Proxy efficacy in cardiac rehabilitation

Abstract

Cardiac rehabilitation (CR) is an effective treatment for cardiovascular disease, yet program adherence and maintenance of behaviour change are problematic. CR programs are delivered by trained interventionists. The CR environment thus provides a model of patient-practitioner interaction in which the CR interventionist assumes a role as proxy agent. Proxy agents can facilitate behaviour change in adaptive ways but can also contribute to patient failures at self-regulation. Studies show patients with strong proxy efficacy beliefs in CR interventionists' capabilities develop stronger self-efficacy and better program adherence. However, some patients also come to rely substantially on assistance from their CR interventionists, which is linked to lower self-efficacy and non-adherence. I will discuss the proxy-patient relationship in CR in terms of: correlational findings illustrating associations between proxy efficacy and exercise adherence, interpersonal conditions that determine proxy efficacy, and an intervention study in which CR interventionists focused on developing patients' self-regulatory skills such as self-monitoring and action planning as a contrast to a traditional supervisory approach. Understanding interpersonal dynamics in CR that may facilitate or undermine the development of skills and beliefs necessary for independent, self-managed exercise should help in the development and translation of knowledge that may improve patient adherence during and following CR.

Acknowledgments: Research Supported by SSHRC