The National Institute for Nursing Research of the National Institutes of Health has awarded $1.2 million to Case Western Reserve University's Frances Payne Bolton School of Nursing for a study that aims to encourage cardiac patients to exercise regularly.
Study subjects will wear high-tech wristwatch heart-rate monitors that measure and record their exercise levels, reports Associate Professor Shirley Moore, director of the four-year project.
Entitled CHANGE (Change Habits by Applying New Goals and Experiences), the intervention program will be tested on about 140 men and 140 women who will be followed for 12 months after they complete a traditional cardiac rehabilitation program.
For cardiac patients -- which includes those who have had heart attacks, heart bypass surgery, or angioplasty -- exercise is critical because it increases heart capacity, improves blood pressure, and enhances weight control, among other benefits. Yet according to Moore, only 30 to 60 percent of heart patients continue to exercise six months after the completion of a traditional rehab program.
Most such programs focus on teaching patients how to exercise after the cardiac event, but give little attention to motivational factors that influence the desire to continue exercising, Moore explains. Since neither evidence of the effectiveness of exercise nor the fear of further cardiac problems seem to motivate patients to stay on an exercise regimen, Moore designed CHANGE as a new approach to teaching long-term, positive exercise habits.
The CHANGE intervention features small-group counseling that emphasizes behavior modification, such as enhancing self-esteem and improving problem-solving skills. Counseling will help patients identify and overcome barriers that interfere with exercise.
Moore and her team of investigators will also look at other factors that may affect the likelihood of continued exercise, such as age, body fat, depression, social support, and the presence of other diseases.
Study subjects will wear a transmitter around their chest and a special high-tech wristwatch that does more than keep time. The transmitter records their heart rate and transmits the data to the wristwatch, where the information is stored. Each month, the subjects will return their wristwatch to the researchers, who download the stored information to a computer. Afterwards, they delete the old files from the wristwatches, which study subjects can then reuse.
These heart-monitoring devices will provide more reliable results than previously possible, according to Moore. Historically, exercise has been difficult to measure, she notes, and researchers have relied on the testimonies of individuals regarding their experiences with exercise and its effectiveness.
In addition to the wristwatch monitors, the study will utilize two other measurement techniques. Patients will keep hand-written diaries of their exercise activity, frequency, and duration. Researchers will also conduct regular telephone interviews regarding the subjects' exercise over the past seven days.
Moore believes the large study sample of both sexes will give a good indication of whether the intervention would be successful in real-world settings. Differences in the effects of the program on men versus women will also be analyzed.
Moore, who has over 10 years of experience researching individuals recovering from heart problems, hopes that this study will change the way cardiac rehabilitation programs are designed. "It's so important to keep people exercising," she says. "I would hope that in the future, third-party payers will pay for habit-changing programs such as CHANGE."
Joining Moore on her research team are Beverly Roberts, professor and associate dean for academic programs at the Bolton School, and Nahida Gordon, associate professor of epidemiology and biostatistics at the School of Medicine. Also involved are Michael Rocco of University Hospitals of Cleveland, Fredric Pashkow of Queens Medical Center in Hawaii, and Paul Ribisl of Wake Forest University in Winston-Salem, North Carolina.