Sedentary behavior is a major risk factor for coronary artery disease (CAD) progression in coronary artery bypass graft (CABG) patients post-discharge. However, existing interventions primarily target patients ready to increase habitual exercise, fail to assist remaining patients progress to the point of physical and psychological readiness, and may have limited accessibility, and high attrition rates. Therefore, a multidimensional, community based, nurse directed intervention model to increase habitual exercise and reduce sedentary behavior is necessary.
The specific aims of this pilot study are to (a) determine whether a trend exists supporting the Sedentary Behavior Intervention Model's (SBIM) effectiveness in decreasing sedentary behavior by promoting habitual exercise by CABG patients and (b) identify the magnitude of subjects attrition, reasons for, and distribution of, attrition among study groups (SBIM-experimental, standard care-control), gender and minorities. Should pilot data support the SBIM s effectiveness, a larger sample clinical trial will be conducted to confirm the SBIM's effectiveness. Data about subject attrition will be used to develop mechanisms to reduce attrition and modify the sampling scheme, as necessary, in the projected clinical trial. The SBIM is adapted from Prochaska and DiClemente's Trans-Theoretical Model which conceptualizes the process of behavioral change. In the SBIM, each patient receives a multi-dimensional set of interventions specifically adapted to his/her readiness to change sedentary behavior and increase habitual exercise. Readiness, expressed as a """"""""stage of change,"""""""" is determined by the patient s current behavior and intended behavior within the next 6 months. SBIM interventions focus upon (a) modifying patient perceptions of the relative benefits to drawbacks of increasing habitual exercise, (b) maximizing the effectiveness of strategies identified by the patient as helping promote exercise, and (c)minimizing barriers and maximizing factors facilitating habitual exercise. The 100 subjects will be stratified with respect to prestudy left ventricular function, gender, and minority status, and their """"""""stage of change"""""""" determined. They will then be randomly assigned to receive either the SBIM (i.e. experimental) or the standard care (i.e. control) intervention for a 9 month period. Interventions will be delivered by a trained team of experienced cardiac nurses in our master's or doctoral nursing programs. A repeated measures experimental design will be used. Outcome variables include energy expenditure, functional capacity, cardiac exercise self-efficacy, and stage of change. Hypotheses/research questions are (a) experimental subject will exhibit significantly greater pre- to post-intervention increases in outcome variables than control subjects and (b) a significant amount of the variance in outcome variables will be accounted for the variables of group, cardiac rehabilitation program participation and prestudy left ventricular function, and (c) how is attrition distributed in the total sample and with respect to group, gender, and minority status.
| Jairath, Nalini; Ulrich, Connie M; Ley, Cathaleen (2005) Ethical considerations in the recruitment of research subjects from hospitalized, cardiovascular patient populations. J Cardiovasc Nurs 20:56-61 |
