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Physical Activity after PCI: Patients should become autonomous managers of their own health and lifestyle

Comment by Patrick Doherty, EACPR Cardiac Rehabilitation Section


This study was part of a long standing research approached initially outlined in 2007 by Charlson et al where the research team set out to investigate the effect of positive affect induction and self determination in patients with cardiopulmonary disease.

This article focuses on patients following PCI and yields findings that are important for any intervention that aims to foster sustained health behaviour change. Albeit some assumptions were not upheld in respect of the repeatability of the tools used (i.e. self administered physical activity questionnaire had not, at the time, been thoroughly tested for reliability) generally the design was robust with good quality reporting for an RCT. The control group (patient education plus phone contacts) and the intervention group (positive affect and affirmation in the form of facilitating positive thinking and use of small gifts) had comparable baseline characteristics and were representative of patients attending clinical practice. Only a small amount of drop out (<5%) occurred over the 12 months of the study.
The results clearly demonstrate sustained and significant improvements in the primary outcome of physical activity (Kcal/week) at 12 months. With the caveat of an underpowered subset analysis the extent of co-morbidity (including depression) did not hinder the benefits for the intervention group.
Although the mechanism of effect was not tested prospectively the authors postulate improvements in depression as a possible contributor.
An important finding, which has implication for when to judge the effectiveness of behavioural interventions, was that a positive trend  in physical activity (Kcals/week) existed for both groups for the first 4 months of the study but thereafter the trend was markedly different and in favour of intervention group. This study was applied to a population of patients, who by-way-of rapid cardiology interventions are increasingly difficult to attract to secondary prevention and rehabilitation.

The message is clear that practitioners should become more skilled in these emerging approaches and utilise them, as part of their repertoire, to enable patients to become autonomous managers of their own health and lifestyle.