The self-regulation of exercise for the purposes of disease prevention and rehabilitation is a complex process that includes temporary lapses from exercise adherence. Research is lacking in the understanding of the cognitive experiences associated with lapsing and the impact of possible negative thoughts, emotions, and self-evaluations on future exercise self-regulation. Using a Social Cognitive Theory (SCT) framework, the primary purpose of the present experimental study was to examine the impact of potential negative reactions to exercise lapse experiences on exercise self-regulatory cognitions (i.e., decisional struggle, exercise self-regulatory efficacy, action planning, and willingness to self-regulate) using an experimental message designed to induce negative thoughts and affect about exercise lapsing. A secondary purpose of the study was to examine the potential moderating influences of the relatively unexplored construct of emotional self-efficacy on possible negative reactions. Forty-four adult participants were recruited from two exercise therapy programs run by the local health region to participate in this study. Participants filled out baseline measures of demographics, exercise self-regulatory efficacy (exercise SRE), and emotional self-efficacy at the first meeting. At the second meeting, participants were randomly assigned to read either an information control message or a negative lapse message. After reading the message, participants responded to affect measures and recorded their acute exercise thoughts. Next, self-regulatory cognitions were measured including decisional struggle, exercise SRE, action planning, and willingness to self-regulate. There were no significant differences between experimental groups on any of the measures, F(9, 34) = .80, Wilks ë = .825, p = .619. Possible explanations for these nonsignificant results are discussed. Given the opportunity to compare the present results to past research on acute positive and negative exercise thoughts by Gyurcsik and colleagues, and to potentially extend these findings to a population of exercise therapy maintainers, post hoc analysis of related research questions was carried out. Groups of positive and negative thinkers were formed based on the measure of acute thoughts. The omnibus MANOVA comparing positive and negative thinkers on social-cognitive measures was significant, F(8, 31) = 2.72, Wilks ë = .588, p = .021. As hypothesized, positive thinkers were found to have higher positive affect (p = .03), lower decisional struggle (p = .006), higher exercise SRE (p = .013), and higher willingness to self-regulate (p = .003). Positive thinkers also exercised more frequently than negative thinkers both at the program, F(1, 36) = 9.5, p = .004, and independently, F(1, 36) = 5.4, p = .026. Results are discussed in relation to SCT and past research on acute exercise thoughts. Limitations of the original experiment are discussed in terms of the negative lapse message. Future research is discussed both for the study of negative reactions to lapsing and for positive and negative thinking related to exercise.

The self-regulation of exercise for the purposes of disease prevention and rehabilitation is a complex process that includes temporary lapses from exercise adherence. Research is lacking in the understanding of the cognitive experiences associated with lapsing and the impact of possible negative thoughts, emotions, and self-evaluations on future exercise self-regulation. Using a Social Cognitive Theory (SCT) framework, the primary purpose of the present experimental study was to examine the impact of potential negative reactions to exercise lapse experiences on exercise self-regulatory cognitions (i.e., decisional struggle, exercise self-regulatory efficacy, action planning, and willingness to self-regulate) using an experimental message designed to induce negative thoughts and affect about exercise lapsing. A secondary purpose of the study was to examine the potential moderating influences of the relatively unexplored construct of emotional self-efficacy on possible negative reactions. Forty-four adult participants were recruited from two exercise therapy programs run by the local health region to participate in this study. Participants filled out baseline measures of demographics, exercise self-regulatory efficacy (exercise SRE), and emotional self-efficacy at the first meeting. At the second meeting, participants were randomly assigned to read either an information control message or a negative lapse message. After reading the message, participants responded to affect measures and recorded their acute exercise thoughts. Next, self-regulatory cognitions were measured including decisional struggle, exercise SRE, action planning, and willingness to self-regulate. There were no significant differences between experimental groups on any of the measures, F(9, 34) = .80, Wilks ë = .825, p = .619. Possible explanations for these nonsignificant results are discussed. Given the opportunity to compare the present results to past research on acute positive and negative exercise thoughts by Gyurcsik and colleagues, and to potentially extend these findings to a population of exercise therapy maintainers, post hoc analysis of related research questions was carried out. Groups of positive and negative thinkers were formed based on the measure of acute thoughts. The omnibus MANOVA comparing positive and negative thinkers on social-cognitive measures was significant, F(8, 31) = 2.72, Wilks ë = .588, p = .021. As hypothesized, positive thinkers were found to have higher positive affect (p = .03), lower decisional struggle (p = .006), higher exercise SRE (p = .013), and higher willingness to self-regulate (p = .003). Positive thinkers also exercised more frequently than negative thinkers both at the program, F(1, 36) = 9.5, p = .004, and independently, F(1, 36) = 5.4, p = .026. Results are discussed in relation to SCT and past research on acute exercise thoughts. Limitations of the original experiment are discussed in terms of the negative lapse message. Future research is discussed both for the study of negative reactions to lapsing and for positive and negative thinking related to exercise.

This preliminary investigation utilized both a top-down theory (Banduras Self-Efficacy Theory: SET, 1997) and a bottom-up theory (Leventhals Common Sense Model: CSM, 1980) to examine the cognitions and exercise behavior of novice cardiac rehabilitation (CR) participants engaged in 3 months of standard CR treatment. The primary purpose of this study was to investigate if the Illness Perception Questionnaire (IPQ,) as a reflection of the CSM, could classify CR novices relative to the strength of their illness perceptions. A further objective was to detect differences at baseline between the illness perception groups when evaluating SET variables and health-related outcomes that have been identified as important correlates of CR adherence. Additionally, the study proposed to determine differences between illness perception groups on adherence to recommended exercise therapy in CR. Lastly, differences between the groups on the assessed variables over the 3 month-rehabilitation period was examined. Forty-nine CR initiates were recruited. Participants were measured at 4 different time points over the 3-month initiation phase of CR. The IPQ, SF-36 (assessing health-related quality of life; HRQL,) and other social cognitive measures, including self-regulatory efficacy and positive and negative outcome expectations, were used to examine individuals. Participants completed measures at initiation of CR, after 2 weeks in CR, 6 weeks in CR and at the end of the 3-month initiate phase of CR. At onset of the program, cluster analysis successfully classified participants to weaker and stronger symptom-identity groups (i.e., illness perception groups). These groups were shown to be significantly different on the illness perceptions of identity, consequences and emotion. Upon initiation of CR, the classified groups were also significantly different on likelihood and value of negative outcome expectations, as well as physical and mental HRQL. At baseline, the group with stronger identity, consequences and emotion had higher negative outcome expectations and lower HRQL. In regards to adherence at the end of 3-months of CR, significant differences were found between the groups such that the group with stronger identity, consequences and emotion were less adherent to CR. This study was an initial exploration of the effectiveness of using the CSM along with SET. The findings offer insight into complementary use of top-down and bottom-up theoretical constructs to study psychological beliefs and adherence to exercise therapy in this rehabilitation setting.

The overall aim of this thesis was to explore and describe women’s recovery after a first myocardial infarction (MI) from an organisational, a relational and an individual perspective. In this thesis a longitudinal, explorative and descriptive design combining both quantitative (papers I-II) and qualitative (papers III-IV) methods has been used. Data was collected from healthcare professionals at 18 acute hospitals (paper I), which on two occasions answered a questionnaire dealing with cardiac rehabilitation efforts. From these 18 hospitals, 240 women who had suffereda first MI (paper II) were consecutively chosen to answer a questionnaire on three occasions on the subject of social support and social network. Descriptive and inferential statistics were used to analyse data over time. Paper III and IV had an exploratory and descriptive design based on an inductive, qualitative content analysis approach. Interviews were conducted with 20 cardiac rehabilitation nurses (CRN) (paper III) and with 26 women suffering a first MI (paper IV). The results showed that patients with MI, and their next of kin, were offered a well-functioning cardiac rehabilitation on both measurement occasions. None of the hospitals offered a CRP that was specifically designed for women (paper I). The women perceived that the extent of general support, support from relatives, and professional support changed positively over time (paper II). The CRNs experienced that women’s recovery was influenced by their ability to cope with the stresses of life, if they wanted to be involved in their own personal care and how they related to themselves, and their opportunities to receive support (paper III). Women experienced that ability to approach the new perspective of life depended on how they embraced the three dimensions; behaviour, i.e. women’s acting and engaging in various activities, social i.e. how women receive and give support in their social environment, and psychological i.e. their way of thinking, reflect and appreciate life (paper IV). In conclusion, the four studies show that women’s recovery after a first MI is depending on factors emerging from an organisational, a relational and an individual perspective. Using knowledge from these three perspectives the possibility of a holistic approach to women’s recovery process to health will increase and the risk of a reductionist thinking will decrease.

Cardiovascular disease (CVD) is the leading cause of death among Canadian women, and accounts for up to 30% of deaths among women worldwide. Women with CVD are typically older than their male counterparts, experience worse functional status, are more likely to experience non-CVD health conditions such as diabetes or arthritis, and will live with these health conditions for more years than men. Physical activity (PA) and cardiac rehabilitation (CR) participation is lower among women compared to men, but little is known about the PA and health promotion experiences, priorities and practices of older women living with CVD. Guided by a socioenvironmental approach to health promotion, a mixed method design involving a mail survey (N=127) and qualitative interviews (N=15) was employed to describe and explore the PA and health promotion practices, preferences and priorities of older women (≥65 years) living with CVD in the Champlain health region of Ontario. Nearly 60% of survey respondents were referred to CR. Logistic regression analysis revealed urban residence as a predictor of CR referral (p<0.01, OR=3.24; 95% CI: 1.44-7.30). Nearly 55% of respondents attended CR, which was predicted by CR referral (p<0.01, OR=32.26; 95% CI: 9.26-111.11), availability of transportation (p<0.05, OR=9.96; 95% CI: 1.22-81.41), and a history of structured PA (p<0.05, OR=3.64; 95% CI: 1.16-11.36). Respondents were more active than their peers, but received little support from their physician for PA. Older women’s incidental PA (walking six or more hours/week for transportation) was predicted by their sense of community belonging (p<0.05, OR=2.6; 95% CI: 1.05-6.29) and having energy for PA (p<0.05, OR=5.8; 95% CI: 1.21-27.92). Interview participants (including four who had attended CR) described health as a resource that enables them to lead busy, active lives. Most participants attributed CVD to genetics or stress, but still engaged in health-promoting activities, including structured and incidental PA. Participants engaged in ‘incidental’ activities such as walking, gardening, and housekeeping tasks purposefully, with the intention of maintaining or improving their health. This research can inform public health initiatives and health care services (including CR) to better meet the needs and preferences of the growing population of older women with CVD.

Introdução: Ensaios clínicos demonstram que pacientes com doença arterial coronariana, submetidos a programa de reabilitação cardíaca, apresentam melhora na função endotelial dependente do endotélio, porém a intensidade do exercício com maior benefício não é conhecida. Objetivo: Comparar os efeitos de duas intensidades de exercício aeróbio sobre a resposta vasodilatadora braquial dependente e independente do endotélio em pacientes com doença arterial coronariana. Métodos: 33 pacientes pós-infarto agudo do miocárdio, do sexo masculino, com idade média (58±6), foram randomizados para: treinamento em cicloergômetro de alta intensidade (AI) (80-85% da freqüência cardíaca máxima; n = 16); ou de moderada intensidade (MI) (65-70 % da freqüência cardíaca máxima; n = 17). O treinamento foi realizado por 45 minutos, 5 vezes por semana. Antes e após 4 semanas de treinamento, os pacientes realizaram teste de esforço com Protocolo de Ellestad e estudo da função endotelial braquial, por ultra-som de alta resolução da artéria braquial. Resultados: O treinamento em AI resultou em maior aumento da capacidade funcional avaliada pelo tempo de máximo tolerado no teste de esforço (AI de 7,45 ± 1,52 para 9,01 ± 1,94 min e MI de 7,55 ± 1,79 para 7,63±1,68 min). O grupo AI também apresentou maior aumento do fluxo da artéria braquial após hiperemia reativa (dependente do endotélio) e após uso de nitrato sublingual (independente do endotélio). Conclusão: Quando comparado ao treinamento de moderada intensidade, o treinamento aeróbio de alta intensidade resulta em maior aumento da capacidade funcional e da resposta vasodilatadora dependente e independente do endotélio em pacientes com doença arterial coronariana. / Introduction: Clinical essays show that patients with coronary artery disease when submitted under a cardiac rehabilitation program present improvement of endothelium dependent endothelial function, however benefits of the exercise intensity are still unknown. Aim: To compare the intensities of aerobic exercise over dependent and independent brachial vasodilation response in patients with coronary artery disease Methods: 33 post acute myocardium infarct males patients, with a mean age of 58 + 6, were randomized trained in high-intensity cycle-ergonomics (AI), (80-85% from maximal cardiac frequency n = 16); or moderate intensity (MI) (65-70 % from maximal cardiac frequency n = 17). Trainings lasted for 45 minutes, 5 times a week. Before and after 4 weeks of training patients underwent maximal treadmill stress tests with Ellestad Protocol and studies of brachial-endothelial function. Results: Training in AI group resulted in increased functional fitness, when assesses by endurance time at treadmill exercise test (AI from 7,45 ± 1,52 to 9,01 ± 1,94 min and MI from 7,55 ± 1,79 to 7,63±1,68 min). Also, AI group presented greater augment of brachial artery flow after reactive hyperemia (endothelium-dependent) and after the sublingual intake of nitrate (endothelium-independent). Conclusion: High-intensity aerobic training compared to moderate-intensity training results in greater functional capacity and endothelium dependent and independent vasodilation response in patients with coronary arterial disease.

Introdução: Ensaios clínicos demonstram que pacientes com doença arterial coronariana, submetidos a programa de reabilitação cardíaca, apresentam melhora na função endotelial dependente do endotélio, porém a intensidade do exercício com maior benefício não é conhecida. Objetivo: Comparar os efeitos de duas intensidades de exercício aeróbio sobre a resposta vasodilatadora braquial dependente e independente do endotélio em pacientes com doença arterial coronariana. Métodos: 33 pacientes pós-infarto agudo do miocárdio, do sexo masculino, com idade média (58±6), foram randomizados para: treinamento em cicloergômetro de alta intensidade (AI) (80-85% da freqüência cardíaca máxima; n = 16); ou de moderada intensidade (MI) (65-70 % da freqüência cardíaca máxima; n = 17). O treinamento foi realizado por 45 minutos, 5 vezes por semana. Antes e após 4 semanas de treinamento, os pacientes realizaram teste de esforço com Protocolo de Ellestad e estudo da função endotelial braquial, por ultra-som de alta resolução da artéria braquial. Resultados: O treinamento em AI resultou em maior aumento da capacidade funcional avaliada pelo tempo de máximo tolerado no teste de esforço (AI de 7,45 ± 1,52 para 9,01 ± 1,94 min e MI de 7,55 ± 1,79 para 7,63±1,68 min). O grupo AI também apresentou maior aumento do fluxo da artéria braquial após hiperemia reativa (dependente do endotélio) e após uso de nitrato sublingual (independente do endotélio). Conclusão: Quando comparado ao treinamento de moderada intensidade, o treinamento aeróbio de alta intensidade resulta em maior aumento da capacidade funcional e da resposta vasodilatadora dependente e independente do endotélio em pacientes com doença arterial coronariana. / Introduction: Clinical essays show that patients with coronary artery disease when submitted under a cardiac rehabilitation program present improvement of endothelium dependent endothelial function, however benefits of the exercise intensity are still unknown. Aim: To compare the intensities of aerobic exercise over dependent and independent brachial vasodilation response in patients with coronary artery disease Methods: 33 post acute myocardium infarct males patients, with a mean age of 58 + 6, were randomized trained in high-intensity cycle-ergonomics (AI), (80-85% from maximal cardiac frequency n = 16); or moderate intensity (MI) (65-70 % from maximal cardiac frequency n = 17). Trainings lasted for 45 minutes, 5 times a week. Before and after 4 weeks of training patients underwent maximal treadmill stress tests with Ellestad Protocol and studies of brachial-endothelial function. Results: Training in AI group resulted in increased functional fitness, when assesses by endurance time at treadmill exercise test (AI from 7,45 ± 1,52 to 9,01 ± 1,94 min and MI from 7,55 ± 1,79 to 7,63±1,68 min). Also, AI group presented greater augment of brachial artery flow after reactive hyperemia (endothelium-dependent) and after the sublingual intake of nitrate (endothelium-independent). Conclusion: High-intensity aerobic training compared to moderate-intensity training results in greater functional capacity and endothelium dependent and independent vasodilation response in patients with coronary arterial disease.

No description available.

Tratou-se de início o problema da reabilitação do cardíaco a partir de uma fundamentação de seus conceitos e análise de sua história. Em seguida estudou-se os aspectos orgânico, social e psíquico que influem no atendimento do paciente coronariano. A partir destes elementos elaborou-se uma metodologia para a reabilitação deste tipo de paciente. Ressaltou-se a importância da equipe de atendimento, bem como recursos de equipamento e planta física. Caracterizou-se a equipe como multiprofissional e multidisciplinar e definiu-se suas atribuições. Estudou-se a situação atual da reabilitação cardíaca no Brasil, com a finalidade de possibilitar o planejamento e a organização de um serviço de reabilitação para o paciente cardíaco, devido ao aumento da morbimortalidade por doença coronariana. Procurou-se determinar a localização geográfica, a situação e os tipos de serviços de reabilitação cardíaca no Brasil, usando-se questionários enviados pelo correio aos serviços de cardiologia do país, indexados no Anuário Estatístico. Realizou-se a análise in loco dos serviços de reabilitação cardíaca da capital do Estado de São Paulo. Posteriormente, comparou-se os demais serviços com o Instituto \"Dante Pazzanese\" de Cardiologia (IDPC). Para se obter dados mais precisos analisou-se a planta física, os recursos humanos, o equipamento, a administração e a avaliação dos serviços de reabilitação cardíaca. Verificou-se que os serviços de reabilitação cardíaca estão localizados apenas nas Regiões Sul (5) e Sudeste (15), incluindo o IDPC. Foi verificado que nas Regiões Sul e Sudeste encontram-se 64.571.000 habitantes o que eventualmente poderá gerar 6.457 cardiopatas. Nestas mesmas áreas notou-se que existe um cardiologista para atender 1.793.638 habitantes. Constatou-se, por outro lado, que as necessidades em área para condicionamento físico, salas para atendimento, pessoal e equipamento necessário são bastante deficientes nas duas Regiões, principalmente quando comparadas à organização do IDPC, que foi utilizada como padrão. Concluiu-se pela necessidade de se encarar a reabilitação cardíaca como um processo dinâmico, que depende do trabalho da equipe, do equipamento, da planta física, da orientação e educação do paciente e seus familiares, da motivação da comunidade, e que o serviço de reabilitação cardíaca não pode estar desvinculado do Hospital e da Comunidade para a qual foi criado. É necessária a preparação de equipes multidisciplinares para suprir as Regiões carentes em reabilitação do paciente cardíaco, bem como a criação de unidades que atendam às necessidades. / The problem of the cardiac patient rehabilitation was initially studied, taken into consideration its concepts and its clinical history. Next, organic, social and psychological aspects that influence the attendance of coronary patients were studied. Based on these elements, rehabilitation methodology for these patients was elaborated. The importance of the attending team, as well as of equipment and physical plant, was stressed. The team was characterized as a multiprofessional and multidisciplinary one and the role of each member was defined. The current situation of cardiac rehabilitation in Brazil was studied, in order to facilitate the planning and organization of a rehabilitation service for cardiac patients, since morbidity and mortality caused by coronary disease are increasing. An attempt was done in order to point out the geographic area, the actual situation and the types of the cardiac rehabilitation services in Brasil. This was done by means of a questionnaire mailed to the indexed services in the \"ANUÁRIO ESTATÍSTICO DO BRASIL\". Concomitantly, an analysis \"in loco\" of the cardiac rehabilitation services in São Paulo City was performed and latter on all services were compared to Instituto \"Dante Pazzanese\" de Cardiologia. In order to obtain more precise data, the plant, human resources, equipment, administration and evaluation of services were analysed. It was found that the cardiac rehabilitation services are located in the southerhand south-eastern areas of Brazil only, where we can find 64.571,000 inhabitants which can eventually present 6.457 cases of cardiopathy. These areas present 1 (one) cardiologist to attend to 1,793,638 inhabitants. On the other hand, the existing material and equipment, as well as appropriate buildings are deficient in both areas, mainly when compared to IDPC organization, that was used as model. It was concluded that we must consider cardiac rehabilitation as a dynamic process, dependant on the work of a team, on the equipment, on the building, on the orientation and education of the patient and his family, on the motivation of the community, and that the cardiac rehabi1itation service cannot be separated Cdetached) from the Hospital and the community it was created for.

Introdução: Ensaios clínicos demonstram que pacientes com doença arterial coronariana, submetidos a programa de reabilitação cardíaca, apresentam melhora na função endotelial dependente do endotélio, porém a intensidade do exercício com maior benefício não é conhecida. Objetivo: Comparar os efeitos de duas intensidades de exercício aeróbio sobre a resposta vasodilatadora braquial dependente e independente do endotélio em pacientes com doença arterial coronariana. Métodos: 33 pacientes pós-infarto agudo do miocárdio, do sexo masculino, com idade média (58±6), foram randomizados para: treinamento em cicloergômetro de alta intensidade (AI) (80-85% da freqüência cardíaca máxima; n = 16); ou de moderada intensidade (MI) (65-70 % da freqüência cardíaca máxima; n = 17). O treinamento foi realizado por 45 minutos, 5 vezes por semana. Antes e após 4 semanas de treinamento, os pacientes realizaram teste de esforço com Protocolo de Ellestad e estudo da função endotelial braquial, por ultra-som de alta resolução da artéria braquial. Resultados: O treinamento em AI resultou em maior aumento da capacidade funcional avaliada pelo tempo de máximo tolerado no teste de esforço (AI de 7,45 ± 1,52 para 9,01 ± 1,94 min e MI de 7,55 ± 1,79 para 7,63±1,68 min). O grupo AI também apresentou maior aumento do fluxo da artéria braquial após hiperemia reativa (dependente do endotélio) e após uso de nitrato sublingual (independente do endotélio). Conclusão: Quando comparado ao treinamento de moderada intensidade, o treinamento aeróbio de alta intensidade resulta em maior aumento da capacidade funcional e da resposta vasodilatadora dependente e independente do endotélio em pacientes com doença arterial coronariana. / Introduction: Clinical essays show that patients with coronary artery disease when submitted under a cardiac rehabilitation program present improvement of endothelium dependent endothelial function, however benefits of the exercise intensity are still unknown. Aim: To compare the intensities of aerobic exercise over dependent and independent brachial vasodilation response in patients with coronary artery disease Methods: 33 post acute myocardium infarct males patients, with a mean age of 58 + 6, were randomized trained in high-intensity cycle-ergonomics (AI), (80-85% from maximal cardiac frequency n = 16); or moderate intensity (MI) (65-70 % from maximal cardiac frequency n = 17). Trainings lasted for 45 minutes, 5 times a week. Before and after 4 weeks of training patients underwent maximal treadmill stress tests with Ellestad Protocol and studies of brachial-endothelial function. Results: Training in AI group resulted in increased functional fitness, when assesses by endurance time at treadmill exercise test (AI from 7,45 ± 1,52 to 9,01 ± 1,94 min and MI from 7,55 ± 1,79 to 7,63±1,68 min). Also, AI group presented greater augment of brachial artery flow after reactive hyperemia (endothelium-dependent) and after the sublingual intake of nitrate (endothelium-independent). Conclusion: High-intensity aerobic training compared to moderate-intensity training results in greater functional capacity and endothelium dependent and independent vasodilation response in patients with coronary arterial disease.