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J Cardiovasc Nurs. 2014 Mar-Apr;29(2):168-77. doi: 10.1097/JCN.0b013e318282c8d6.

Exercise self-efficacy and symptoms of depression after cardiac rehabilitation: predicting changes over time using a piecewise growth curve analysis.

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Alisha D. Howarter, MA Doctoral Candidate, Department of Psychology, University of Missouri-Kansas City. Kymberley K. Bennett, PhD Assistant Professor, Department of Psychology, University of Missouri-Kansas City. Carolyn E. Barber, PhD Assistant Professor, Department of Counseling and Educational Psychology, University of Missouri-Kansas City. Stacia N. Gessner, MA Graduate Student, Department of Psychology, University of Missouri-Kansas City. Jillian M.R. Clark, BS Graduate Student, Department of Psychology, University of Missouri-Kansas City.



Cardiac rehabilitation is often recommended after experiencing a cardiac event and has been shown to significantly improve health outcomes among patients. Several psychosocial variables have been linked with cardiac rehabilitation program success, including exercise self-efficacy. However, little is known about temporal patterns in patients' exercise self-efficacy after program completion.


This study examined changes in exercise self-efficacy among 133 cardiac rehabilitation patients and whether symptoms of depression impacted the rate of change in exercise self-efficacy.


Participants completed questionnaires at the beginning and end of cardiac rehabilitation and at 6-month intervals for 2 years.


Growth curve analyses showed that exercise self-efficacy levels were highest at the beginning of cardiac rehabilitation, significantly declined 6 months after cardiac rehabilitation, and leveled off over the next 18 months. Results also showed that baseline depressive symptoms interacted with time: Compared with participants with fewer symptoms, participants high in depressive symptoms began cardiac rehabilitation with lower levels of exercise self-efficacy and evidenced significant declines 6 months after cardiac rehabilitation. At no time were they equal to their counterparts in exercise self-efficacy, and their means were lower 2 years after cardiac rehabilitation than before cardiac rehabilitation.


Our findings imply that patients show unrealistic optimism surrounding the ease of initiating and maintaining an exercise program and that integrating efficacy-building activities into cardiac rehabilitation, especially for patients who show signs of distress, is advisable.

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