A Randomized Controlled Trial to Reduce Hopelessness through Enhanced Physical Activity in Adults with Ischemic Heart Disease

ABSTRACT (R01-funded parent RCT)Hopelessness is associated with a 3.4 times increased risk of mortality or nonfatal myocardial infarction inpatients with ischemic heart disease (IHD), independent of depression. Hopelessness has been identified in27-52% of patients with IHD and can persist for up to 12 months after hospital discharge. Hopelessness, anegative outlook and sense of helplessness toward the future, can be a temporary response to an event (state)or a habitual outlook (trait). Hopelessness is associated with decreased physical functioning and lower physicalactivity (PA) levels in individuals with IHD. Low levels of PA independently contribute to increased death andadverse events in patients with IHD. Rates of PA in IHD patients continue to be unacceptably low in bothhospital-based cardiac rehabilitation and home settings. Hopelessness frequently compounds this issue. Thelinks among hopelessness, PA, and mortality and morbidity for patients with IHD remain unknown. Whileresearch has investigated strategies to increase PA among IHD patients in general, we are the only group todesign an intervention to promote PA specifically in hopeless IHD patients. Our work, based on SelfDetermination Theory and Cohen's Stress and Coping Social Support Theory, has shown feasibility andpreliminary efficacy for a motivational intervention that integrates social support from both the patient's nurseand significant other to promote increased PA. The purpose of this randomized controlled trial is to establishthe effectiveness of our 6-week mHealth intervention (Heart Up!) to promote increased PA in hopeless patientswith IHD. We will enroll 225 hopeless IHD patients from a large community teaching hospital in the Midwest.Patients will be randomized (75 per group) to one of three groups: 1) motivational social support (MSS) from anurse, 2) MSS from a nurse with additional significant other support (SOS), or 3) attention control (AC). Datawill be collected at baseline, 8 and 24 weeks using an accelerometer for PA and valid and reliable instrumentsof physical and emotional health and behaviors. The specific aims are to: 1) test the effectiveness of 6 weeksof MSS and MSS with SOS on increasing mean minutes per day of moderate to vigorous PA, measured by anActiGraph accelerometer; 2) determine the effects of change in minutes per day of moderate to vigorous PA onstate hopelessness, measured by the State-Trait Hopelessness Scale; and 3): determine if social support(measured by the ENRICHD Social Support Inventory) and motivation (measured by the Exercise Self-Regulation Questionnaire) mediate the effects of the Heart Up! intervention on PA. The findings from this studycould transform care for IHD patients who are hopeless by promoting self-management of important PA goalsthat can contribute to better health outcomes. This proposal supports NINR's investment in self-managementto improve the quality of life for individuals with chronic illness.