Social cognitive theory in cardiac rehabilitation: A prediction and comparison of self-efficacy scores

Date of Completion

January 1992


Engineering, Biomedical|Health Sciences, Nursing|Education, Health




Experts in the fields of public health and exercise science have recommended that the cognitive and behavioral skills necessary to initiate and maintain a physical activity program need to be specified (Dishman, Sallis, & Orenstein, 1985). Social cognitive theory (Bandura, 1977; 1986) proposes that cognitive processes play a major role in the attainment and retention of new behavior patterns. It served as the theoretical rationale for this descriptive and correlational study that investigated self-efficacy in actual and potential cardiac rehabilitation patients.^ Cardiac rehabilitation exercise self-efficacy (CRESE) as measured by the Cardiac Exercise Self-efficacy Instrument (CESEI) at the time of hospital discharge was predicted in a group of 213 patients who had myocardial infarction, coronary artery bypass surgery, or both. The predictors included previous habitual physical activity, cardiovascular factors, and demographic variables. In addition, CRESE was compared for patients who were referred to a cardiac rehabilitation program and those who were not referred. CRESE was also compared for patients who did not enroll, who finished, and who dropped out of cardiac rehabilitation. Finally, in a subgroup of patients CESEI scores were compared before, during, and after cardiac rehabilitation.^ Multiple regression analysis indicated that habitual physical activity is a significant predictor of CRESE. Cardiovascular and demographic variables did not add significantly to the prediction of CRESE beyond habitual physical activity. Comparison of CESEI scores for patients who were referred by their physicians to cardiac rehabilitation and those who were not referred did not differ significantly. In addition, analysis of variance (ANOVA) indicated that there were no significant differences on CESEI scores between referred patients who did not enter, completed, or dropped out of cardiac rehabilitation. A repeated measure ANOVA demonstrated that CRESE was significantly increased after four weeks of cardiac rehabilitation and was maintained for the duration of the program.^ Future research needs to confirm if patients with high CRESE engage in regular exercise without formal cardiac rehabilitation. In addition, a threshold of CRESE needs to be established to distinguish patients who will exercise of their own accord and those who will need cardiac rehabilitation. ^