Predictors of Physical Activity Maintenance in Older Adults with Coronary Heart Disease

1. Predictors of Physical Activity Maintenance in Older Adults with Coronary Heart Disease Julie Fleury Michael Belyea Adriana Perez

2. Background • Maintenance of physical activity is essential to promote cardiovascular health and prevent loss of rehabilitative gains • Despite benefits of cardiac rehabilitation, failure to maintain physical activity is a fundamental problem • Little is known about the social contextual or motivational determinants through which physical activity is maintained following cardiac rehabilitation

3. Purpose • The purpose of this study was to determine which social contextual resource and behavioral change process variables within the wellness motivation theory were significant predictors of physical activity among individuals with diagnosed coronary heart disease (CHD), who had completed a program of cardiac rehabilitation

4. Wellness Motivation Theory Self- regulation Behavioral Social Contextual Resources Action Change Processes Demographic Regular Physical Activity Motivation Appraisal Social Environmental

5. Research Design • Prospective, longitudinal study to examine predictors of physical activity maintenance • Measurement occurred at three time points: • T0: 2 weeks post-rehabilitation program • T1: 3 months post-rehabilitation program • T2: 6 months post-rehabilitation program

6. Setting • Cardiac Rehabilitation Centers • Serve diverse patient populations • Target urban and rural communities • Incorporate preventive services • Foster multidisciplinary focus

7. Participants • English literate • Clinically diagnosed CHD • Graduates from monitored rehabilitation • Clinically categorized as low risk • AACVPR • AHA

8. Procedures • Recruit/screen for eligibility • Provide informed consent • Measurement • Self-report measures

9. Variables and Measurement: Social Contextual Resources • ConceptMeasureDescription • Demographic Age, Gender, Individual Education Characteristics • Social resource Support Support Friends • Environment Neighborhood Resources resource Home Resources

10. Variables and Measurement:Behavioral Change Processes • ConceptMeasureDescription • Motivation Index of Readiness Commitment Appraisal Goal strategies • Self-regulation Index of Self- Stimulus control, Regulation Behavioral monitoring

11. Variables and Measurement: Action • ConceptMeasureDescription • Activity type Activity mode: PA Intentional activity • Activity frequency, Days per week Weekly minutes duration Minutes per event • Activity maintenance Minutes per week Sum of weekly time in minutes

12. Data Analysis • Latent Growth Curve Model • Mean structure provides information about: • Average rate of change in time spent in Physical Activity (mean slope) • Average initial time spent in Physical Activity (mean intercept) • Latent variances provide information about: • Variability of initial time spent in Physical Activity • Variability of rate of change in time spent in Physical Activity

13. Data Analysis • Time-Invariant Covariates • Gender, age, education, neighborhood environment, home environment added as predictors of intercepts and slopes • Structural means become intercept values • Initial level and rate of change adjusted for covariates

14. Data Analysis • Time-Varying Covariates • Motivation Appraisal, Self-Regulation and Social Support as Time Varying Covariates • Variables measured at 3 time points • Included as predictors of time spent in Physical Activity at each time point • Initial level and change in time spent in Physical Activity adjusted for Motivation Appraisal, Self-Regulation, and Social Support

15. Time-Varying and Time-Invariant Covariatesin Physical Activity Growth Curve Model

16. Results: Sample Characteristics

17. Results: Unconditional Growth Model

18. Results: Model including Time-Invariant Covariates and Time-Varying Covariates

19. Results: Model including Time-Invariant Covariates and Time-Varying Covariates

20. Results: Model including Time-Invariant Covariates and Time-Varying Covariates

21. Summary • Moderate level of time spent in physical activity following a cardiac rehabilitation program • A small drop in time spent over 6 months • Significant differences in the initial level of time spent and rate of change over time • Demographic variables did not account for variability in initial levels or rate of change over time

22. Summary • Neighborhood environment was positively related to the rate of change • Higher perceived neighborhood resources was related to more physical activity • Home environment was negatively related to change over 6 months • Higher perceived resources resulted in less physical activity

23. Summary • Changes in social support were positively related to time spent in physical activity • Changes in self-regulation were positively related to time spent in physical activity

24. Conclusions • Data provide a basis for programmatic research, and guide development of theory-based interventions to foster the maintenance of physical activity among patients with diagnosed CHD • Latent growth curve analysis provides important information about positive and negative shifts in physical activity following cardiac rehabilitation • Data support the need for a multi-level approach to promoting physical activity maintenance, including environmental resources, engagement in social interactions, and skill building in self-regulation