Cardiac Rehab Research

Cardiac Rehab Research

Cardiac Rehab Research Abstracts 1997-1999

Cardiac Rehab Research Abstracts 1997-1999

Scales, R., Cosgrove, R, Mann, P. (1999). Self-reported adherence to medication in patients with coronary artery disease. International Pharmaceutical Abstracts, Abstract 34: P-13R, 36, 21: 2251.

Scales, R., Cosgrove, R, Mann, P. (1999). Self-reported adherence to medication in patients with coronary artery disease. International Pharmaceutical Abstracts, Abstract 34: P-13R, 36, 21: 2251.

Cardiac health may be compromised by non-adherence to prescribed medication. Therefore, the Medication Adherence Scale (MAS; Brooks et al., 1994) was used to assess adherence in patients with coronary artery disease. The study comprised 61 patients (71% males) who had experienced a cardiac event 40 days (SD=37) days earlier. The MAS consisted of 4 yes-no questions about adherence over the previous 3 months. Thirty-four percent self-reported full adherence to prescribed medication. The most common reasons for non­adherence included forgetfulness (57%) and carelessness (26%). In patients who were feeling better, 5% stopped taking medication and 7% took less than prescribed. It appears that the MAS may be a worthwhile method of identifying non-adherence to medication in patients with coronary artery disease.


Scales, R., Regensteiner, J. G., Haskell, W., Bottaro, M. M. (1999). Assessing the physical activity levels of cardiac patients with the Lo-PAR Questionnaire. Proceedings of a conference (Abstract, 99, 9: A-115). 22nd Simposio Internaticional de Ciências do Esporte, Sao Paulo, Brazil.

Scales, R., Regensteiner, J. G., Haskell, W., Bottaro, M. M. (1999). Assessing the physical activity levels of cardiac patients with the Lo-PAR Questionnaire. Proceedings of a conference (Abstract, 99, 9: A-115). 22nd Simposio Internaticional de Ciências do Esporte, Sao Paulo, Brazil.

The Surgeon General’s Report on Physical Activity and Health (USDHHS, 1996) recognizes the health benefits of intermittent bouts of habitual physical activity. However, standard methods of self-report have inadequately assessed low level activity. Therefore, the modified 7-day Physical Activity Recall (Lo-PAR; Regensteiner et al., 1996) has been designed to assess physical activity regardless of fitness level. In this study, 61 patients (71% males) with coronary artery disease were assessed with the Lo-PAR on entry to an early outpatient cardiac rehabilitation program. Patients were 60 (SD=10) years old and had experienced a cardiac event (angina, myocardial infarction, angioplasty or bypass surgery) 40 (SD=37) days earlier. The Lo-PAR is an interview-administered recall of the previous week’s sleep and activity at work, in the home and during recreation. The mean physical activity score was 229 (SD=27) MET-hours/week. Forty-four percent of the patients were classified as very inactive (<225), 36% were inactive-somewhat active (225-250), 16% were active (251­300) and 3% were very active (>300). The Lo-PAR appears to be an appropriate method of quantifying the physical activity levels of cardiac patients entering rehabilitation. Furthermore, it is recommended that initiatives be designed to more effectively improve the level of physical activity in this population.


Scales, R., Weitkunat, S., Atterbom, H. A., Lueker, R. D. (1999). Motivational interviewing and skills-based counseling for sustained reduction in saturated fat intake. Journal of the American Dietetic Association, Abstract, 99, 9: A-115.

Scales, R., Weitkunat, S., Atterbom, H. A., Lueker, R. D. (1999). Motivational interviewing and skills-based counseling for sustained reduction in saturated fat intake. Journal of the American Dietetic Association, Abstract, 99, 9: A-115.

Guidelines for health recommend restricting the consumption of saturated fat. Motivating clients to sustain this type of lifestyle is challenging. This 24 week study was designed to assess the impact of motivational interviewing (MI) and skills-based counseling (SBC) on the lifestyles of cardiac patients. Saturated fat intake (% of total calories) was determined from 3-day food records. Two 60­minute MI sessions (weeks 1 & 13) and three 30-min SBC sessions (weeks 2, 3 & 7) added to a traditional (TR) 12-week rehabilitation program comprised the experimental treatment (ET); TR=control treatment (CT). Sixty patients with coronary artery disease were assigned at random to ET (n=28) or CT (n=32). ANCOVA was performed at both 12 and 24 weeks. At 12 weeks ET resulted in a significantly (p=0.047) greater reduction in saturated fat consumption than the CT. At 24 weeks ET patients had reduced their intake of saturated fat from 5.8% at baseline to 4.9%. The CT patients had changed from 7.1% to 7.2%. The difference between groups remained significant (p=0.014) from baseline to 24 weeks. It was concluded that adding MI and SBC to a traditional early outpatient cardiac rehabilitation program significantly improves saturated fat consumption for at least 6 months.


Scales, R., Atterbom., H. A., Lueker, R. D., Gibson, A. (1999). Enhancing physical activity in cardiac rehabilitation with stage-matched counseling. Medicine & Science in Sports & Exercise. Abstract 1710, 31, 5: 338.

Scales, R., Atterbom., H. A., Lueker, R. D., Gibson, A. (1999). Enhancing physical activity in cardiac rehabilitation with stage-matched counseling. Medicine & Science in Sports & Exercise. Abstract 1710, 31, 5: 338.

Outcomes of cardiac rehabilitation interventions may be compromised if they are not matched to the patient’s stage of readiness to change behavior. The Cardiovascular Health Initiative and Lifestyle Education (CHILE) Study was designed to assess the impact of stage-matched counseling on the behaviors of patients who attended cardiac rehabilitation. Two 60-min motivational interviewing (MI) sessions (wks 1 & 13) and three 30-min skills-based counseling (SBC) sessions (wks 2, 3 & 7) were added to a traditional (TR) 12-wk program of exercise and education. The MI and SBC sessions were integrated within the framework of the transtheoretical model of behavior change. This enhanced program (MI+SBC+TR) was the experimental treatment (ET), the TR was the control treatment (CT). Initially, 60 patients with coronary artery disease were assigned at random to either the ET group (n=28) or the CT group (n=32). Physical activity (PA) was quantified with the modified 7-day Physical Activity Recall (Lo-PAR; Regensteiner et al., 1996). Univariate analysis of covariance did not identify a significant difference (p>0.05) in PA between groups at 12-wks. However, among the 54 patients remaining in the study at 24-wks, there was a significantly greater improvement (p=0.007) in the ET group. The ET group increased PA from 233 (SD=26) to 287 (SD=41) MET-hours/wk, while the CT group increased from 224 (SD=28) to 256 (SD=32) MET-hours/wk. Adding a combination of motivational interviewing and skills-based counseling to early outpatient cardiac rehabilitation appears to improve long-term physical activity.


Scales, R., Lueker, R. D., Atterbom, H. A., Jackson, K. A., Handmaker, N. S. (1999). Optimizing lifestyle change with motivational counseling. Annals of Behavioral Medicine, Abstract, 21: 19.

Scales, R., Lueker, R. D., Atterbom, H. A., Jackson, K. A., Handmaker, N. S. (1999). Optimizing lifestyle change with motivational counseling. Annals of Behavioral Medicine, Abstract, 21: 19.

Aggressive changes in the lifestyle of cardiac patients have been shown to stabilize the atherosclerosis. However, motivating cardiac patients to adhere to this type of regimen is a challenge. The Cardiovascular Health Initiative and Lifestyle Education (CHILE) Study was designed to assess the impact of motivational interviewing (MI) and skills-based counseling (SBC) on the behaviors of patients attending cardiac rehabilitation. Two 60-minute sessions of MI (wks 1 & 13) and three 30-min SBC sessions (wks 2, 3 & 7) were added to a traditional (TR) 12-wk program of exercise and education. This enhanced program (MI+SBC+TR) was the experimental treatment condition and the TR was the control treatment condition. Sixty patients with coronary artery disease were assigned at random to the MI+SBC+TR group (n=28) or the TR group (n=32). Perceived stress (PS), physical activity (PA) and dietary fat intake (DF) were quantified with the PSS-10, the Lo-PAR and a 3-day food record, respectively. MANCOVA was performed on the data at both 12-wks and 24-wks. At 12-wks there was a significantly (p=0.002) greater improvement in the linear combination of scores for PS, PA and DF. At 24-wks, among the 54 patients remaining in the study without further treatment, the improvement was sustained (p=0.026). It was concluded that adding motivational interviewing and skills-based counseling to an early outpatient cardiac rehabilitation program significantly improves lifestyle change for at least 6 months.


Scales, R., Lueker, R. D., Atterbom, H. A., Jackson, K. A., Handmaker, N. S. (1998). Stress reduction with motivational interviewing and skills-based counseling. Proceedings of a conference. (Abstract 0022). 2nd World Congress on Stress, Melbourne, Australia.

Scales, R., Lueker, R. D., Atterbom, H. A., Jackson, K. A., Handmaker, N. S. (1998). Stress reduction with motivational interviewing and skills-based counseling. Proceedings of a conference. (Abstract 0022). 2nd World Congress on Stress, Melbourne, Australia.

Managing emotional stress reduces cardiac morbidity and mortality in patients recovering from coronary artery disease (CAD). A 12-wk study was conducted to assess the impact of motivational interviewing (MI) and skills-based counseling (SBC) on behavior. MI is a counseling style designed to increase motivation for changing unhealthful behaviors; through SBC the goal setting strategies initiated during the MI are reinforced. MI and SBC were integrated within the framework of the transtheoretical model to provide a stage-matched approach to changing multiple lifestyle behaviors simultaneously. One 60-min session of MI (1st wk) and three 30-min SBC sessions (2nd, 3rd, and 7th wk) were integrated into a traditional cardiac rehabilitation (TCR) program (exercise and education). The integrated program (MI+SBC+TCR) was the experimental condition and TCR the control condition. Sixty-one patients with CAD were assigned at random to either the experimental (n=29) or control (n=32) condition. Perceived stress was assessed with the PSS-10 (Cohen & Williamson, 1988). Univariate analysis showed that the experimental program resulted in a significantly (p=0.005) greater improvement in perceived stress scores from baseline to 12-wks when compared to the control program. The perceived stress scores decreased from 16.5 (SD=5.7) to 9.5 (SD=7.2) compared to the control condition, from 15.8 (SD=8.0) to 13.7 (SD=6.9). It was concluded that adding a combination of MI and SBC to traditional cardiac rehabilitation program significantly reduces stress.


Scales, R., Rossi, S. R., Lueker, R. D., Atterbom, H. A. (1998). Stages of change across multiple behaviors in early outpatient cardiac rehabilitation. Journal of Cardiopulmonary Rehabilitation, Abstract 18, 5: 370.

Scales, R., Rossi, S. R., Lueker, R. D., Atterbom, H. A. (1998). Stages of change across multiple behaviors in early outpatient cardiac rehabilitation. Journal of Cardiopulmonary Rehabilitation, Abstract 18, 5: 370.

Are cardiac patients motivated to adopt a lifestyle which could stabilize the atherosclerosis? Assessing motivation to changing multiple behaviors (exercising, avoidance of dietary fat, quitting smoking, managing stress, taking medication) simultaneously is not standard practice in cardiac rehabilitation. In this 12-wk study, algorithms were used to identify a patient’s stage of readiness to change, i.e., precontemplation, contemplation, preparation, action, maintenance. The algorithms were applied upon entry into early outpatient cardiac rehabilitation. The 61 patients (70.5% males) in the study were 59.6 (SD=10.4) years old, and had experienced a cardiac event (angina, myocardial infarction, bypass surgery or angioplasty) 39.5 (SD=37.3) days prior to commencing rehabilitation. Results show that almost all of the patients were at least thinking about making positive changes across all of the risk behaviors within 30 days. It appears that, in early outpatient cardiac rehabilitation, patients are receptive to making lifestyle changes across multiple behaviors simultaneously. Cardiac rehabilitation outcomes may be compromised if interventions are not matched with each individual’s readiness to change unhealthful behaviors. Employing algorithms for the purpose of matching treatments with a patient’s readiness to changing lifestyle may be a useful precursor to the development of effective interventions in cardiac rehabilitation.


Scales, R., Bottaro, M. M., Lueker, R. D., Atterbom, H. A., Ellingboe, K. (1998). Does motivational interviewing and skills-based counseling improve body composition in cardiac rehabilitation patients? Proceedings of a conference (Abstract 244: 125). 21st Simposio Internaticional de Ciências do Esporte, Sao Paulo, Brazil.

Scales, R., Bottaro, M. M., Lueker, R. D., Atterbom, H. A., Ellingboe, K. (1998). Does motivational interviewing and skills-based counseling improve body composition in cardiac rehabilitation patients? Proceedings of a conference (Abstract 244: 125). 21st Simposio Internaticional de Ciências do Esporte, Sao Paulo, Brazil.

Improving body composition with lifestyle changes is recommended to cardiac patients. However, motivating patients to adopt and maintain such changes presents a major challenge to medical practitioners. This 12-wk study was designed to assess the impact of motivational interviewing (MI) and skills-based counseling (SBC) on the body composition of patients in cardiac rehabilitation. MI is a counseling style designed to increase motivation for changing unhealthful behaviors; through SBC the goal setting strategies initiated during the MI are reinforced. One 60-min session of MI (wk 1) and three 30-min SBC sessions (wks 2, 3 & 7) were added to a traditional rehabilitation (TR) program (exercise and education) as the experimental treatment (MI+SBC+TR). TR alone was the control treatment. 61 patients with coronary artery disease were assigned at random to the MI+SBC+TR group (n=29) or to the TR group (n=32). At 12-wks, percent body fat, determined from skinfold measurements, was available for 84% of the patients (37 males and 14 females). ANCOVA indicated that there was no significant difference (p>0.05) in percent body fat between groups. However, t-tests identified significant improvements (p=0.001) from baseline to 12-wks in both groups. The MI+SBC+TR group improved from 31.0% (SD=6.3) to 25.5% (SD=6.1). The TR group improved from 29.9% (SD=5.9) to 25.1% (SD=5.7). It was concluded that early outpatient cardiac rehabilitation does improve the body composition of patients. However, there is no immediate benefit to adding a combination of MI and SBC to the traditional approach. It is recommended that follow-up assessment be conducted beyond 12-wks to determine the long-term effects of MI and SBC on body composition.


Scales, R., Lueker, R. D., Atterbom, H. A., Weitkunat, S. (1998). Can motivational interviewing and skills-based counseling improve dietary fat intake? Proceedings of a conference (Abstract O89, 46). Society of Nutrition Education’s 31st Annual Meeting, Albuquerque, New Mexico.

Scales, R., Lueker, R. D., Atterbom, H. A., Weitkunat, S. (1998). Can motivational interviewing and skills-based counseling improve dietary fat intake? Proceedings of a conference (Abstract O89, 46). Society of Nutrition Education’s 31st Annual Meeting, Albuquerque, New Mexico.

Guidelines for health recommend restricting the intake of saturated dietary fat consumption. This 12 week study was designed to assess the impact of motivational interviewing (MI) and skills-based counseling (SBC) on lifestyle behaviors of patients attending cardiac rehabilitation. Total and saturated dietary fat intake, expressed as percentages of total calories consumed, was determined from three-day food records. One 60-minute session of MI (in week one) and three 30-minute SBC sessions (in weeks two, three and seven) were added to a traditional rehabilitation (TR) program (exercise and education) as the experimental treatment (MI+SBC+TR). TR alone was the control treatment. Sixty-one patients with coronary artery disease were assigned at random to the MI+SBC+TR group (n=29) or the TR (n=32) group. At 12 weeks, a univariate analysis of covariance did not identify a significant difference (p>0.05) between groups in total dietary fat consumption. However, ANCOVA indicated that the MI+SBC+TR treatment resulted in a significantly greater reduction (p=0.047) in saturated fat consumption. The MI+SBC+TR group changed from 5.7 percent (SD=3.5) to 4.7 percent (SD=2.3), as compared with the TR group which changed from 7.2 percent (SD=3.6) to 6.5 percent (SD=2.9). It was concluded that adding MI and SBC to a traditional early outpatient cardiac rehabilitation program significantly reduces the intake of saturated fat.


Scales, R., Atterbom, H. A., Lueker, R. D. (1998). Impact of motivational interviewing and skills-based counseling on physical activity and exercise. Medicine & Science in Sports & Exercise, Abstract 524, 30, 5: 92.

Scales, R., Atterbom, H. A., Lueker, R. D. (1998). Impact of motivational interviewing and skills-based counseling on physical activity and exercise. Medicine & Science in Sports & Exercise, Abstract 524, 30, 5: 92.

Guidelines for health now recommend daily physical activity in addition to exercise. This 12 week (wk) study was conducted to assess the impact of motivational interviewing (MI) and skills-based counseling (SBC) on levels of PA and exercise in patients attending cardiac rehabilitation. PA and exercise were measured with the modified 7-day Physical Activity Recall (Lo-PAR; Regensteiner et al., 1996). One 60-min session of MI (wk 1) and three 30-min SBC sessions (wks 2, 3 & 7) were integrated into a traditional rehabilitation (TR) program (exercise & education) as the experimental treatment (MI+SBC+TR). TR alone was the control treatment. 61 patients with coronary artery disease were assigned at random to the MI+SBC+TR (n=29) and TR (=32) groups. At 12-wks a univariate analysis of covariance did not identify a significant difference (p>0.05) between groups in PA. However, ANCOVA indicated that the MI+SBC+TR group resulted in a significantly greater increase (p=0.033) in self-reported exercise participation. The MI+SBC+TR group increased exercise participation from 9.0 (SD=9.0) to 30.0 (SD=32.2) MET-hours/wk, while the TR group increased from
6.1 (SD=5.1) to 14.0 (SD=8.5) MET-hours/wk. It was concluded that integrating MI and SBC into a traditional early outpatient cardiac rehabilitation program does not significantly improve PA; however it does significantly improve exercise participation.


Scales, R. (1998). Motivational interviewing and skills-based counseling in cardiac rehabilitation: The Cardiovascular Health Initiative and Lifestyle Education (CHILE) Study (Dissertation). University of New Mexico. Dissertation Abstracts International, 59-03A: 0741.

Scales, R. (1998). Motivational interviewing and skills-based counseling in cardiac rehabilitation: The Cardiovascular Health Initiative and Lifestyle Education (CHILE) Study (Dissertation). University of New Mexico. Dissertation Abstracts International, 59-03A: 0741.

Motivating cardiac patients to adopt and maintain the type of lifestyle that may stabilize the atherosclerosis presents a major challenge to medical practitioners. Therefore, the CHILE Study was conducted to assess the impact of motivational interviewing and skills-based counseling on the health-related behaviors of patients attending cardiac rehabilitation. Sixty-one patients who had entered a traditional early outpatient cardiac rehabilitation program were assigned at random to either a control treatment (CT), i.e., the traditional rehabilitation program, or to an experimental treatment (ET). The ET consisted of the traditional program plus a 1-hour motivational interview conducted by a counselor (week 1) and three 30-minute skills-based counseling sessions conducted by a health educator (weeks 2, 3 & 7). The transtheoretical model of behavior change provided the framework for a counseling style that was matched with the patient’s stage of readiness to change multiple behaviors simultaneously. MANCOVA indicated that ET resulted in a significantly greater improvement (p=0.002) in the linear combination of scores for perceived stress, physical activity and dietary fat intake when compared with CT at 12 weeks. Univariate analysis of covariance identified that the ET group resulted in a significantly greater reduction (p=0.005) in perceived stress when compared with the CT group. Perceived stress decreased from a mean score of 16.5 to 9.5 in the ET group, while the CT group decreased from 15.8 to 13.7. Univariate analysis of covariance did not identify significant differences (p >.05) between groups in physical activity and dietary fat intake. ANCOVA identified that ET resulted in a significantly greater increase (p=0.033) in exercise participation, and in a significantly greater reduction (p=0.047) in saturated fat intake when compared with CT. Exercise participation increased from 9.0 to 30.0 MET-hours/week in the ET group, while the CT group increased from 6.1 to 14.0 MET-hours/week. Saturated fat intake decreased from 5.7% to 4.7% of total calories consumed in the ET group, while the CT group changed from 7.2% to 6.5%. In conclusion, integrating motivational interviewing and skills-based counseling into a traditional early outpatient cardiac rehabilitation program helps motivate patients to adopt a more healthful lifestyle.


Scales, R., Lueker, R. D., Atterbom, H. A., Handmaker, N. S., Jackson, K. A. (1998). Motivational interviewing and skills-based counseling to change multiple lifestyle behaviors. Annals of Behavioral Medicine, Abstract 22 D, 20: 68.

Scales, R., Lueker, R. D., Atterbom, H. A., Handmaker, N. S., Jackson, K. A. (1998). Motivational interviewing and skills-based counseling to change multiple lifestyle behaviors. Annals of Behavioral Medicine, Abstract 22 D, 20: 68.

A 12-wk study was conducted to assess the impact of motivational interviewing (MI) and skills-based counseling (SBC) on behavior. MI is a counseling method designed to increase motivation for changing unhealthful behaviors; through SBC the goal setting strategies initiated during the MI are reinforced. MI and SBC were integrated within the framework of the transtheoretical model to provide a stage-matched approach to change in multiple lifestyle behaviors simultaneously. One 60-min session of MI (1st wk) and three 30-min SBC sessions (2nd, 3rd, and 7th wk) were integrated into a traditional rehabilitation (TR) program (exercise and education). The integrated program (MI+SBC+TR) was the experimental condition and TR the control condition. 60 patients with coronary artery disease were assigned at random to either the experimental (n=28) or the control (n=32) condition. Perceived stress, physical activity (PA), and dietary fat intake were quantified with the 10-item PSS-10, the Lo-PAR, and a 4-day food record, respectively. MANCOVA showed that the experimental treatment resulted in a significantly (p<0.01) greater change in the linear combination of scores for stress, PA, and dietary fat. It was concluded that a combination of MI and SBC within the framework of the transtheoretical model facilitates lifestyle change across multiple behaviors.


Scales, R., Lueker, R. D., Atterbom, H. A., Handmaker, N. S., Jackson, K. A. (1997). Impact of motivational interviewing and skills-based counseling on outcomes of cardiac rehabilitation. Journal of Cardiopulmonary Rehabilitation, Abstract, 17, 5: 328.

Scales, R., Lueker, R. D., Atterbom, H. A., Handmaker, N. S., Jackson, K. A. (1997). Impact of motivational interviewing and skills-based counseling on outcomes of cardiac rehabilitation. Journal of Cardiopulmonary Rehabilitation, Abstract, 17, 5: 328.

This 12 week study was conducted to assess the impact of motivational interviewing (MI) and skills-based counseling (SBC) on cardiac rehabilitation. MI is a counseling method designed to increase motivation for changing unhealthful behaviors, and through SBC the goal setting strategies initiated during the MI are reinforced. One 60-min session of MI (during 1st wk) and three 30-min SBC sessions (2nd, 3rd, and 7th wk) were integrated into a traditional rehabilitation (TR) program (exercise and education) as the experimental treatment (MI+SBC+TR) with TR alone as the control treatment. 41 patients with coronary artery disease were assigned at random to MI+SBC+TR (n=22) and TR (n=19). Physical activity (PA) was quantified with the modified Physical Activity Recall (Lo-PAR; Regensteiner et al., 1996) and perceived stress level by the 10-item Perceived Stress Scales (PSS-10; Cohen & Williamson, 1988). When compared to TR, MI+SBC+TR resulted in significantly greater changes (p>0.05) in PA and perceived stress level from baseline to 12-wks. The PA scores increased from 233 +28 MET-hours per week (MET-h/wk) to 278 +37, as compared to the TR condition where the increase was from 221 +27 MET-h/wk to 250 +25. The perceived stress scores decreased for the MI+SBC+TR condition from 16 +5.4 to 8.8 +4.7, as compared to the TR condition where the decrease from 15.4 +9.1 to13.9 +7.0 was not significant. It was concluded that adding a combination of MI and SBC to a cardiac rehabilitation program significantly improves outcomes.