Improving physical activity and decreasing hopelessness in patients with ischemic heart disease: Testing of the heart up! Intervention

Introduction: Rates of physical activity (PA) in adults with ischemic heart disease (IHD) continue to be unacceptably low and enrollment in hospital‐based cardiac rehabilitation (CR) is abysmal. Compounding the issue is that PA levels are significantly lower among hopeless IHD patients in both home and hospital‐based CR settings. Purpose: The purpose of this pilot randomized controlled trial (RCT) was to evaluate the feasibility of a 6‐week intervention, Heart Up!, designed to increase PA and reduce hopelessness in adults with IHD. Methods: Patients hospitalized for an IHD event and screened as hopeless were randomized to one of 3 groups; 1) motivational social support (MSS) from a nurse, 2) MSS from a nurse with social support from a significant other (SOS), or 3) attention control (AC). The MSS and MSS‐SOS groups participated in a motivational interviewing session with a nurse at week 1, followed by daily automated text messages from the nurse for 6 weeks. The MSS‐SOS group also received text messages (developed by researchers) from their significant other over the same time period. The AC group received factual information about IHD. Data were collected at baseline and 8 weeks and included PA measurement by accelerometer. Results: Fifty‐six patients met the criteria for mild to severe state hopelessness using the State‐Trait Hopelessness Scale. Of eligible patients, 69.8% (n= 30) enrolled and 67% (n= 20) completed the study. Patients in the MSS‐SOS and MSS only groups expressed satisfaction with the Heart Up! intervention (mean>3.0/4, with 1=strongly disagree to 4=strongly agree). Patients in the MSS‐SOS group showed increases of 3.11±6.38 minutes/day (p=0.25; n=7) in moderate to vigorous PA after 8 weeks, compared to a 0.56±1.09 minute/day increase (p=0.22; n=7) and 1.05±6.47 minute/day decrease (p=0.74; n=6) for the MSS only and AC groups, respectively. Medium sized effects (d>0.5) were identified when comparing PA in the MSS‐SOS group to the MSS only and AC groups. Conclusions: This RCT demonstrated feasibility and revealed a medium effect size, which provide the scientific premise for a larger trial.