The Effect of Self-Efficacy Promotion Combined with Self-Regulation Program on Physical Activity in Patients with Chronic Coronary Syndrome

Abstract

Cardiac rehabilitation in patients with chronic coronary syndrome, focusing on enhancing cardiac function through engagement in daily physical activities, plays a vital role in preventing recurrence. However, most patients tend to exhibit low levels of physical activity,primarily engaging in light-intensity movements. Therefore, promoting a systematic and structured increase in physical activity intensity is crucial for the care and rehabilitation of this patient population. This study employed a quasi-experimental research design with a two-group pretest-posttest approach. Its objective was to examine the effects of a self-efficacy combined with self-regulation
program on physical activity in patients with chronic coronary syndrome. The sample consisted of 50 patients classified as Class I–II in disease severity who received care at the outpatient department of internal medicine at a tertiary hospital. The participants were randomly assigned to either a control group (n = 25), which received routine nursing care, or the experimental group (n = 25), which received the self-efficacy combined with self-regulation program for 30 days. The program included: 1) Physical and emotional readiness assessment by inquiring about current symptoms, allowing time for personal needs, and observing facial expressions and body language prior to the educational session on day 1; 2) Mastery experiences: this component involved providing knowledge about the disease, its treatment, and appropriate physical activities for the condition. Participants were also trained in skills such as self-monitoring of pulse rate,calculating their target heart rate, and recording physical activity in a physical activity handbook developed by the researcher on the first day of the program. Training continued until participants could perform these tasks accurately and    indepen dently; 3) Vicarious experiences: this involved observational learning through exposure to successful behavioral models. On the first day of the program, participants viewed a video clip featuring patients with chronic coronary artery disease who had successfully engaged in physical activity consistent with their individualized goals; 4) Verbal persuasion: this strategy involved the use of verbal encouragement combined with motivational text messages to promote engagement in physical activity. These persuasive messages were delivered on days 5, 10, 15, and 20 of the program. Additionally, follow-up and reinforcement were conducted via an official LINE account on days 7, 14, 21, and 28 to maintain adherence and motivation throughout the intervention. These strategies were combined with self-regulation,which is known to support lasting behavioral change by enhancing personal motivation and autonomy. Self-regulation was implemented through two main processes: 1) goal setting,where weekly physical activity intensity targets were established for each participant, and 2) self-monitoring, tracking, and recording physical activity behaviors in a personal logbook. The data collection instrument included a physical activity questionnaire. Its content validity was confirmed by expert review, yielding a content validity index (CVI) of 0.83. The reliability of the instrument was assessed using Cronbach’s alpha coefficient, which was found to be 0.71.Data were analyzed using descriptive statistics, the chi-square test, and t-tests.

The results showed that before the intervention, the control group had a mean physical activity score of 26.61 METs (SD = 11.11) in the control group and 25.23 METs (SD = 10.34)in the experimental group, with no significant difference between groups (t = .45, p = .65).Post-intervention, the experimental group showed a significant increase in physical activity scores compared to their baseline (t = -4.88, p = < .001). The post-intervention mean scores were 27.16 METs (SD = 8.56) in the control group and 33.99 METs (SD = 10.48) in the experimental group, with a significant difference between groups (t = -2.53, p = .01) The findings indicate that the self-efficacy combined with self-regulation program effectively increased physical activity levels in patients with chronic coronary syndrome. Nurses should implement this program to promote moderate to vigorous physical activity in this patient population.

Keywords: Chronic coronary syndrome, Physical activity, Self-efficacy, Self-regulation