Patient Preference and Adherence (Dec 2020)
The Added Value of a Behavioral Medicine Intervention in Physiotherapy on Adherence and Physical Fitness in Exercise-Based Cardiac Rehabilitation (ECRA): A Randomised, Controlled Trial
Abstract
Sabina Borg,1,2 Birgitta Öberg,1 Lennart Nilsson,3 Anne Söderlund,4 Maria Bäck1,5 1Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden; 2Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; 3Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University, Linköping, Sweden; 4Department of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden; 5Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, SwedenCorrespondence: Maria BäckDepartment of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, S-581 83, Linköping, SwedenTel +46 700 852795Email [email protected]: Despite beneficial effects, adherence to exercise-based cardiac rehabilitation (exCR) is low in patients with coronary artery disease (CAD). The aim of this study was to investigate adherence to and the effects of a behavioral medicine intervention in physiotherapy (BMIP) added to routine exCR care on the primary outcome of physical fitness compared with routine exCR care.Patients and Methods: In a randomized, controlled trial, 170 patients with CAD (136 men), mean age 62.3 (7.9) years, were included at a Swedish university hospital. Patients were randomized 1:1 to routine exCR care (RC) or to a BMIP added to routine exCR care for four months, with a long-term follow-up at 12 months. The outcome assessment included submaximal aerobic exercise capacity, muscle endurance and self-reported physical activity and physical capacity.Results: The four-month follow-up showed improvements in all outcomes for both groups, but changes did not differ significantly between the groups. Patients in the BMIP group were more adherent to exCR recommendations compared with the RC group (31% vs 19%) and a non-significant tendency towards the maintenance of submaximal aerobic exercise capacity over time was seen in the BMIP group, whereas patients in the RC group appeared to deteriorate.Conclusion: Both groups improved significantly at the four-month follow-up, while the 12-month follow-up showed a non-significant tendency towards better long-term effects on submaximal aerobic exercise capacity and exercise adherence for a BMIP compared with RC. In spite of this, a better understanding of the role of a BMIP in enhancing adherence is needed.Keywords: aerobic capacity, coronary artery disease, control theory, secondary prevention
