gms | German Medical Science

Lifestyle changes are of utmost importance in secondary prevention of coronary heart disease. The motivational stage of change (SOC) according to the transtheoretical model of behaviour change is important to assess readiness for lifestyle changes in individual patients, but information on SOC in coronary patients are currently lacking. Therefore, this study aimed to investigate SOC with respect to smoking cessation, weight reduction and physical activity in coronary patients.

A cross-sectional questionnaire survey was carried out among 1,339 patients with established coronary heart disease in the region of Münster, Germany, in 2003. The questionnaire aimed at knowledge and attitudes towards cardiovascular risk factors and readiness for lifestyle changes according to the transtheoretical model.

A total of 980 (73.2%) patients participated, 28.3% were female, mean age was 64.7 years. Among smokers, 37% were not considering cessation (precontemplation stage), 47% were thinking about cessation (contemplation stage), and 17% were preparing to stop smoking (preparation stage). Among overweight patients (BMI ≥25 kg/m²), 42% claimed to actively loose weight (action and maintenance stage). Among those who did not report weight reduction, however, 51% were in precontemplation, 31% in contemplation and 18% in preparation stage, respectively. Seventy-seven percent of patients reported regular physical activity (action and maintenance stage), but 52% of those who indicated to be physically inactive reported to be in precontemplation, 24% in contemplation and 24% in preparation stage, respectively. Patients with increasing age were more likely to report action/maintenance stage in physical activity (p<0.05) but were less likely to report action/maintenance stage in weight reduction (p<0.05). Higher education was associated with higher motivational stages in weight reduction (p<0.05). Other sociodemographic factors had no significant impact on motivational stages of change in our survey.

About half of coronary patients reporting unhealthy behaviour do not consider lifestyle change and will be difficult to reach with interventions. The other half, however, is actively considering or planning to change behaviour. Identification of these patients and tailoring interventions to their SOC may be a key element to support patients’ lifestyle change and to improve secondary prevention of coronary heart disease.