EXERCISE CONSULTATION TO IMPROVE ADHERENCE TO PHASE 4 EXERCISE:

1
EXERCISE CONSULTATION TO IMPROVE ADHERENCE TO
PHASE 4 EXERCISE TARGETING RESOURCES TO THOSE
MOST IN NEED OF SUPPORT
Mundy C1, Catto S1, Clark A2, Kerr D1, MacIntyre
P1. 1Royal Alexandra Hospital, Paisley
2University of Alberta, Canada
INTRODUCTION
RESULTS
DISCUSSION

• Many patients fail to maintain regular physical
  activity (PA) levels1,2, in accordance with
  current health recommendations3, following
  completion of Phase 3 Cardiac Rehabilitation
  (CR).
• Exercise consultations have previously been
  identified as a means of helping to improve
  adherence to physical activity4 (PA), however,
  resource limitations may inhibit the provision of
  consultations to all patients.
• As part of Phase 4 services within a CR programme
  in the west of Scotland, exercise consultations
  are offered to individuals who are identified as
  being in need of additional support to maintain
  regular participation in physical activity.

• No significant differences existed between the EX
  and DR groups at baseline in age, gender,
  employment status or deprivation category
  (pgt0.05).
• A significantly lower proportion of the EX group
  participated in regular physical activity at
  baseline (74 met HEBS1 or HEBS2 in comparison to
  86 in the DR group p0.002).
• Phase 4 uptake rates were also lower in the EX
  group (68 compared to 87 in the DR group,
  plt0.001). However, following uptake of PA, 81
  of the EX group maintained PA at 6 months,
  compared to 63 in the DR group (plt0.001) (see
  Figure 1).
• Overall, these variations resulted in equivalent
  overall adherence rates to phase 4 activity
  between groups (55 p0.104).
• Figure 1 Total uptake, maintenance and overall
  adherence rates in the DR and EX groups.
  ( Difference from DR group, plt0.001)
• The EX group increased their SPAQ levels by 66.7
  minwk-1 (p0.131), but the DR group remained
  more active at 6 months (666.456.4 vs.
  292.343.3 minwk-1, plt0.00).
• Over the period of the study, the DR group were
  more likely to make a positive change in SOC (75
  vs. 40.9, p0.008).
• At 6 months, 88.5 of the DR group were in the
  action or maintenance SOC, versus 63.6 in the EX
  group (p0.03), and 100 of the DR group were
  meeting HEBS1 or HEBS2 vs. 81.8 of the EX group
  (p0.009).

• Patients in the EX group were less active at
  baseline.
• Following exercise consultation, less patients in
  the EX group took up Phase 4 exercise, but those
  who did were much more likely to maintain regular
  activity when compared to the DR group.
• The patients in the EX group were those
  identified as needing additional support, and
  traditionally, these patients would have been at
  high risk of not uptaking or dropping out of
  regular physical activity.
• Adherence rates to Phase 4 activity were similar
  for those patients in both the EX and DR groups,
  whereas without the exercise consultation
  intervention, it is likely that adherence rates
  would have been significantly lower in the EX
  group.
• Overall physical activity levels were high after
  6 months, with 100 of the DR group meeting HEBS1
  or HEBS2 vs. 81.8 of the EX group. This suggests
  that individuals recognised the importance of
  physical activity and even when they were unable
  to maintain attendance at structured Phase 4
  classes, they remained physically active.
• It should be noted that due to staffing levels,
  it was not possible to follow up all patients.
  Follow up data was obtained for 38/49 patients in
  the EX group and 53/70 in the DR group.

AIM
The present study aimed to compare uptake and
adherence to Phase 4 exercise, 6 months after
referral, in individuals directly referred to
Phase 4 exercise options versus those referred
via an exercise consultation service.


METHODS

• DESIGN
• Prospective Longitudinal Study
• PARTICIPANTS
• 119 patients were recruited to the study 49
  patients (mean age 64.51 yrs, 67 male) in the
  exercise consultation group, and 70 patients
  (mean age 63.7 1 yrs, 63 male) in the direct
  referral group.
• PROCEDURES
• Prior to progression on to Phase 4 activities,
  all patients received a standard discharge
  assessment to discuss available options for
  progressing to one of 35 Phase 4 activities in
  the local area.
• Forty-nine patients were identified as needing
  additional support, or were undecided about their
  Phase 4 options, and were referred for an
  individual exercise consultation (EX). Seventy
  patients were directly referred (DR) onto a
  Phase 4 programme.
• Stage of Change (SOC) and criteria for attainment
  of national physical activity recommendations
  (HEBS level one HEBS1 5x30mins accumulated
  PAwk-1 HEBS level two HEBS2 3x20mins
  continuous vigorous PAwk-1) were used to measure
  PA. The Scottish Physical Activity Questionnaire
  (SPAQ) was administered at baseline to the EX
  group only.
• Repeat measurements of SOC, HEBS level and SPAQ
  were obtained for all patients 6 months after
  referral. Phase 4 uptake and adherence were also
  recorded.
• ANALYSIS
• Data were analysed for differences between groups
  and over time. Paired t-tests were used for
  continuous variables, McNemars test was used for
  paired binary variables and the Chi-Square test
  for association was used for all other
  categorical data.
• All data are reported as mean S.E.M. unless
  otherwise stated.

CONCLUSIONS

• Referral to Phase 4 services alone was sufficient
  to improve physical activity levels in those
  identified as not needing additional support.
  This group (DR) were consistently more active
  throughout the period of the study, and the
  majority remained regularly active at follow-up.
• Exercise consultations, in addition to provision
  of Phase 4 exercise options can be effective in
  helping less active individuals maintain
  adherence to Phase 4 options.
• Where resources are limited, exercise
  consultations may be targeted towards patient
  groups at high risk of not uptaking or adhering
  to Phase 4 exercise, resulting in comparable
  rates of adherence with patients not in need of
  additional support.

REFERENCES

• Oldridge NB (1983). Predictors of dropout from
  cardiac exercise rehabilitation Ontario exercise
  - heart collaborative study. American Journal of
  Cardiology, 51 71-74.
• Stahle A et al (1999). Improved physical fitness
  and quality of life following training of elderly
  patients after acute coronary events. A 1 year
  follow-up randomised controlled study. European
  Heart Journal, 20 1475-1484.
• Health Education Board for Scotland (2003). The
  promotion of physical activity in Scotland
  strategic statement.
• Hughes AR et al (2002). Exercise consultation
  improves short-term adherence to exercise during
  Phase IV cardiac rehabilitation a randomised,
  controlled trial. Journal of Cardiopulmonary
  Rehabilitation, 22 421-425.

FOR FURTHER INFORMATION
Please contact claire.mundy_at_rah.scot.nhs.uk