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Correlates of exercise self-efficacy in a randomized trial of mind-body exercise in patients with chronic heart failure
Yeh GY, Mu L, Davis RB, Wayne PM
Journal of Cardiopulmonary Rehabilitation and Prevention 2016 May-Jun;36(3):186-194
clinical trial
3/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: No; Point estimates and variability: No. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

PURPOSE: Exercise self-efficacy is one of the strongest predictors of physical activity behavior. Prior literature suggests that Tai Chi, a mind-body exercise, may increase self-efficacy; however, this is not extensively studied. Little is known about the factors associated with development of exercise self-efficacy in a population with heart failure. METHODS: We utilized data from a randomized controlled trial of 12 weeks of group Tai Chi classes versus education in patients with chronic heart failure (n = 100). Multivariable linear regression was used to explore possible correlates of change in exercise self-efficacy in the entire sample and in the subgroup who received Tai Chi (n = 50). Covariates included baseline quality of life, social support, functional parameters, physical activity, serum biomarkers, sociodemographics, and clinical heart failure parameters. RESULTS: Baseline 6-minute walk (beta -0.0003, SE 0.0001, p = 0.02) and fatigue score (beta 0.03, SE 0.01, p = 0.004) were significantly associated with change in self-efficacy, with those in the lowest tertile for 6-minute walk and higher tertiles for fatigue score experiencing the greatest change. Intervention group assignment was highly significant, with self-efficacy significantly improved in the Tai Chi group compared to the education control over 12 weeks (beta 0.39, SE 0.11, p < 0.001). In the Tai Chi group alone, lower baseline oxygen uptake (beta -0.05, SE 0.01, p = 0.001), decreased mood (beta -0.01, SE 0.003, p = 0.004), and higher catecholamine level (epinephrine beta = 0.003, SE 0.001, p = 0.005) were significantly associated with improvements in self-efficacy. CONCLUSIONS: In this exploratory analysis, our initial findings support the concept that interventions like Tai Chi may be beneficial in improving exercise self-efficacy, especially in patients with heart failure who are deconditioned, with lower functional status and mood.
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