Abstract
Supervised exercise therapy in cardiac rehabilitation (CR) is a key factor in reducing the risk of a future event. Self-regulatory efficacy (SRE) is critical in motivating physical activity adherence in CR (Bandura, 1997; Ewart, 1991). Berkhuysen et al (1999) argued that self-efficacy stimulates changes in CR and is itself an important outcome. A 2008 review of CR exercise self-efficacy noted most studies assess task efficacy. Only nine assessed SRE for actions facilitating exercise adherence (e.g. overcoming barriers; scheduling). We conducted a follow-up review between 2008-17, and identified 22 eligible SRE and CR exercise studies. Four coders examined each to identify if they a) represented a link between exercise and SRE, b) whether they addressed 2008 review recommendations, and c) study quality. Despite previous recommendations, our critical evaluation suggests the evidence is of mixed quality. Specifically, only 10/22 studies were of high measurement quality; 15/22 were concept valid; 13/22 stated a timeframe for relating SRE to behaviour; only 9/22 used SRE correspondent with the dependent variable. Only 6 studies tested mediation, yet 3/6 had design problems and only 3 were significant. Only 4 studies examined SRE as a CR outcome. The strength of the relationships between SRE and CR outcomes varied greatly (-.02 < |r| < .85). Numerous 2008 review recommendations were overlooked. This literature remains problematic despite published suggestions for multiple improvements. Advocates for heart disease prevention and rehabilitation promotion need to "rehabilitate" the SRE - exercise research to examine motivated post CR exercise change and adherence.Acknowledgments: Diabetes Canada Postdoctoral Fellowship; MSFHR Postdoctoral Fellowship; Canada Research Chair Training Funds