Self-Regulatory Efficacy for Exercise in Cardiac Rehabilitation: Review and Recommendations for Measurement

Purpose: Self-regulatory efficacy (SRE) is a psychological resource necessary for cardiac rehabilitation (CR) exercise adoption and maintenance. A 2008 review of self-efficacy for CR exercise identified the need for more high-quality research on SRE. The present review had 4 purposes: (a) to review the characteristics of empirical SRE and CR exercise research since 2008; (b) to examine the quality of SRE measurement; (c) to determine whether varying quality of SRE measurement moderated the relationship between SRE, exercise, and CR social cognitions; and (d) to make recommendations for better measurement for future research. Method: An initial search of 766 possible studies identified 29 for review. These included individuals engaged in or completing CR where SRE for exercise and relevant outcomes was assessed. Meta-analysis examined whether SRE measurement quality was associated with the magnitude of effects observed and to determine potential moderation by quality. Results: There were 11 unique operationalizations of SRE for exercise. Problematic factors included: non-SRE variables assessed as the construct, using global versus specific measures, and lack of a time frame over which SRE applied. Effect size was related to stronger relationships as level of study and measurement quality increased. Conclusion: Since 2008, an increase in studies examining SRE and CR exercise was observed. To advance SRE and CR exercise research, measurement and research quality improvements are recommended that have implications for future mediation and CR intervention assessment. Impact and Implications This review qualifies the last 12 years of research in terms of the measurement of and strength of the relationship between self-regulatory efficacy and exercise for patients in cardiac rehabilitation. Measurement issues identified led to suggestions for better self-regulatory efficacy measurement and improvement in the quality of future research. Self-regulatory efficacy for exercise self-management is an important psychological resource for patients to develop to help them maintain regular exercise following cardiac rehabilitation. Cardiac rehabilitation programs should not only help patients to develop self-regulatory efficacy for exercise, but also insure accurate measurement and evaluation of changes in this social cognition for clinical purposes.