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Motivation for physical activity predicts effect of cardiac rehabilitation in an elderly cardiac population

Session Poster Session 1

Speaker Nicolai Mikkelsen

Event : ESC Congress 2019

  • Topic : preventive cardiology
  • Sub-topic : Rehabilitation: Outcomes
  • Session type : Poster Session

Authors : N Mikkelsen (Copenhagen,DK), C Dall (Copenhagen,DK), A Holdgaard (Copenhagen,DK), M Frederiksen (Copenhagen,DK), H Rasmusen (Copenhagen,DK), E Prescott (Copenhagen,DK)

N Mikkelsen1 , C Dall1 , A Holdgaard1 , M Frederiksen1 , H Rasmusen1 , E Prescott1 , 1Bispebjerg University Hospital, Department of Cardiology - Copenhagen - Denmark ,


Background: Motivation for physical activity is a psychological parameter that is sparsely described in secondary prevention, and it is plausible that motivation contributes to differential effect of CR. 

Purpose: To investigate if motivation, measured using the behavioural regulation in exercise questionnaire (BREQ-2), predicts VO2peak in elderly cardiac patients before and after CR. 

Methods: Prospective cohort study (Danish cohort from the EU-CaRE study) of elderly patients with ischemic or valvular disease enrolled in CR. Motivation for physical activity was measured using the BREQ-2 questionnaire at baseline, which measures five constructs of motivation and a summed score. VO2peak was measured before and after CR by a cardiopulmonary exercise test (CPET). The impact of motivation on VO2peak was examined using standardized multiple regression analyses.

Results:  203 patients performed the baseline tests. 182 (90%) completed CR and had full data available. Dropout was not associated with motivation. VO2peak at baseline was 18 ml/kg/min (SD±5.1) and was associated with motivation score: for each SD increase in motivation VO2peak was 1.05 (0.43 - 1.69) ml/kg/min higher (p<0.01). Mean improvement was 2.3 (12%) ml/kg/min (SD±4.3). Higher motivation was positively associated with VO2peak (0.78 (0.33 - 1.24) pr. SD improvement (p=0.01) after adjusting for age, sex, depression, comorbidities and baseline VO2peak (Table). Subscales of the BREQ2 indicate that internal but not external motivation drives this positive association. 

Conclusion: In elderly cardiac patients, level of motivation is important to achieve benefits of CR. Future studies should address if motivation measured with BREQ-2 can be applied as a screening tool for elderly patients to provide more personalized intervention.

Age and sex adjusted

Multiple adjusted model

Motivation (RAI pr. SD)


(.12 - 1.01) *


(.33 - 1.24) **

Baseline VO2peak (pr. SD)


(-1.16 - .21)


(-1.94 - -.66) ***

Age (pr. SD)


(-1.85 - .18)


(-2.01 - -0.01) *

Sex (male)


(-1.21 - .85)


(-.28 - 1.76)

Previous smoker


(-1.22 - .77)


( -1.34 - .59)

Current smoker


(-3.00 - .14)


(-3.36 - -.40) *

Diabetes (Yes)


(-2.50 - -.24) *


(-2.78 - -.48) **

Kidney disease (Yes)


(-2.37 - 0.42)


(-2.84 - -0.06) *

PHQ-9 (pr. SD)


(-.24 - .69)


(-.24 - .66)


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