,A,M C< P,A,M P< A,M

PC: Pre-contemplation, C: Contemplation, P: Preparation, A: Action, M : M aintenance

Discussion

surgery, only 10.8% of the patients were in

The results of the present study showed that

action

despite the importance of performing physical

maintenance phase of physical activity. It is

activity after CABG surgery in preventing

worth noting that 76.7% of the patients were in

recurrence of disease, most people did not

the early stages of change. In the study of

have regular physical activity after surgery. In

Huang et al., six months after open-heart

other words, more than three months after

surgery, 39.2% of the patients were in action 30

stage

and

12.5%

were

in the

Moazzami et al.


stage and 37.7% were in maintenance phase.

decreased significantly. The relationship of

The mentioned study was conducted within

individuals’ self-efficacy and viewpoints about

longer duration after surgery and had better

the pros and cons of physical activity with

results in comparison with the current study

their readiness to accept and perform them has

[17]. Jue and Cunnigham investigated the

been investigated in various studies. For

adherence of 253 cardiac patients over 60

example, Kirk et al. in their study on

years to exercise two years after CABG

cardiovascular and diabetic patients showed

surgery. Their results showed that 67% of the

that self-efficacy and positive aspects of

people had a long adherence to continuous

decisional balance increased during the change

physical activity, while 33% were still in the

stages, and those who were in maintenance

stages of pre-contemplation and contemplation

phase had higher scores in self-efficacy and

[18]. In the study conducted by Kirk et al. on

benefitted more than those who were in

85 patients with heart disease and diabetes, 2%

contemplation stage [19]. In addition, Henchoz

were in action stage, 29% were in maintenance

et al. studied patients with rheumatoid arthritis

stage, and more than 65% of the participants

and reported that those who were in pre-

were in two stages of contemplation and

contemplation phase had fewer perceived

preparation [19]. In order to achieve the

advantages and more barriers in performing

recommended level of physical activity in

physical activity than patients who were in

cardiac patients, to ensure about their health of

maintenance stage [20]. In Ronald's study,

to prevent from symptoms’

self-efficacy had a meaningful relationship

returning, continuous effort is needed to

with the physical activity stages of change, and

encourage and persuade these patients for

as a strong predictor, it explains performance

physical activity. This is due to the fact that

of exercise in adults with diabetes from

patients

preparation

heart,

and

may

forget

the

post-operation

to

maintenance

phase

[21].

educations they received or face with new

Patients' decision to move in the course of

obstacles after passing of time.

physical activity change stages depends on

In the current study, perceived advantages,

their positive and negative attitudes toward

self-efficacy, and perceived disadvantages

physical activity. Therefore, efforts to promote

were significantly correlated with the stages of

physical activity behavior in patients after

change. It means that with progress throughout

operation need to highlight its benefits and

the change processes, perceived advantages

identify the obstacles patients are going to be

and self-efficacy increased, while barriers

faced 31

with.

Health

professionals

should

Stages of Physical Activity in Patients after …

conduct

appropriate


interventions

and

mean score of daily exercise and the constructs

encourage patients who are in stages of action

of

and maintenance to perform physical activities

decision-making balance. This means that the

by positive reinforcement and regular follow-

scores of these variables increase throughout

ups. Furthermore, by advising and presenting

the change stages with the increase of daily

solutions, health professionals can overcome

activity [25]. Moodi et al. in their study over a

the existing barriers and fight against the

group of university staffs showed that the

patients’ negative perceptions about post-

mean scores of cognitive and behavioral

operative physical activity. They also can

processes increased significantly with progress

increase the self-efficacy of patients who are in

throughout the stages of change; from pre-

contemplation and pre-contemplation stages

contemplation stage to preparation, action, and

and help them to progress towards preparation

maintenance stages [26]. Fahrenwald and

and higher stages of change.

Walker demonstrated that use of change

In the present study, both cognitive and

processes along with self-efficacy would make

behavioral processes

patients

adults progress and move throughout stages of

indicated significant increase during the stages

change for participation in physical activity

of

to

[27]. Moreover, the results of a study on

change

patients with CVDs and diabetes showed that

processes represent cognitive, emotional, and

people who were at higher levels of change

behavioral strategies, and are overt and covert

stages used change processes, such as increase

actions that people can use to regulate their

in

behavior. In fact, use of cognitive strategies

relationships, reinforcement management, and

usually leads people who are moving over

counter-conditioning more frequently [19].

different stages of change to preparation stage,

Exchanges between stages and processes of

and application of behavioral strategies directs

change

them towards the action stage. Scientific

promotion of physical activity. In addition,

evidences have also proved the relationship

every process has higher effects in a particular

between the stages of change in a behavior and

stage of change. Considering these issues,

the particular processes used in those stages

information must be given to individuals by

[22-24]. Heydari et al. carried out a study on

conducting

393 patients with type 2 diabetes and found a

precisely proportional to the participants’ place

positive and significant correlation between the

in stages of change. In this regard, Marcus et

change

maintenance.

from The

in cardiac

pre-contemplation constructs

of

32

change

processes,

awareness,

have

self-efficacy,

self-freedom,

significant

unique

helping

implications

interventions

and

in

that are

Moazzami et al.

al.

emphasize


that

measuring

and

Lisabeth LD, Liu S, Mackey RH, Matchar

understanding the processes of change for

DB, McGuire DK, Mohler ER 3rd, Moy

physical activity behavior can help health

CS, Muntner P, Mussolino ME, Nasir K,

professionals to design interventions in order

Neumar RW, Nichol G, Palaniappan L,

that people move more quickly from one stage

Pandey DK, Reeves MJ, Rodriguez CJ,

to another [28].

Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW,

Conclusion

Turner MB. Heart disease and stroke

Generally, the findings of the present study

statistics 2015 update: a report from the

indicated that more than half of the cardiac

American Heart Association. Circulation

patients did not have regular physical activity

2015; 131(4): 322-9.

after CABG surgery and were at the early

2. Gaziano

TA,

Bitton

A,

Anand

S,

stages of preparation. This can lead to the

Abrahams-Gessel S, Murphy A. Growing

return of disease symptoms and complications.

Epidemic of Coronary Heart Disease in

Thus, physicians, physiotherapists and other

Low- and Middle-Income Countries. Curr

professionals working in this area are required

Probl Cardiol 2010; 35(2): 72-115.

to increase the patients’ physical activities and

3. Hadaegh F, Harati H, Ghanbarian A, Azizi

improve their health level by using motivating

F. Prevalence of coronary heart disease

factors within the framework of a proper

among Tehran adults: Tehran Lipid and

behavioral pattern such as TTM.

Glucose Study. East Mediterr Health J 2009; 15(1): 157-66. 4. Rosenfeldt F, Braun L, Spitzer O, Bradley

Acknowledgments We appreciate the cooperation of all patients

S, Shepherd J, Bailey M, Van der Merwe J,

and the respected authorities of Ekbatan

Leong JY, Esmore D. Physical conditioning

Hospital of Hamadan.

and mental stress reduction - a randomised trial in patients undergoing cardiac surgery.

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