This study assessed differences in the knowledge of cardiac risk factors and the attitude toward computer assisted instruction (CAI) in cardiac rehabilitation patients instructed by lecture and transparencies or CAI. The quasi-experimental two-group posttest design used a convenience sample of 30 volunteers enrolled in a cardiac rehabilitation program. After randomization, cardiac risk factor instruction was conducted via lecture or the investigator developed CAI. The subjects completed a knowledge instrument which demonstrated content validity and a Kuder-Richardson formula 20 reliability coefficient of .0 and the Attitude Toward CAI scale which demonstrated content validity and a Cronbach's alpha .853 and .759. The data were analyzed by the two-sample t-test utilizing the .05 probability level. The results indicated a nonsignificant t value of .00 (df 28, p = 1.00) in the knowledge scores and a nonsignificant t value of 2.00 (df 28, p = .05) in attitude scores therefore the results failed to reject both null hypotheses. The conclusions drawn from this study are that CAI was as effective as lecture for patient education and that attitudes toward CAI were favorable. / School of Nursing

Cardiac rehabilitation is profoundly effective at improving physical activity and reducing morbidity and mortality of heart patients. Despite its effectiveness, it is highly underutilized. Research indicates proxy-efficacy and self efficacy positively correlate and predict exercise adherence after Phase II cardiac rehabilitation (Bray & Cowan, 2004; Bray, Brawley, & Millen, 2006). The purpose of the current study aims to investigate the relationship of Phase I patients' proxy-efficacy and self efficacy and their intention to enroll in Phase II cardiac rehabilitation. Thirty participants completed measurements of self-efficacy and proxy-efficacy, a demographic questionnaire, and asked to indicate intent to enroll. Results revealed proxy-efficacy does not predict intention to enroll into Phase II cardiac rehabilitation. Even though patients generally had high confidence in their cardiac rehabilitation specialists, proxy-efficacy was an insufficient predictor of intention to enroll in subsequent cardiac rehabilitation services. Moreover, results indicate proxy-efficacy and self efficacy for exercise are not related. / School of Physical Education, Sport, and Exercise Science

D.Litt. et Phil. (Psychology) / Over the past four decades we have witnessed the emergence of amazingly sophisticated means of cardiovascular diagnosis and therapy. For the first time in many years, some Western countries could report a decline in cardiovascular deaths. During this same span of years we have witnessed the remarkable development of an array of technological achievements that include the means for invasive diagnostic procedure such as cardiac catherization, and non-invasive methods of echocardiography, magnetic, radio-isotopic and positron imagery which provide detailed diagnostic and prognostic information. This innovations along with synthetic grafts have permitted surgical interventions that would not have been conceivable at the outset of this cardiovascular odyssey. Another major advance has been the appearance of new pharmacological modalities; the diuretics, the beta-adrenergic receptors and angiotension converting enzyme inhibitors, the calcium antagonists and other anti-hypersensitive agents, a spectrum of antiarrhythmic compounds, anticoagulants and fibrinolytic therapy, and the promise of still more innovative and novel modes of therapy which will appear via genetic engineering. Over the past years there has been equally significant development in the area of cardiovascular epidemiology. These advances include the demonstration of validity and the efficacy of various therapeutic programmes by the unique development of complex multi-center trials, as well as long-term population-based studies. Through this endeavours specific risk factors that impart independent risk ofpremature cardiovascular morbidity and mortality has been identified. Some of these risk factors are clearly not modifiable such as advancing years, male gender and race. Others are at least partly modifiable: predisposition to diabetes myelitis and increased body mass. By virtue of multi-center trials we have clear evidence that cigarette smoking, rising systolic and diastolic arterial pressures, serum cholesterol levels, and diabetes are modifiable. It is a known fact that not all individuals with coronary artery disease are cured by medication or by means of a surgical intervention. In addition to this, the reduction of traditional biomedical risk factors have been shown to be insufficient in averting the reocclusion and the further occlusion of coronary arteries in patient populations.

An experiment was conducted to investigate three different treatment strategies in the rehabilitation of coronary artery bypass graft (CABG) patients. Fifteen CABG patients were randomly assigned to one of three training groups: an outpatient cardiac rehabilitation exercise group (which met three times per week for three months); a second group which participated in weekly stress management training for seven weeks in addition to the cardiac rehabilitation exercise sessions; and a third group which participated in a weekly discussion on social support in addition to the exercise sessions. The groups were compared (pre- and post training) on the following physiological dependent measures: systolic and diastolic blood pressure, mean heart rate, cholesterol, triglycerides, high density lipoproteins, and the cholesterol/high density lipoprotein ratio. Psychological self-report measures included: the Beck Depression Inventory, the Spielberger State/Trait Anxiety Index, the Jenkins Activity Survey, and the Hassles and Uplifts Questionnaire. The Structured Interview was given to each patient prior to training only. It was predicted that the group trained in stress management and exercise would show the most positive changes on physiological and psychological dependent measures compared to the other two groups. The results indicated no significant pre/post differences on any of the variables for any of the groups. Thus, the additional components of stress management training and the social support discussion group did not appear to effect more positive change in those patients compared to those who participated in exercise only. Findings may have been influenced by several factors including a small N in each group and large within group variability. Suggestions for future research are discussed.

The American College of Sports Medicine has published formulae that are widely used to predict functional aerobic capacity for any treadmill speed and grade combination. However, it has been demonstrated that these formulae overpredict oxygen consumption (V̇O₂) for patients with coronary artery disease as well as for apparently healthy individuals. To study this, we measured V̇O₂, ventilation (V̇_E), and respiratory exchange ratio (R) responses in 21 apparently healthy subjects (AH) and 16 coronary artery diseased subjects (CAD) during a modified Balke protocol. Modification of the protocol consisted of extending the stage time from two minutes to three minutes at the higher intensities to allow a greater time for a physiological steady-state to occur. The attainment of a steady-state may lead to the reduction of or the elimination of prediction errors. No differences were observed between two and three minute VO₂ responses at maximal and submaximal exercise for either group. At peak exercise, the AH group was significantly (P≤.05) different from the CAD group when compared for heart rate (164±2.6 vs 140±4.8 bts•min⁻¹ ), V̇O₂ (33.3±1.1 vs 26.7±2.3 ml•kg⁻¹•min⁻¹), and total treadmill time (9.9±.33 vs 8.1±.54 min). At submaximal exercise, V̇O₂ responses were also significantly (p≤.05) greater for the AH group when compared to the CAD group (26.6±.95 vs 21.9±1.8 ml•kg⁻¹•min⁻¹). No significant differences were observed for RPE and blood lactate at peak exercise and V̇_E and R responses at submaximal or peak exercise between the two groups. Predicted values for peak V̇O₂ were significantly (p≤.05) higher than measured values (33.3±1.1 vs 38.8±1.1 ml•kg⁻¹•min⁻¹) and (26.7±2.3 vs 34.1±1.7 ml•kg⁻¹•min⁻¹) for the AH and CAD groups, respectively. However, no significant differences were noted between predicted and measured V̇O₂ responses at submaximal exercise for either group. Individuals classified as Type A were not significantly different from classified Type B individuals when compared for the cardio-respiratory variables measured. These data demonstrate that the ACSM prediction formulae significantly overpredict V̇O₂ for both AH and CAD subjects at maximal treadmill intensities. However, at submaximal intensities, these prediction formulae are acceptable for both groups of subjects. Furthermore, these data suggest that two minutes per stage allows sufficient time for physiological steady-state to occur at clearly submaximal intensities. Although at the higher intensities, extending the stage time beyond two minutes may be indicated. / M.S.

Nine male CHD patients volunteered for testing to determine variations in heart rate response (HR), walk-jog velocity (W) and compliance to the target heart rate zone under three monitoring conditions. Determination of variations in W, peripheral perceived exertion (RPE_L) chest perceived exertion (RPE_C) and post-exercise lactate accumulation (La) during exercise which was held constant between 60-80% maximum HR reserve were also made. Procedures consisted of three 20 min walk-jog exercise conditions. First, two baseline condition (BC) trials were performed on separate days with exercise intensity regulated through intermittent defibrillator-ECG HR checks and radial/carotid artery palpation. Next, continuous telemetry monitoring of HR by staff was added during a single exercise trial (TC). Finally, two Exersentry_Rcondition (EC) trials were performed on separate days with continuous feedback concerning HR response provided to the patient via Exersentry_R devices. Evaluation of HR and W revealed no significant variation between conditions. However, % target HR reserve attained was significantly (p>0.05) lower during early and late BC, as compared to TC. Furthermore, "frequency in" vs "frequency out" of target HR zone was significantly (p>0.05) greater during EC, as compared to TC. During EC, no significant variations in HR, W, La, RPE_L and RPE_C were noted. Correlation coefficient values between 0.76-0.95 and 0.58-0.80 were reported for RPE_L and RPE_C, respectively. This data suggested that continuous feedback concerning HR response resulted in the greatest compliance to the target HR zone. With the exception of the first five min of EC, only RPE_L reliably mirrored HR and W. Index terms: Intermittent heart rate monitoring, continuous heart rate monitoring, heart rate response, walk-jog velocity, target heart rate compliance, peripheral perceived exertion, chest perceived exertion, post-exercise lactate accumulation. / M.S.

Controversy exists regarding the effects of beta-blocker medications on functional capacity in cardiac patients and in the effects of disease-related impairments on cardiorespiratory dynamics during exercise testing. Therefore, this study was conducted to examine the exercise responses of 26 subjects (ages 37-66 years) to a graded exercise test. Subjects were divided into three groups based on clinical status: apparently healthy (AH; N=8); cardiacs receiving beta-blockers (C-BB; N=8); cardiacs not receiving beta-blockers (Câ NBB; N=lO). / Master of Science

BACKGROUND Increasingly, it is recognised that the unique needs of people from culturally and linguistically diverse backgrounds (CaLDB) should be addressed within a framework of cultural competence. To date, there are limited data on the issues facing CaLDB patients in the Cardiac Rehabilitation (CR) setting. Appreciation of an individual???s values, attitudes and beliefs underpins negotiation of behaviour change in the CR setting. Therefore an understanding of patient and professional interactions is of key importance. OBJECTIVES The focus of this study has been to undertake an exploration of CR service delivery to people from culturally and linguistically diverse backgrounds, using Arabic speaking people as an exemplar of a CaLDB group. More broadly, this research project has sought to identify factors, which influence the practice of health professionals towards CaLDB patients, and to develop a model for evaluation of culturally competent health care in the CR setting. The study sought to achieve these aims by addressing the following research questions: 1. In what way do health practitioners in CR adjust their treatment and support to accommodate the perceived needs of CaLDB communities? 2. In what way do factors (such as individual and organisation perspectives) influence the adjustment of clinical practice and service delivery of CR practitioners; and what are practitioners??? and patients??? perception of barriers and facilitators to service delivery? 3. To what level are CaLDB patients satisfied with CR services? This study design is comprised of the following elements: (1) interviews with health practitioners and Arabic speaking background patients as an exemplar of CaLDB patients; (2) review of policy and procedure documents and medical records; and (3) field observation. METHOD This thesis embraces a qualitative approach as the primary method of investigation to align with the exploratory and descriptive nature of the study. The main methods used in the study were: in depth interviews with health professionals and patients; field observations; appraisal of relevant documents and consultation with expert panels. Study samples were selected through a purposive sampling strategy.Data were analysed using the method of content analysis, guided by the research questions. FINDINGS In total, 25 health professionals (20 female and 5 male) and 32 patients (21 male and 11 female) were interviewed. The method of qualitative content analysis was used for data analysis. Data analysis revealed four major themes: 1) The challenging context; 2) Tuning practices; 3) Influencing factors; and 4) Goodness of fit. The study demonstrated a challenging context for CR delivery, both from the perspective of patients and health professionals. Data reveal a process of reflection, negotiation, and navigation of care by CR health professionals in an effort to understand and meet the diverse needs of CALDB patients. CONCLUSION On the basis of the study findings, a process-oriented model of tuning practice to achieve cultural competence in CR delivery is proposed to inform policy, research and clinical practice.

BACKGROUND Increasingly, it is recognised that the unique needs of people from culturally and linguistically diverse backgrounds (CaLDB) should be addressed within a framework of cultural competence. To date, there are limited data on the issues facing CaLDB patients in the Cardiac Rehabilitation (CR) setting. Appreciation of an individual???s values, attitudes and beliefs underpins negotiation of behaviour change in the CR setting. Therefore an understanding of patient and professional interactions is of key importance. OBJECTIVES The focus of this study has been to undertake an exploration of CR service delivery to people from culturally and linguistically diverse backgrounds, using Arabic speaking people as an exemplar of a CaLDB group. More broadly, this research project has sought to identify factors, which influence the practice of health professionals towards CaLDB patients, and to develop a model for evaluation of culturally competent health care in the CR setting. The study sought to achieve these aims by addressing the following research questions: 1. In what way do health practitioners in CR adjust their treatment and support to accommodate the perceived needs of CaLDB communities? 2. In what way do factors (such as individual and organisation perspectives) influence the adjustment of clinical practice and service delivery of CR practitioners; and what are practitioners??? and patients??? perception of barriers and facilitators to service delivery? 3. To what level are CaLDB patients satisfied with CR services? This study design is comprised of the following elements: (1) interviews with health practitioners and Arabic speaking background patients as an exemplar of CaLDB patients; (2) review of policy and procedure documents and medical records; and (3) field observation. METHOD This thesis embraces a qualitative approach as the primary method of investigation to align with the exploratory and descriptive nature of the study. The main methods used in the study were: in depth interviews with health professionals and patients; field observations; appraisal of relevant documents and consultation with expert panels. Study samples were selected through a purposive sampling strategy.Data were analysed using the method of content analysis, guided by the research questions. FINDINGS In total, 25 health professionals (20 female and 5 male) and 32 patients (21 male and 11 female) were interviewed. The method of qualitative content analysis was used for data analysis. Data analysis revealed four major themes: 1) The challenging context; 2) Tuning practices; 3) Influencing factors; and 4) Goodness of fit. The study demonstrated a challenging context for CR delivery, both from the perspective of patients and health professionals. Data reveal a process of reflection, negotiation, and navigation of care by CR health professionals in an effort to understand and meet the diverse needs of CALDB patients. CONCLUSION On the basis of the study findings, a process-oriented model of tuning practice to achieve cultural competence in CR delivery is proposed to inform policy, research and clinical practice.

Twenty subjects were audio and video taped during their exercise leadership examination. The tapes were used to code the interactions that occurred between the exercise leaders and the participants in the simulated cardiac rehabilitation exercise session using an interaction analysis system developed specifically for this physical activity setting group. The system identified interactions that could occur during the warm-up, stimulus, and cool-down phases of the session. The tapes were coded using the Datamyte 801 Observational Recorder. The phases of the sessions were coded individually. A frequency count was made as the interaction categories occurred. The frequencies were converted into rates of interaction (f•min⁻¹) for comparison. The mean rates of interaction were low for the phases and overall (warm-up= .38/min; stimulus= .59/min; cool-down= .29/min; total= .46/min). The individual subject's rates of interaction were all less than 1 interaction per minute (minimum= .28/min; maximum= .72/min). Related t-tests across category facets between phases showed the instruction and explanation facets in the warm-up phase differed significantly from the same facets in the stimulus phase. The compliance facet differed significantly in the stimulus phase from the compliance facet in the other two phases. The monitor facet in the stimulus phase differed significantly from the monitor facet in the cool-down phase. There was no significant differences across facets between the warm-up and cool-down phases. Higher rates of interaction occurred more frequently in the stimulus phase. The coding showed the differences in the interactions of the exercise leaders in the different phases in the simulated exercise session. The low rates of interaction suggest that the exercise leaders may have been reactive to the specific examination situation in which these data were collected. / M.S.