BACKGROUND: The importance of promoting exercise adherence among individuals with acute coronary syndrome (ACS) is imperative. However, challenges in maintaining behavior among ACS patients are also well-documented. Emerging findings in the general population have supported the use of habit-formation techniques, which include incorporating routine consistency and cues, to be effective for facilitating exercise behavior. The effectiveness of habit formation approaches, however, has not been tested on participants with ACS. The purpose of this study was to test the effectiveness of facilitating physical activity habits among patients with ACS in a two-arm, parallel design, randomized controlled pilot trial. METHODS: Participants (n = 13) were older adult patients (mean age 64.20, SD 5.35) with ACS who were referred to a cardiac rehabilitation center. The experimental group attended monthly group meetings from months 1 to 3 and received phone call follow-ups from months 4 to 6. CONCLUSIONS: The experimental group showed an increase in weekly moderate-to-vigorous level physical activity, mean 228.20 mins (SD 112.45), compared with the control group, mean 151.17 (SD 112.22), d = 0.61. The experimental condition also showed greater use of routine consistency (experimental mean 4.60 (SD 0.548); control mean 3.76 (SD 1.62)) and cue usage (experimental mean 3.60 (SD 0.471); control mean 2.60 (SD 0.398)) over the control condition at the six-month mark. The study supports the effectiveness of habit-building techniques among patients with ACS, with effect sizes ranging from a medium to large magnitude. Findings from this pilot study support a full clinical trial with larger sample size.

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