Targeted Health Coaching to Improve Physical Activity Post-Structured Cardiac Rehabilitation

Duke University13 enrolled

Overview

To identify factors and triggers influencing physical activity (PA) participation after structured cardiac rehabilitation (CR) among older adults who have enrolled in a center-based CR program, and compare the effects of a targeted health coaching intervention versus standard care immediately following structured CR on PA maintenance and functional fitness.

Approximately 800,000 individuals in the United States have a heart attack every year, with almost 1 in 4 of those individuals already having suffered a previous heart attack. Attending cardiac rehabilitation (CR) following a cardiovascular event improves cardiorespiratory fitness and health-related quality of life, as well as decreases the risk of future illness and death from heart disease. Unfortunately, once an individual finishes a CR program, continued participation in physical activity (PA) too often reverts to previous sedentary patterns, limiting beneficial health effects. Continued participation in PA post-CR is especially challenging among older adults - likely due to a lack of self-efficacy and confidence in their ability to perform PA due to either their age or other health conditions that make PA more challenging. However, the need to address other health conditions, in conjunction with the benefits of improved strength and mobility, makes continued PA participation following a structured CR program even more useful for older adults. Although individuals typically understand habitual participation in PA is good for their health, we poorly understand why some individuals successfully adhere to and maintain PA habits, while others succumb to barriers preventing them from maintaining the health benefits beyond CR. In addition to understanding factors and triggers influencing PA maintenance beyond CR, little research has developed or investigated interventions targeting this important transition period following structured CR programming to promote continued PA participation "at home". Therefore, this proposal aims to 1) identify factors and triggers influencing PA participation after a traditional 36-session CR program (Stage 0); and 2) test a targeted health coaching intervention using these identified triggers to optimize PA maintenance and mobility among older adults who completed a center-based CR program.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

NONE

Enrollment

Conditions

Cardiac Rehabilitation Health Coaching Physical Activity

Interventions

Targeted Health Coaching GroupBEHAVIORAL

Participants in the THC group will receive an exercise prescription (steps/day) based on their last cardiac rehabilitation session exercise prescription. Participants will be provided a Garmin wearable device to track steps/day. Additionally, participants will partake in 6 virtual or in-person health coaching sessions lasting approximately 30-60 minutes in duration. These sessions will take place approximately every other week during the 3-month intervention period.

Standard Care GroupBEHAVIORAL

Participants in the SC group will receive an exercise prescription (steps/day) based on their last cardiac rehabilitation session exercise prescription. Participants will be provided a Garmin wearable device to track steps/day. Additionally, participants will be provided with a single virtual or in-person education session, lasting approximately 30 minutes, at the beginning of the 3-month intervention period.

Eligibility

Sex: ALLMin age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Willingness to provide informed consent to participate in the Target-CR Study * Must be able to read and speak English well enough to provide informed consent and understand instructions * Age ≥60 years * Diagnosed with coronary heart disease * Of adequate clinical stability to allow study participation * Own a smartphone device for application download Exclusion Criteria: * Planned relocation during the 3-month study period * Medical procedure scheduled within the 3-month study period that may limit physical activity (i.e., joint replacement) * Decompensated heart failure * Heart failure - New York Heart Association class IV * Severe pulmonary hypertension * End-stage renal disease * Cardiac transplantation * Impairment from stroke, injury, or other medical condition that would prevent participation in the intervention * Dementia that would prevent participation in the intervention and following study protocols * Any other illnesses that, in the opinion of the local clinician, would negatively impact or mitigate participation in and completion of the protocol * Psychiatric illness (self-report and screening) * Hospitalization for any psychiatric condition within one year (self-report) * Integrative Health Coaching Mental Health Screening Questionnaire score \>4 (screening) * Participation in an inpatient substance abuse rehabilitation program within one year

Locations (1)

Duke Center For Living

Durham, North Carolina, United States

Outcomes

Primary Outcomes

Change in Physical Activity as Measured by Steps Per Day

Time frame: Baseline, 3 months

Average Adherence to Physical Activity Prescription

A metric of adherence to the steps/day prescription, calculated as (steps/day completed) divided by (steps/day prescribed) times 100 and averaged across the study period. Reported as the average adherence (percent) to the steps per day prescription across the three-month study period.

Time frame: Baseline to 3 months

Secondary Outcomes

Change in Senior Fitness Test Score (SFT) - Chair Stands

The chair stand test is similar to a squat test to measure leg strength, in which participants stand up repeatedly from a chair for 30 seconds. Reported as the number of completed chair stands in 30 seconds.

Time frame: Baseline, 3 months

Change in Senior Fitness Test Score (SFT) - Arm Curls

The Arm Curl test is a test of upper body strength and involves performing as many arm curls as possible in 30 seconds, while sitting in a chair. Reported as change in the number of arm curls completed in 30 seconds.

Time frame: Baseline, 3 months

Change in Senior Fitness Test Score (SFT) - 6-minute Walk Test (6MWT)

The 6MWT is reported as the distance walked in 6 minutes to the nearest meter.

Time frame: Baseline, 3 months

Change in Senior Fitness Test Score (SFT) - 2-Minute Step Test

The 2-Minute Step Test is a measure of endurance or physical stamina, reported as change in the number of steps, marching in place, achieved in 2 minutes.

Time frame: Baseline, 3 months

Data from ClinicalTrials.gov

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