The Effect of Phase I Cardiac Rehabilitation Training on Self-Efficacy in Patients After Coronary Artery Bypass Graft Surgery Based on Body Mass Index: A Clinical Trial Study

Document Type : Original Article

Authors

1 Department of Nursing, Faculty of Nursing and Midwifery, Hormozgan University of Medical Science, Bandar Abbas, Iran

2 Chronic Diseases (Home Care) Research Center, Faculty of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran

3 Department of of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran

4 Department of Nursing, Faculty Nursing & Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran

5 Cardiovascular Surgeon, Hamadan University of Medical Sciences, Hamadan, Iran

6 Department of Public Health, School of Health; Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran

10.34172/jhad.1152

Abstract

Background: Body Mass Index (BMI) is an influential factor in conducting cardiac rehabilitation programs for patients following coronary artery bypass graft (CABG) surgery. This study aimed to investigate the effect of Phase I cardiac rehabilitation training on the self-efficacy of CABG patients based on their BMI.
Methods: This clinical trial was conducted on 60 patients who had undergone CABG surgery, selected through convenience sampling. The recruited individuals were randomly allocated into two groups of 30: an intervention group and a control group. Generally, Phase I of the cardiac rehabilitation program, encompassing both theoretical and practical components, was delivered 72 hours after CABG surgery. Data were collected using the Cardiac Self-Efficacy Scale completed by patients in both groups at three time points: pre-intervention, at discharge, and one month after discharge.
Results: The mean age of the participants in the intervention group was 61.6 years, and that of the patients in the control group was 57.9 years. The overall mean self-efficacy score for the patients in the intervention group showed a significant difference compared to pre-intervention only in individuals with normal weight and overweight status at discharge (P < 0.05) and one month after the intervention (P < 0.05). Although the overall mean self-efficacy score in obese individuals in the intervention group showed a noticeable difference compared to the control group at discharge and one month after the intervention, this difference was not statistically significant.
Conclusion: The impact of BMI on the effectiveness of cardiac rehabilitation programs varies among patients following CABG surgery. Patients with normal weight and those who are overweight experience a greater increase in the mean scores across various dimensions of cardiac self-efficacy compared to obese individuals. The implementation of cardiac rehabilitation programs appears to be less effective in obese patients.

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References

  1. Subih M, Elshatarat RA, Sawalha MA, Almarwani AM, Alhadidi M, Alrahahleh M, et al. Exploring the impact of cardiac rehabilitation programs on health-related quality of life and physiological outcomes in patients post coronary artery bypass grafts: a systematic review. Rev Cardiovasc Med. 2024;25(4):145. doi: 31083/j.rcm2504145.
  2. Garavand A, Rabiei R, Emami H. Design and development of a hospital-based coronary artery disease (CAD) registry in Iran. Biomed Res Int. 2023;2023:3075489. doi: 1155/2023/3075489.
  3. Darba S, Safaei N, Mahboub-Ahari A, Nosratnejad S, Alizadeh G, Ameri H, et al. Direct and indirect costs associated with coronary artery (heart) disease in Tabriz, Iran. Risk Manag Healthc Policy. 2020;13:969-78. doi: 2147/rmhp.S261612.
  4. Park DW, Ahn JM, Park H, Yun SC, Kang DY, Lee PH, et al. Ten-year outcomes after drug-eluting stents versus coronary artery bypass grafting for left main coronary disease: extended follow-up of the PRECOMBAT trial. Circulation. 2020;141(18):1437-46. doi: 1161/circulationaha.120.046039.
  5. Van Rooy L, Coopoo Y. Comprehensive cardiac rehabilitation and quality of life in coronary artery bypass graft patients. SA Heart. 2017;14(3):154-60. doi: 10520/EJC-c61c743d5.
  6. Nedkoff L, Briffa T, Zemedikun D, Herrington S, Wright FL. Global trends in atherosclerotic cardiovascular disease. Clin Ther. 2023;45(11):1087-91. doi: 1016/j.clinthera.2023.09.020.
  7. Şahin B, İlgün G. Risk factors of deaths related to cardiovascular diseases in World Health Organization (WHO) member countries. Health Soc Care Community. 2022;30(1):73-80. doi: 1111/hsc.13156.
  8. Fahimfar N, Khalili D, Ghajarieh Sepanlou S, Malekzadeh R, Azizi F, Mansournia MA, et al. Cardiovascular mortality in a Western Asian country: results from the Iran Cohort Consortium. BMJ Open. 2018;8(7):e020303. doi: 1136/bmjopen-2017-020303.
  9. Javanbakht M, Jamshidi AR, Baradaran HR, Mohammadi Z, Mashayekhi A, Shokraneh F, et al. Estimation and prediction of avoidable health care costs of cardiovascular diseases and type 2 diabetes through adequate dairy food consumption: a systematic review and micro simulation modeling study. Arch Iran Med. 2018;21(5):213-22.
  10. Buschmann K, Wrobel J, Chaban R, Rösch R, Ghazy A, Hanf A, et al. Body mass index (BMI) and its influence on the cardiovascular and operative risk profile in coronary artery bypass grafting patients: impact of inflammation and leptin. Oxid Med Cell Longev. 2020;2020:5724024. doi: 1155/2020/5724024.
  11. Chan PG, Sultan I, Gleason TG, Wang Y, Navid F, Thoma F, et al. Contemporary outcomes of coronary artery bypass grafting in obese patients. J Card Surg. 2020;35(3):549-56. doi: 1111/jocs.14415.
  12. Pirlet C, Voisine P, Poirier P, Cieza T, Ruzsa Z, Bagur R, et al. Outcomes in patients with obesity and coronary artery disease with and without bariatric surgery. Obes Surg. 2020;30(6):2085-92. doi: 1007/s11695-020-04467-7.
  13. Abiri B, Ramezani Ahmadi A, Amini S, Akbari M, Hosseinpanah F, Madinehzad SA, et al. Prevalence of overweight and obesity among Iranian population: a systematic review and meta-analysis. J Health Popul Nutr. 2023;42(1):70. doi: 1186/s41043-023-00419-w.
  14. Damacena FC, Batista TJ, Ayres LR, Zandonade E, Sampaio KN. Obesity prevalence in Brazilian firefighters and the association of central obesity with personal, occupational and cardiovascular risk factors: a cross-sectional study. BMJ Open. 2020;10(3):e032933. doi: 1136/bmjopen-2019-032933.
  15. Lopez-Jimenez F, Almahmeed W, Bays H, Cuevas A, Di Angelantonio E, le Roux CW, et al. Obesity and cardiovascular disease: mechanistic insights and management strategies. A joint position paper by the World Heart Federation and World Obesity Federation. Eur J Prev Cardiol. 2022;29(17):2218-37. doi: 1093/eurjpc/zwac187.
  16. Han P, Yu H, Xie F, Li M, Chen X, Yu X, et al. Effects of early rehabilitation on functional outcomes in patients after coronary artery bypass graft surgery: a randomized controlled trial. J Int Med Res. 2022;50(3):3000605221087031. doi: 1177/03000605221087031.
  17. Galih A, Tjahjono CT, Rizal A, Martini H. Phase I cardiac rehabilitation intervention in patients undergoing coronary artery bypass grafting. Heart Sci J. 2022;3(4):4-8. doi: 21776/ub.hsj.2022.003.04.2.
  18. Højskov IE, Moons P, Egerod I, Olsen PS, Thygesen LC, Hansen NV, et al. Early physical and psycho-educational rehabilitation in patients with coronary artery bypass grafting: a randomized controlled trial. J Rehabil Med. 2019;51(2):136-43. doi: 2340/16501977-2499.
  19. Moreira JM, Grilo EN. Quality of life after coronary artery bypass graft surgery - results of cardiac rehabilitation programme. J Exerc Rehabil. 2019;15(5):715-22. doi: 12965/jer.1938444.222.
  20. Greco A, Steca P, Pozzi R, Monzani D, Malfatto G, Parati G. The influence of illness severity on health satisfaction in patients with cardiovascular disease: the mediating role of illness perception and self-efficacy beliefs. Behav Med. 2015;41(1):9-17. doi: 1080/08964289.2013.855159.
  21. Alizadeh T, Takasi P. Effect of telenursing on self-efficacy of patients undergoing coronary artery bypass grafting surgery: a systematic review. J Nurs Rep Clin Pract. 2024;2(3):158-64. doi: 32598/jnrcp.2401.1011.
  22. Ghlichi Moghaddam N, Namazinia M, Hajiabadi F, Mazlum SR. The efficacy of phase I cardiac rehabilitation training based on augmented reality on the self-efficacy of patients undergoing coronary artery bypass graft surgery: a randomized clinical trial. BMC Sports Sci Med Rehabil. 2023;15(1):156. doi: 1186/s13102-023-00770-9.
  23. Golshahi J, Sadeghi M, Esteki Ghashghaei F, Roohafza H, Pourmoghaddas A. Is rehabilitation program more effective in obese women with coronary artery disease? J Isfahan Med Sch. 2014;32(294):1142-8.
  24. Sanaie N, Nejati S, Zolfaghari M, Alhani F, Kazemnejad A. The effect of family-centered empowerment in self efficacy and self-esteem in patients undergoing coronary bypass graft surgery. J Res Dev Nurs Midwifery. 2013;10(2):44-53.
  25. Varaei S, Shamsizadeh M, Cheraghi MA, Talebi M, Dehghani A, Abbasi A. Effects of a peer education on cardiac self-efficacy and readmissions in patients undergoing coronary artery bypass graft surgery: a randomized-controlled trial. Nurs Crit Care. 2017;22(1):19-28. doi: 1111/nicc.12118.
  26. Mohebbi H, Mazlom SR, Kasraei MR, Hamedi Z, Hosseinikhah H, Dehghan Moghimi H, et al. Comparison of the effects of media-based and face-to-face cardiac rehabilitation training programs on self-efficacy in patients undergoing coronary artery bypass grafting. Evid Based Care. 2018;8(2):67-77. doi: 22038/ebcj.2018.30407.1757.
  27. Nourali N, Hosseini M, Ghasemi S, Nasiri M. The effect of educational program based on the clinical practice protocol on treatment adherence, self-efficacy and quality of life of patients undergoing coronary artery bypass graft surgery. J Educ Health Promot. 2023;12:323. doi: 4103/jehp.jehp_1375_22.
  28. Javadi A, Amouzeshi A, Barani F. The role of self-efficacy beliefs in positive and negative perception of stress in coronary artery bypass patients. J Surg Trauma 2022;10(3):114-21. doi: 32592/jsurgery.2022.10.3.104.
  29. Eghbali T, Tirgari B, Dehghani Z, Forouzi MA. Planned discharge program effectiveness on cardiac self-efficacy and hope in patients undergoing coronary artery bypass graft surgery: a quasi-experimental study. Proc Singap Healthc. 2022;31:20101058211064669. doi: 1177/20101058211064669.
  30. Kärner Köhler A, Tingström P, Jaarsma T, Nilsson S. Patient empowerment and general self-efficacy in patients with coronary heart disease: a cross-sectional study. BMC Fam Pract. 2018;19(1):76. doi: 1186/s12875-018-0749-y.
  31. Musa MI, Algamar EA, Ismail ME, Elsanousi OM, Alhussein AS, Ahmed ZA, et al. Effect of health education program on self-efficacy and functional capacity of patients with coronary artery bypass surgery in Khartoum state-Sudan, 2015-2019. World J Cardiovasc Surg. 2023;13(12):167-80. doi: 4236/wjcs.2023.1312018.
  32. Rengo JL, Khadanga S, Savage PD, Ades PA. Response to exercise training during cardiac rehabilitation differs by sex. J Cardiopulm Rehabil Prev. 2020;40(5):319-24. doi: 1097/hcr.0000000000000536.
  33. Gunstad J, Luyster F, Hughes J, Waechter D, Rosneck J, Josephson R. The effects of obesity on functional work capacity and quality of life in phase II cardiac rehabilitation. Prev Cardiol. 2007;10(2):64-7. doi: 1111/j.1520-037x.2007.05860.x.
  34. Kasapoğlu Aksoy M, Aykurt Karlıbel İ, Arı H, Altan L. The effect of obesity on functional capacity, anxiety and daily life activities in patients with coronary artery disease and phase II cardiac rehabilitation. Eur Res J. 2018;4(2):85-91. doi: 18621/eurj.332008.
  35. Jiang X, Xu J, Zhen S, Zhu Y. Obesity is associated with postoperative outcomes in patients undergoing cardiac surgery: a cohort study. BMC Anesthesiol. 2023;23(1):3. doi: 1186/s12871-022-01966-1.
Health and Development Journal
Volume 13, Issue 4
December 2024
Pages 187-193

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History

  • Receive Date: 19 July 2024
  • Revise Date: 26 June 2025
  • Accept Date: 28 June 2025

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