Cardiac Rehab Research

Cardiac Rehab Research

Cardiac Rehab Research Abstracts 2002-2003

Cardiac Rehab Research Abstracts 2002-2003

Scales, R., Akalan, C., Miller, J. H., Lueker R. D. (2003). Can a health educator improve physical activity with motivational counseling in a clinical setting? Medicine & Science in Sports & Exercise, Abstract 798, 35, 5: S144.

Scales, R., Akalan, C., Miller, J. H., Lueker R. D. (2003). Can a health educator improve physical activity with motivational counseling in a clinical setting? Medicine & Science in Sports & Exercise, Abstract 798, 35, 5: S144.

Healthcare providers are challenged to motivate patients to become physically active during brief clinical consultations. In a randomized-control trial, we previously demonstrated that Motivational Counseling (MC) added to traditional cardiac rehabilitation significantly enhances physical activity and exercise. This investigation was conducted to determine the feasibility of applying research to practice by adding MC to daily practice within an established clinical setting. Brief MC sessions (wks 1, 2 & 7) conducted by a health educator were added to a 12-wk early outpatient cardiac rehabilitation program of exercise, education and medical support. One hundred and one patients (71% males) were assessed at baseline and 12 wks. Physical activity was quantified with the Lo-PAR; an interview-administered recall of the previous week’s sleep and activity at work, in the home and during recreation. Patients ranged in age from 33-91 (Mean=63, SD=13) years and had experienced a recent cardiac event (angina, myocardial infarction, angioplasty or bypass surgery). A dependent sample t-test indicated a significant mean difference between baseline and 12-wk physical activity scores (p<0.05). The mean physical activity score changed from 228 (SD=21) to 267 (SD=37) MET­hrs/wk. The proportion of patients classified as very inactive (<225 MET-hrs/wk) changed from 43% at baseline to 11% at 12 wks. Inactive-somewhat active patients (225-250 MET-hrs/wk) changed from 44% to 27%. Active patients (251­300 MET-hrs/wk) changed from 13% to 50%. None of the patients were very active (>300 MET-hrs/wk) at baseline compared to 12% at 12 wks. The mean difference between scores for exercise alone was also significant from baseline to 12-wks (p<0.05). The mean exercise scores changed from 3 (SD = 4) MET-­hrs/wk to 18 (SD = 12) MET-hrs/wk. It was concluded that it is feasible for a non-mental health specialist to successfully integrate MC into a clinical setting and significantly improve physical activity in the early phase of recovery from heart disease.


Akalan, C., Scales, R., Miller, J. H., Lueker, R. D. (2002). Screening for emotional distress and problem drinking in cardiac rehabilitation. Proceedings of a conference (Abstract 26: pp.537). American Association of Cardiovascular and Pulmonary Rehabilitation’s 17th Annual Meeting, Charlotte, North Carolina.

Akalan, C., Scales, R., Miller, J. H., Lueker, R. D. (2002). Screening for emotional distress and problem drinking in cardiac rehabilitation. Proceedings of a conference (Abstract 26: pp.537). American Association of Cardiovascular and Pulmonary Rehabilitation’s 17th Annual Meeting, Charlotte, North Carolina.

Screening for emotional distress and problem drinking is not routine practice in cardiac rehabilitation. Consequently, this study investigates the associated level of risk among patients entering an early outpatient cardiac rehabilitation program. One hundred and two patients (75% white & 70 % male) with coronary artery disease were assessed for perceived stress, depression and alcohol intake with the 10-item Perceived Stress Scale (PSS-10), the Beck Depression Inventory (BDI) and the Alcohol Use Disorder Identification Test (AUDIT) respectively. Patients ranged in age from 33-85 (Mean=61, SD=13) years and had experienced a recent cardiac event (angina, myocardial infarction, angioplasty or bypass surgery). Thirty-eight percent of patients had perceived stress scores which were considered to be at risk (PSS-10 >14), 40% had at risk depression scores (BDI >9) and 4% indicated an at risk score for problem drinking (AUDIT >7). Fifty-four percent of all patients had at least one at risk score across the three measured categories and 28% had at least two at risk scores. It appears that screening for emotional distress and problem drinking may help detect patients at risk and in need of appropriate intervention. It is recommended that a larger study with an equal distribution of patients be conducted to identify differences in gender, ethnicity and social-economic status.


Scales, R., Akalan, C., Burke, C., Miller, J. H., Lueker, R. D. (2002). Reducing stress in cardiac patients with motivational counseling. Stress: The International Journal on the Biology of Stress, Abstract P170, 5: 127.

Scales, R., Akalan, C., Burke, C., Miller, J. H., Lueker, R. D. (2002). Reducing stress in cardiac patients with motivational counseling. Stress: The International Journal on the Biology of Stress, Abstract P170, 5: 127.

Stress may compromise recovery after a cardiac event. In a randomized-control trial, we previously demonstrated that Motivational Counseling (MC) added to traditional cardiac rehabilitation significantly reduces perceived stress during the early period of recovery. Consequently, this investigation was conducted to determine the feasibility of applying research to practice by adding MC to daily practice within an established clinical setting. Brief MC sessions (wks 1, 2 & 7) conducted by a health educator were added to a 12-wk early outpatient cardiac rehabilitation program of exercise, education and medical support. One hundred and two patients (71% males) were assessed on entry to the program. Patients ranged in age from 33-91 (Mean=63, SD=13) years and had experienced a recent cardiac event (angina, myocardial infarction, angioplasty or bypass surgery). Perceived stress was assessed with the 10-item Perceived Stress Scale (PSS-10). A dependent sample t-test indicated a significant mean difference between baseline and 12-wk scores (p<0.05). The proportion of patients with very low-low perceived stress scores at baseline and 12 wks changed from 63% to 80% respectively. Moderate-high-very high perceived stress scores changed from 37% to 20% respectively. It was concluded that it is feasible for a non-mental health specialist to successfully integrate MC into a clinical setting and significantly reduce perceived stress in the early phase of recovery from heart disease.


Scales, R., Akalan, C., Villareal, C. F., Regensteiner, J. G., Lueker, R. D. (2002). Assessing physical activity with the Lo-PAR Questionnaire in patients completing cardiac rehabilitation. Medicine & Science in Sports & Exercise, Abstract 1168, 34, 5: 207.

Scales, R., Akalan, C., Villareal, C. F., Regensteiner, J. G., Lueker, R. D. (2002). Assessing physical activity with the Lo-PAR Questionnaire in patients completing cardiac rehabilitation. Medicine & Science in Sports & Exercise, Abstract 1168, 34, 5: 207.

Standard methods of assessing physical activity through self-report have not adequately recognized low level activity. Consequently, the modified 7-day Physical Activity Recall (Lo-PAR) has been designed to measure physical activity regardless of fitness. This study investigates the feasibility of using the Lo-PAR with cardiac patients in a clinical setting. Ninety-five patients (71 % male) with coronary artery disease were assessed with the Lo-PAR on completion of a 12-week early outpatient cardiac rehabilitation program. Patients were 62 (SD=13) years old and had experienced a cardiac event (angina, myocardial infarction, angioplasty or bypass surgery). The Lo-PAR is an interview-administered recall of the previous week’s sleep and activity at work, in the home and during recreation. Cardiovascular fitness (CVF) was measured by performance on a graded sub-maximal treadmill walk test. Moderate intensity exercise on the Borg Category-Ratio Scale (RPE=3) was used as the marker for CVF. Correlations between CVF and Lo-PAR scores were determined with the Pearson Product Moment Correlation Coefficient (p<0.05). The mean CVF score was 5.3 (SD=2.1) METs. Thirty percent of patients had a CVF score <3.5 METs. The mean Lo-PAR score was 268 (SD=37) MET-hrs/wk and correlated with CVF (r=0.46, p<0.01). The exercise component of Lo-PAR by itself had a mean score of 18 (SD=12) MET-hrs/week, which also correlated with CVF(r=0.59, p<0.01). The Lo-PAR appears to be a reasonable method of quantifying the physical activity level of patients recovering from heart disease. It is recommended that additional investigations be conducted to further validate this method of assessing physical activity in clinical populations.


Scales, R., Akalan, C., Burke, C., Miller, B., Lueker, R. D. (2002). Clinical application of motivational counseling to cardiac rehabilitation: Preliminary findings. Annals of Behavioral Medicine, Abstract 52, 24.

Scales, R., Akalan, C., Burke, C., Miller, B., Lueker, R. D. (2002). Clinical application of motivational counseling to cardiac rehabilitation: Preliminary findings. Annals of Behavioral Medicine, Abstract 52, 24.

Healthcare practitioners are challenged to motivate cardiac patients during brief encounters within the clinical setting. In a randomized-control trial, we previously demonstrated that Motivational Counseling (MC) added to traditional cardiac rehabilitation significantly enhances patient behavior. Consequently, this investigation was conducted to determine the feasibility of applying research to practice by adding MC to a clinical setting. Brief MC sessions (wks 1, 2 & 7) conducted by a health educator were added to a 12-wk early outpatient cardiac rehabilitation program of exercise, education and medical support. One hundred patients (70% males) were assessed on entry to the program. Patients were 62 (SD=13) years old and had experienced a recent cardiac event. Perceived stress, depression, dietary fat intake, physical activity and exercise were quantified with the PSS-10, the Beck Inventory, the Block Dietary Fat Screen and the Lo-PAR respectively. Dependent sample t-tests indicated a significant mean difference between baseline and 12-wk scores for all behaviors (p<0.05). It was concluded that it is feasible to apply research to practice and that MC conducted by a non-mental health specialist could be successfully integrated into the clinic.