"Too much of a good thing? " reliance on cardiac rehabilitation staff and the proxy dilemma


Background: Regular physical activity (PA) aids recovery after a cardiac incident. Despite cardiac rehabilitation (CR) success, many participants fail to adhere six months after CR. Proxy agency (cf. social-cognitive theory; Bandura, 1997) identifies one potential adherence liability: participants' reliance on CR staff. Strong reliance on staff (proxies) becomes problematic when self-managing (SM) exercise (Bray et al., 2006). Purposes: (1) Examine differences within those reporting high proxy reliance between late-CR and 1 month post-CR for (a) self-regulatory efficacy (SRE)-exercise, (b) persistence, and (c) SM-PA. (2) Compare high and low late-CR Proxy Reliant individuals with respect to their post-CR (a) SRE-exercise and (b) SRE for SM-exercise. (3) Utilize late-CR SRE-exercise to predict (a) persistence and (b) SRE for SM-exercise post-CR. Design and Methods: This prospective study, followed CR initiates (n = 95) from two health region CR sites for 4 months. Baseline and post-CR social cognitive and PA measures were obtained. Results: (1) For the high proxy reliance group, paired one-way contrasts revealed differences for SRE-exercise, SM-PA (Cohen's d's < .42), and persistence (p < .05). (2) MANCOVA revealed main effects of high versus low proxy reliance for post-CR SRE after controlling for late-CR SRE (p < .05). (3) Late-CR SRE predicted: (1) post-CR persistence and (2) post-CR SM-SRE-exercise (R2adjusted, p < .05). Conclusions: Findings support Bandura's proxy dilemma suggestion. Individuals relying on CR-staff were less confident and persistent in self-managing exercise post-CR. CR programs should provide participants with opportunities to develop SM skills to sustain PA post-CR (Brawley et al., 2014).

Acknowledgments: Royal University Hospital (RUH) Foundation & Canada Research Chair (CRC) Training Funds