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Self-efficacy reflects an individual's perceptions or beliefs about how capable he or she is of performing a specific activity or task and measures self-confidence to perform that specific activity or task. This study investigated the effect of in-patient cardiac rehabilitation on self-efficacy scores for 3 categories of activities: routine physical activities, daily living tasks and levels of concentration and ability to cope. On discharge from the intensive or coronary care unit, patients without contraindications to early ambulation were randomized to either a ward ambulation program (n = 26) or a dedicated exercise center program (n = 25) with all patients receiving the same standardized education/counseling. There were no differences between the groups in self-efficacy at baseline, at hospital discharge or 7 days later. Significant improvements in self-efficacy scores were observed by day 28 in both groups for routine physical activities and daily living tasks with no change in self-efficacy scores for concentration or ability to cope. At that time the exercise center patients had higher self-efficacy scores for walking time (p = 0.041) and overall exertion (p = 0.024) than the ward ambulation patients. For the majority of the self-efficacy variables considered, both in-patient exercise rehabilitation programs were equally effective in improving self-efficacy scores for physical activities and daily living tasks over the first 28 days after return to home. The lower cost associated with ward ambulation programs suggests that they are more cost-effective than developing a program in a dedicated in-patient exercise center.

The Ontario Exercise-Heart Collaborative Study was a multicenter randomized clinical trial of high intensity exercise for the prevention of recurrent myocardial infarction in 733 men. Of the 678 subjects who could have participated for at least 3 years, 315 (46.5%) dropped out. Stepwise multiple linear logistic regression analysis was carried out to examine the relation between subject characteristics and the probability of dropping out during the study. Analysis was performed on the entry group as a whole by considering those subjects who had reinfarction while complying with the program and also by excluding all subjects with reinfarctions. The consistent and statistically significant predictors of dropout in both analyses were smoking and a blue collar occupation. Angina was significantly associated with dropout only when reinfarctions were excluded. It may be important to consider these factors when investigating the potential for compliance-improving strategies in reducing dropout from exercise rehabilitation programs.