A Self-Regulation Intervention for Maintenance of Lifestyle Change following Cardiac Rehabilitation: Moving beyond (New Year’s) Resolutions?
Cardiovascular disease is the leading fatal illness worldwide, claiming more deaths and disability than any other disease. The modification of risk factors and related lifestyle behaviors lies at the very core of cardiac rehabilitation programs. However, research on the maintenance of lifestyle changes shows that many cardiac patients slip back into old habits. Clearly, mere will alone is not sufficient to sustain behavior change.
When Janssen was in her early twenties, she was diagnosed with a life-threatening autoimmune disease. A period of regular hospital visits followed and her life was turned upside down. Janssen was studying Psychology in London at the time, and typical student life as she had known it came to a sudden stop. Even though the quality of medical care she received was excellent, she was surprised by how little psychological support there was. This awakened her interest in health psychology- in particular the psychosocial aspects of dealing with chronic illness. Upon returning from London with a Bachelor’s degree in Psychology, Janssen was lucky to be able to start the international Master in Health Psychology here at Leiden University. This led to the start of her PhD project five years ago, and ever since she has felt very privileged to be able to work in this field. Janssen sincerely hopes that her research contributes to the adjustment processes in other chronically ill patients.
On the basis of self-regulation theory, Janssen and colleagues developed an intervention program for cardiac patients targeting the skills and cognitions elementary to long-term lifestyle change. The intervention is patient-centered and consists of a motivational interview, group sessions and home work assignments, in which patients work towards what constitute meaningful recovery goals to themselves. They randomized 196 cardiac patients to receive either the lifestyle program based on self-regulation principles or standard care. Risk factors and health behaviors are assessed at baseline (end of cardiac rehabilitation), and six and 15 months after. Janssen and colleagues see all patients individually, as the assessments include biomedical measurements (blood pressure, weight, waist circumference, and serum cholesterol), as well as a structured interview on lifestyle habits. Currently, Janssen and colleagues have carried out over a hundred motivational interviews, over 400 face-to-face assessments, delivered the lifestyle intervention to 9 groups of patients, and collected nearly all the follow-up data. Janssen explains: ‘these twelve labors of Hercules could never have been completed without the help of my wonderful team; hard-working, enthusiastic interns, thesis students and research assistants, to whom I am eternally grateful’.
The first results are promising; preliminary analyses show a significant effect of the lifestyle program after 6 months, which can be primarily be attributed to changes in diastolic blood pressure, systolic blood pressure, waist circumference, and exercise behavior. However, they will have to wait and see if this effect holds over time and under different conditions. If it does, then the intervention program might be a cost-effective way of preserving the benefits of cardiac rehabilitation in the long term.
(Maintenance of) behavior change is multi-applicable and relevant to different populations. Last year, Janssen and colleagues adapted the lifestyle intervention to suit a bigger public and delivered it over the Internet as part of the Volkskrant E-Coaching initiative. It would be very interesting to experiment with different types of multimedia interventions, as she is convinced that e-health holds the future!