| The literature on Phase II cardiac rehabilitation programs has shown positive effects on outcomes related to physical and psychosocial health. However, little is known about the therapeutic processes responsible for beneficial changes and how those factors may act. Specific process factors, such as self-efficacy related to diet and exercise, as well as more general factors, such as the working alliance between staff and patients, may be at work. The degree to which a cardiac patient accepts and engages in a self-management plan for cardiac care may also account for changes that take place. Due to the emphasis that cardiac rehabilitation programs place on the patient's need to take some responsibility in the recovery process, readiness to adopt a self-management approach may better predict outcome than previously studied therapeutic processes. This study used a panel design and cross-lagged analyses to examine whether: (a) early-treatment changes in process factors (diet and exercise self-efficacy, mood, working alliance, and readiness to adopt a self-management approach) predicted later-treatment changes in outcome factors (cardiorespiratory fitness, activity level, diet, weight, and cardiac depression), but not vice versa (b) variance in readiness to adopt a self-management approach to cardiac care predicted changes in outcome with other process variables controlled. Seventy-six cardiac patients in a 12-week Phase II cardiac rehabilitation program completed measures at pre-treatment, Week 3, Week 6, Week 9, and Week12 (post-treatment). Results showed that early-treatment changes in global positive mood was related to later changes in cardiorespiratory fitness, early changes in working alliance predicted later changes in cardiac depression, and changes in readiness to adopt a self-management approach were related to later changes in weight, but not vice versa. Further analyses revealed that the relationship between readiness to adopt the self-management approach to cardiac care and weight remained significant with other process variables controlled. Findings suggest that a variety of processes, rather than a single factor, may influence treatment gains in cardiac rehabilitation. |
