Type of Document	Dissertation
Author	Parish, Tracie Rena
Author's Email Address	tparis1@lsu.edu
URN	etd-12162005-090458
Title	Examination of the Constructs of the Transtheoretical Model in Patients with Heart Failure: A Focus on Physical Activity Readiness
Degree	Doctor of Philosophy (Ph.D.)
Department	Kinesiology
Advisory Committee	Advisor Name Title Michael Welsch Committee Chair Dennis Landin Committee Member Gary Gintner Committee Member Maria Kosma Committee Member Michael Lefevre Dean's Representative
Keywords	stages of change exercise chronic heart failure
Date of Defense	2005-11-17
Availability	unrestricted
Abstract The goal of this research was to gain greater understanding about the management of heart failure patients. A particular focus was to evaluate exercise tolerance and behavior. The major findings of the first study included: (1) evidence that few heart failure patients receive adequate information regarding physical activity; (2) performance on a six-minute walk test were ~42% lower, and SF-36 scores were also lower in heart failure patients compared to controls; (3) stability in hemodynamic measures and distance walked on the 6-minute walk test were adequate, and (4) home exercise resulted in 19% improvement in maximum walking distance and 30% improvement in physical function score on the SF-36. The second study showed the feasibility to implement a care-managed program for heart failure patients in a family practice setting. However, a significant barrier was recruitment. Despite this failure, patients improved ~24% on the maximum walking distance and 29%, 46%, and 13% on the physical function, vitality, and mental health scores on the SF-36. The third study examined the motivation and readiness of heart failure patients to engage in planned physical activity. The findings revealed 22 patients in precontemplation, 33 in contemplation, 41 in preparation, 23 in action, and 29 in maintenance. In regards to the Transtheoretical model constructs (self-efficacy, pros and cons of decisional balance, and experiential processes) the data revealed that self-efficacy scores were lowest in the precontemplation and increased in linear fashion to maintenance. Decisional balance changed from greater perceived cons and lower perceived pros in precontemplation and contemplation to lower perceived cons and higher perceived pros in action and maintenance. Experiential processes were used predominantly in precontemplation and contemplation, whereas behavioral processes were more prominently used in action and maintenance. The most important predictors of physical activity stages of change were the behavioral processes (r2= .78)followed by perceived self-efficacy (r2= .66). Finally, this study indicated that patients in preaction stages of readiness to exercise have significant lower exercise tolerance then those in action and maintenance. These data suggest greater clinical emphasis should be placed on strategies to move patients toward the preparation and action stages of readiness.
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