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Table of Contents
Year : 2018  |  Volume : 7  |  Issue : 1  |  Page : 43-44

Predictors of exercise self-efficacy among patients with coronary artery disease

1 Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
2 Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

Date of Web Publication1-Feb-2018

Correspondence Address:
Touba Hossein-Zadeh
PhD Student, Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/nms.nms_81_17

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How to cite this article:
Paryad E, Hossein-Zadeh T, Kazemnejad-Leili E, Javadi-Pashaki N. Predictors of exercise self-efficacy among patients with coronary artery disease. Nurs Midwifery Stud 2018;7:43-4

How to cite this URL:
Paryad E, Hossein-Zadeh T, Kazemnejad-Leili E, Javadi-Pashaki N. Predictors of exercise self-efficacy among patients with coronary artery disease. Nurs Midwifery Stud [serial online] 2018 [cited 2022 Jan 26];7:43-4. Available from: https://www.nmsjournal.com/text.asp?2018/7/1/43/224557

Dear Editor,

Physical activity is a preventive strategy against cardiovascular diseases. Conversely, low physical fitness and lack of physical activity are associated with higher risk for developing cardiovascular diseases.[1] Yet, most cardiac patients have limited adherence to cardiac rehabilitation and physical activity programs.[2],[3]

Exercise self-efficacy (ESE) is a health-promoting mechanism for physical activity promotion.[4] However, little attention has been paid so far to factors behind ESE among cardiac patients.[5] This cross-sectional study aimed to determine the predictors of ESE among patients with coronary artery disease.

From September to November 2010, 195 patients with coronary artery disease were conveniently selected from the cardiac clinic of a teaching hospital in Rasht, Iran. Sample size was estimated based on the results of an earlier study [4] and using the following parameters: α = 0.05; β = 0.1; ρ = 0.25; δ = 1.017; and e = 2.71. Inclusion criteria were a history of coronary artery disease for at least 6 months (as confirmed by a cardiologist) and no history of serious cardiac complications or chronic conditions which could undermine patients' ability to do physical activity.

Study data were collected through a demographic and clinical characteristics questionnaire, the cardiac ESE instrument (CESEI), and the illness perception questionnaire (IPQ). CESEI is comprised of ten items which are scored on a five-point Likert-type scale from 1 (“very little”) to 5 (“quite a lot”). The total score of CESEI is 10–50; scores 10–30 and 30–50 are interpreted as low and high cardiac ESE, respectively. IPQ contains 33 items in five subscales. The identity subscale comprises eight items which assess the frequency of cardiac symptoms on a four-point Likert-type scale while the timeline, consequences, control/cure, and cause subscales collectively contain 25 items which are scored on a five-point Likert-type scale. Consequently, the overall IPQ score is 33–157. Scores 33–75 and 76–157 are interpreted as negative and positive illness perception, respectively. The level of physical exercise was also categorized from low to high based on the guidelines of the American Heart Association. Content validity of the questionnaires was assessed and confirmed by the faculty members of Guilan University of Medical Sciences, Rasht, Iran. Reliability assessment was also performed through the internal consistency method. The Cronbach's alpha values of CESEI and IPQ were 0.84 and 0.88, respectively. An investigator completed the questionnaires through interviewing participants or referring to their medical records. Chi-square test was conducted to examine the relationships among study variables while the multiple logistic regression analysis was used to determine ESE predictors.

Most participants were male (53.8%) and married (87.7%), aged 46–65 (56.6%), had received the diagnosis of angina pectoris (68.2%), suffered from coronary artery disease for more than 6 months (63.6%), had a family history of cardiac disease (63.1%), were afflicted by comorbid chronic conditions (95.4%), lived with their own families (66.2%), and had been hospitalized more than once (66.2%). Around one-third of the participants were homemakers. The majority of them had previously received self-care training (79.5%), had a positive illness perception (73.8%), had a low level of physical activity (68.8%), and obtained a mean ESE score of <3.61 ± 0.91.

ESE was found to have a significant relationship with participants' educational status (P < 0.001), employment status (P < 0.0001), illness perception (P < 0.0001), and family history of cardiac disease (P < 0.01).

Multiple logistic regression analysis indicated that laborers/employees (odds ratio [OR] =3.87, P = 0.025), self-employed participants (OR = 1.51, P = 0.47), and retired participants (OR = 7.16, P = 0.003) had better chances for high cardiac ESE compared with their homemaker counterparts. Besides, each one-point increase in IPQ score was associated with 1.1-point increase in CESEI score (P < 0.0001).

Patients with higher educational status have better understanding about healthy behaviors and thus are more likely to engage in doing physical activity. Moreover, personal experiences and knowledge of family members who suffer from health problems can enhance patients' understanding about the positive effects of physical activity and enhance their self-efficacy in doing physical activity.

Study findings revealed employment status as a significant predictor of cardiac ESE so much so that retirement was the most significant predictor of ESE. This finding may be due to the fact that retired people have more spare time and thus are more likely to perform physical activity. Another significant predictor of ESE was illness perception or patients' knowledge about their illnesses. Patients with greater knowledge about their illnesses are more likely to participate in physical activity. Accordingly, improving patients' illness perception or knowledge can be an effective psychological intervention to encourage participation in physical activities among cardiac patients.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Bahram ME, Akkasheh G, Akkasheh N. Aerobics, quality of life, and physiological indicators of inactive male students' cardiovascular endurances, in Kashan. Nurs Midwifery Stud 2014;3:e10911.  Back to cited text no. 1
Lapier TK, Cleary K, Kidd J. Exercise self-efficacy, habitual physical activity, and fear of falling in patients with coronary heart disease. Cardiopulm Phys Ther J 2009;20:5-11.  Back to cited text no. 2
Heydari A, Ziaee ES, Gazrani A. Relationship between awareness of disease and adherence to therapeutic regimen among cardiac patients. Int J Community Based Nurs Midwifery 2015;3:23-30.  Back to cited text no. 3
Lau-Walker M. Importance of illness beliefs and self-efficacy for patients with coronary heart disease. J Adv Nurs 2007;60:187-98.  Back to cited text no. 4
Kang Y, Yang IS. Cardiac self-efficacy and its predictors in patients with coronary artery diseases. J Clin Nurs 2013;22:2465-73.  Back to cited text no. 5


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