Exercise Self-Efficacy, Habitual Physical Activity, and Fear of Falling in Patients with Coronary Heart Disease The purpose of this study was to determine if a relationship exists between self-efficacy for physical activity and other pertinent factors in patients with coronary heart disease (CHD). A secondary purpose of this study was to determine if self- efficacy and exercise behavior are different in patients who report a fearing of falling (fallers) as compared to patients who do not report a fear of falling (non-fallers). This study included 50 patients who were admitted to the hospital for a CHD related diagnosis. Patients completed assessments of cardiac self-efficacy (Modified Barnason Efficacy Expectation Scale) and exercise behavior self- efficacy (Self Efficacy for Exercise Behavior Scale). In addition, the Physical Function subscale of the RAND 36-Item Health Survey and the Telephone Interview of Cognitive Function were used to characterize physical and cognitive function, respectively. Older patients reported higher levels of cardiac self-efficacy. Further, a positive correlation was found between cardiac self efficacy and pre hospitalization level of physical function. Resisting Relapse subscale scores were significantly correlated. A higher percent of fallers failed to meet minimum exercise guidelines as compared to non-fallers. Abstract and Purpose LaPier T, Cleary K, Kidd J. Exercise Self-Efficacy, Habitual Physical Activity, and Fear of Falling in Patients with Coronary Heart Disease. Cardiopulmonary Physical Therapy. 2009;20(4):5-11 Introduction Study participants (n = 50) were volunteers prospectively recruited from Sacred Heart Medical Center. Inclusion criteria: hospital admission due to a CHD-related diagnosis, ability to follow directions, ability to understand English, and emotionally stable Exclusion criteria: included cardiac transplantation or ventricular assist device placement, cardiac arrhythmia or heart failure without concurrent diagnosis of CHD, isolation precautions in place, and/or cognitive deficit (< Level 6 on Rancho Los Amigos Level of Cognitive Functioning Scale). Data analysis info included age, BMI, income, education level, fear of falling &exercise habits. Fear of falling was scored as answering yes to one or more of the following questions: 1) Are you afraid of falling? 2) Do you limit any household activities because you are worried you may fall? 3) Do you limit any outside activities because you are worried you may fall? Exercise habits were determined by answering yes or no to exercising 30 mins or more in which increased once HR at least 3 days a week. Data collection involved completion of a packet of self report questionnaires (The Self-Efficacy for Exercise Behavior Scale, The Barnason Efficacy Expectation Scale, and The RAND 36-Item Health Survey) and administration of the Telephone Interview of Cognitive Status by a study investigator. Data Analysis -A correlational matrix: Pearson Product Correlations, T-tests, Chi Square Analysis and Alpha level of 0.05 Methods and Materials Clinical Significance Results Conclusion Study results suggest that patients with CHD are at risk for exercise drop out, and many fail to meet minimum exercise guidelines. Further, patients with higher income may have more resources to support their exercise adherence. Patients with lower physical function are less likely to independently engage in previous physical activities after a cardiac event compared to those with higher physical function. Results also may indicate that age brings experience and possibly confidence in coping with physical impairments. The majority of fallers failed to meet minimum exercise guidelines, indicating that fear of falling may contribute to activity restriction. It is important to identify factors associated with exercise self- efficacy. While multiple factors may contribute to higher or lower self- efficacy within a specific patient population, strategies to increase self-efficacy and patients’ participation in their own care should be implemented. Article #1 Pope L, Harvey-Berino J, Savage P, et al. The impact of high-calorie-expenditure exercise on quality of life in older adults with coronary heart disease. Journal of Aging and Physical Activity, 2011;19: This article is an Experimental-Randomized Clinical Trial (RCT) with a large amount of subjects (n=74) that were randomly assigned to 2 groups. Also concludes that a higher physical function level is better. Results showed that a high-calorie-expenditure (HCE) group had larger changes from baseline to 5 mo on scores of physical, emotional, and social functioning along with a greater positive change in exercise enjoyment than a standard cardiac- rehabilitation exercise group. Also used the topic of exercise in older adults with CHD as their focus. Discussion Kellie Johnston Bellarmine University D.P.T. Student While exercise is very important for all individuals, especially those with CHD and the elderly, many things can attribute to keeping one from doing so. It is very important for a physical therapist to help identify these negative factors causing them not to engage in physical activity, or what factors they need to avoid to stay engaged in exercise. Some of these include, but are not limited to the level one exercises and the fear of falling. If someone exercises at a higher level not only will that benefit them more physically, but emotionally as well (which will help in regards to one’s quality of life) and although the fear of falling may keep one from currently exercising, once they begin to do it, their fear will decrease. Physical Therapists can use this article to begin to identify certain risk factors for their individual patients in which might affect their self-efficacy and in turn affect their ability to commit to an exercise plan upon discharge to lead them towards benefits and away from regression. Yamada M, Arai H, Uemura K, et al. Effect of resistance training on physical performance and fear of falling in elderly with different levels of physical well being. Age and ageing. 2011;40(5): This article is an experimental clinical trial as two independent variables were manipulated.. Resistance training improved the physical performance (leg lean mass and balance) and decreased the fear of falling of subjects in frail group. However no improvement was shown from the resistance program in physical performance nor the fear of falling in their robust group. Concluded that it is essential to decrease the fear of falling by targeting downstream aspects as physical functioning or predictors of those factors. Like the original article, this study showed that the fear of falling and the performance of exercise do in fact relate to one another and in turn influence one another. Regular physical activity is an important lifestyle component for patients with CHD. Benefits include increased aerobic capacity, quality of life, anginal threshold, and ability to carry out daily activities and live independently. Current recommendations suggest that a comprehensive exercise program should include aerobic, flexibility, and strength training components are most beneficial for these patients. Many factors influence patients’ ability to engage is this such as lack of time, fear of injury, and considering it unimportant. Health care providers need to consider learning styles and obstacles to assist patients in the success of starting and sticking with an exercise program. Participation in outpatient cardiac rehabilitation (CR) is sometimes an option Less than half of patients eligible for outpatient CR actually enroll due to negative perceptions of their control over their health, financial constraints, limited accessibility, return to work, and lack of physician referral which along with self-efficacy often outweighs the benefits. Prior studies indicate that there is a relationship between self-efficacy and exercise behavior, functional status, quality of life, and social support in patients with CHD. Previous falls and or loss of balance and the subsequent fear of falling may contribute to sedentary behavior. Little is known about the relationships between exercise self-efficacy and age, socioeconomic status, prior physical function, cognition, and fear of falling in patients with CHD and therefore gaining this knowledge is the focus of this study. Article #2 The subjects of this study received scores on the Self-Efficacy for Exercise Scale that were less than 70% which indicated an increased risk for these participants to drop out of an exercise program. A correlation was made between one’s confidence level to sticking to an exercise plan and one’s income level in which the higher the income level the higher the confidence possibly due to more available resources, less physical demanding jobs, etc. Participants with a higher physical function were more confident in returning to physical activity as they may not have as limited repertoire of physical activities as lower physical functioning individuals have. With less confidence to begin with, people with lower physical functioning might have more to gain. The results of this study indicated that older individuals were more confident in their ability to return to physical activity. Along with age comes the experience of coping which in turn can better prepare one to engage in exercise. Less than 60% of the subjects participated in the minimum amount of exercise the guidelines suggest prior to being admitted into the hospital. 57% of non-fallers met the minimum of the guidelines where only 25% of fallers did. This proposes that previous falls and therefore a consequence of fear of falling, restricts one to sedentary behavior. Summary