Background:
Exercise continues to be promoted for the primary and secondary prevention of heart disease, yet many adults remain inactive and ethnic minority adults are less active than Whites. One of the goals of Healthy People 2020 is to increase the proportion of office visits that include counseling about exercise with patients diagnosed with heart disease; one approach may be the use of motivational interviewing (MI). However, adherence to the essential principles of MI is critical in achieving desired outcomes.
Purpose:
The purpose of this study was to evaluate the use of MI in an exercise counseling intervention in a sample of minority adults with heart failure (HF).
Methods:
Twenty ethnic minority adults with stable HF were recruited from an urban HF clinic. Measures of physical activity (International Physical Activity Questionnaire (IPAQ); weekly step-counts via accelerometer) and functional status (Duke Activity Status Index (DASI); 6-minute walk test [6MWT]) were taken at baseline and 12-weeks. The initial exercise counseling session (15 minutes) using MI discussed previous exercise experience, future goals, and practical exercise guidelines, including symptom management. The interview guide, written using principles of MI, was reviewed with an expert in MI and revised prior to the first interview. During subject recruitment, four subjects’ interviews were reviewed (#3, #4, #16, #20) by another independent expert and scored for use of MI. After each scoring and discussion of results, the interview guide was again revised to further facilitate the use of MI. The initial session was followed by 12 weekly 5-minute phone calls.
Results:
Interview #3 scored 50% overall adherence to MI with more closed than open questions (6 vs.4) and 44% of reflections were complex (vs. simple). Interview #4 ranked 40% MI adherent with more closed vs. open questions (9 vs. 3) and only 30% complex reflections. Interview #16 ranked 100% adherent with more closed than open questions (6 vs. 3) but more complex reflections (54%). Interview #20 ranked 80% adherent with more open vs. closed questions (8 vs. 1) and 42% complex reflections. At 12 weeks, there were concurrent significant improvements in the IPAQ walking score (p=.04), weekly step-counts (p=.03), and 6MWT (p=.0006) with a trend toward significant improvement in the DASI (p=.08).
Conclusion:
The use of MI in brief exercise counseling and phone follow-up may lead to increases in physical activity and functional status. Independent scoring and repeated review of the practice of MI over time may improve its continued use. Further testing of the intervention in a randomized trial is warranted.
An integrated motivational interviewing and cognitive-behavioural intervention promoting physical activity maintenance for adults with chronic health conditions: A feasibility study
