A randomized controlled trial of staged cardiac rehabilitation based on the Health Belief Model on kinesiophobia, self-efficacy and activities of daily living in elderly patients with coronary heart disease.

INTRODUCTION

Kinesiophobia is highly prevalent in elderly patients with coronary heart disease (CHD) and severely limits participation in cardiac rehabilitation. However, phased, theory-based interventions targeting this population are lacking.

METHODS

This single-blind randomized controlled trial of 139 elderly CHD patients evaluated a staged cardiac rehabilitation intervention based on the Health Belief Model (HBM). The intervention group (n = 69) received a staged HBM-based programme plus usual care; the control group (n = 70) received usual care only. Outcomes (TSK-SV Heart, Barthel Index, SEE) were measured at admission (T0), discharge (T1), and 1 month (T2) and 3 months (T3) post-discharge.

RESULTS

Repeated-measures ANOVA revealed significant time, group, and interaction effects for all outcomes (P < 0.05). The intervention group showed significantly higher Barthel Index and SEE scores at T1, T2, and T3, and lower TSK-SV Heart scores at T2 and T3 versus controls (P < 0.05). Within the intervention group, kinesiophobia at T2/T3 was lower than at T0/T1, and self-efficacy at T1-T3 was higher than at T0 (P < α'). No exercise-related adverse events occurred.

DISCUSSION: A staged HBM-based cardiac rehabilitation programme reduces kinesiophobia, improves ADL, and enhances exercise self-efficacy in elderly CHD patients, with sustained effects and excellent safety. This nurse-led, low-cost programme can be integrated into standard cardiac rehabilitation pathways for older adults.