models by health educators. Keywords: Physical activity, Coronary artery bypass graft surgery, Trans-theoretical model. 1. M.Sc. in Health Education and ...
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.
Health Education and Health Promotion (HEHP) (2016) Vol. 4 (3)
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
Health Education and Health Promotion (HEHP) (2016) Vol. 4 (3)
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
Health Education and Health Promotion (HEHP) (2016) Vol. 4 (3)
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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