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Effects of a problem-based learning rehabilitation program on physical activity in patients with coronary artery disease
Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences.
Department of Physical Education and Health, Örebro University, Örebro, Sweden and MRC Epidemiology Unit, Cambridge, United Kingdom.
Department of Caring Sciences, Örebro University, Örebro, Sweden.
Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences.
2006 (English)In: Journal of Cardiopulmonary Rehabilitation (JCR), ISSN 0883-9212, E-ISSN 1539-0691, Vol. 26, no 1, 32-38 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To evaluate the effects of a problem-based learning (PBL) rehabilitation program on physical activity.

METHODS: We randomized 207 consecutive patients younger than 70 years, with a recent event of coronary artery disease (CAD), to a PBL group (n = 104) or a control group (n = 103). In addition to standard treatment, the PBL patients participated in a 1-year program with 13 sessions in small groups, where learning needs and behavior change were focused upon. Physical activity was assessed by means of interviews with all patients and by an activity monitor in 69 patients at pretest and in 175 after 1 year.

RESULTS: Only small differences between groups were found at posttest. Interview data revealed significantly less activity at low-intensity level in the control group, whereas the activity monitor showed no significant differences. No changes were found in total physical activity during the year within the 2 groups. The self-reported physical activity indicating a level of brisk walking was markedly higher than that measured by the activity monitor, the latter indicating that only 35% of the patients achieved a 10-minute period of continued physical activity per day on an adequate level.

CONCLUSIONS: Our PBL program had no important impact on the physical activity pattern of patients with CAD. The activity monitor is a feasible way of measuring physical activity in these patients, indicating a lower level of physical activity than interview data.

Place, publisher, year, edition, pages
2006. Vol. 26, no 1, 32-38 p.
Keyword [en]
Cardiac rehabilitation, Coronary artery disease, Physical activity, Problem-based learning
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-50323DOI: 10.1097/00008483-200601000-00007OAI: diva2:271219
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2012-10-02Bibliographically approved
In thesis
1. Problem-based learning in the rehabilitation of patients with coronary artery disease
Open this publication in new window or tab >>Problem-based learning in the rehabilitation of patients with coronary artery disease
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and aims: A well-informed patient is a prerequisite for adherence to lifestyle changes and drug treatments, which improve prognosis of CAD. Problem-based learning (PBL) is in line with principles of adult learning. The aim was to develop and evaluate a PBL rehabilitation programme for coronary artery disease (CAD) patients.

The PBL model: In the PBL programme, 6-9 patients and a tutor met ftrst at 9 (I), and after revision at 13 (III and IV) sessions during a one year period. Learning needs related to CAD, its treatment, psychosocial issues, and behavioural changes were focused upon.

Subjects and methods: To validate the PBL programme, six tutors were interviewed, seven PBL groups were videotaped, and 44 other patients answered a questionnaire (I). To evaluate the validity of the MTI/CSA activity monitor, as a means of measuring physical activity intensity, 34 patients walked on a treadmill at three different speeds. Indirect calorimetry was used to determine energy expenditure (EE) (11). In order to evaluate the effects of the PBL programme (III and IV), 207 patients (55% of all eligible), were randomised to the PBL programme (n=104) or to a control group (n=103). All patients received standard therapy. Physical activity was measured by interview and by the activity monitor, and quality of life by the Ladder of Life, Self-rated Health, Cardiac Health Profile, and SF-36. All measurements were performed before randomisation and at the end of the programme.

Results: The PBL-model could be incorporated into the clinical routine with a high participation rate. Initial problems with the tutor role and the structured problem-solving process in the group-work were revealed, which led to revision of the model. PBL stimulated participants to search actively for knowledge, while remaining to fmd demands adequate and being positive about the education. According to self-reports, lifestyle changes had been performed (I). The MTI/CSA activity monitor was a valid tool for quantifying both amount and intensity of physical activity during walking (II). The PBL programme did not affect physical activity. No increase in activity was found in any of the groups over the one year period Activity, as measured by the activity monitor, was lower than recommended in guidelines for secondary prevention (III). On the contrary, self-reports indicated higher and adequate physical activity. The PBL programme seemed to have positive effects on quality of life, as measured by global instruments. No effects were found on health-related or disease specific aspects of quality of life (IV).

Conclusion: The PBL programme was feasible to run in clinical practice. Education of tutors was crucial and required time. The programme stimulated participants to become active learners. The PBL model had no effects on physical activity, but some effects on global quality of life. Physical activity remained unchanged and low in both groups, as measured by the activity monitor, which was a useful and reliable tool, while self-reports seemed to overestimate performed physical activity. Quality of life improved in both groups over the year. More data are needed to evaluate the usefulness of the PBL-model.

Place, publisher, year, edition, pages
Linköping: Linköpin Universitet, 2005. 65 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 890
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-31915 (URN)17748 (Local ID)91-7373-869-7 (ISBN)17748 (Archive number)17748 (OAI)
Public defence
2005-04-29, Berzeliussalen, Hälsouniversitetet, Linköping, 13:00 (Swedish)


Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-10-02Bibliographically approved

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