Confused and afraid in the wilderness: The case of exercise self-efficacy in cardiac rehabilitation


Exercise therapy is a hallmark of cardiac rehabilitation (CR) programs. Berkhuysen et al (1999) argued that self-efficacy encourages beneficial recovery and rehabilitation behaviour in CR. Development of participants' confidence in abilities to self-regulate exercise is critical to motivating persistence during CR and for maintaining exercise behavior change post-CR. Following a 2008 review of self-efficacy in CR, there have been multiple studies of exercise and self-efficacy. We conducted a 2008-17 Review, and identified 22 SRE and CR exercise studies. Examination of their quality using principles outlined by Bandura (2006), and Gosselin and Maddux, (2003) underscores a series of problems that limit what we can conclude about the SRE to CR exercise adherence relationship. Do such problems pervade exercise research? To illustrate, our purpose is to identify and explain these and provide examples of poor and good quality protocols and measures. The larger issue is that the problems our Review revealed is a lack of understanding about (a) what the construct of SRE is and conceptually-valid scales, (b) dependent variables to which it should be related and their link to specific functioning (c-i), the complexity of the behavior, (c - ii) the context in which it occurs, and (d) when SRE should be prospectively assessed. Not surprisingly, low to moderate effects were observed for SRE and CR exercise. We recommend that exercise researchers generally and those focused on rehabilitation specifically, move away from borrowing from other health/exercise contexts to avoid treating SRE as a standardized measure (Maibach & Murphy, 1995).

Acknowledgments: SSHRC Canada Research Chair Training Funds