Cardiovascular disease accounts for 50% of all deaths in the United States. While participation in Cardiac Rehabilitation (CR) significantly reduces re-hospitalization and mortality among cardiac patients, the impact of CR on public health is substantially weakened due to poor maintenance of health behaviors, particularly physical activity, after CR is ended. The goal of the proposed project is to test the efficacy of a tailored, motivation-matched intervention to enhance the maintenance of physical activity following CR. The overall scientific question posed by this project is: Can a low-cost, motivationally-tailored intervention delivered via computer expert system significantly improve patients' physical activity participation in the year following phase II cardiac rehabilitation? A two-group design will compare: 1) CR with Tailored Support (Tailored), versus 2) Care as usual following CR (Standard Care). This project utilizes a repeated measures design consisting of baseline (at completion of phase II CR), and follow-up at one, three, six, nine and twelve months. Exercise tolerance tests will be used to validate the primary outcome of self-reported exercise participation. Analyses of important cognitive-behavioral mediators of the intervention efficacy and cost efficacy analyses will be performed. This proposal responds to recommendations of the NHLBI calling for additional research into cost effective behavioral interventions for use in large populations and which target the identification of factors which enhance adherence to preventive behaviors (USDHHS, 1995; 2001), and an NIH joint initiative to investigate innovative approaches to disease prevention through behavior change (1997).
