Effects of Cognitive-behavioral Education and Exercise Interventions on Smoking Cessation and Physical and Mental Health in Patients With Coronary Heart Disease: Application of the Transtheoretical Model
Phase: NA
Conditions: Coronary Artery Disease, Smoking Cessation
Sponsor: Cathay General Hospital

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Effects of cognitive-behavioral education and exercise 
interventions on smoking cessation and physical and mental 
health in patients with coronary heart disease: Application of the 
transtheoretical model 
 
 
 
 
 
 
 
 
 
 
 
 
 
September 20, 2021 
 
 

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A. Document type: 
Study Protocol with SAP. 
 
B. Background 
Smoking is a major risk factor of coronary artery disease (CAD) 
and is responsible for the death of one in three patients with 
cardiovascular diseases. Smoking cessation is one of the most 
favorable methods for reducing the risk of cardiovascular 
diseases; even for patients with a heart disease, quitting smoking 
can reduce the chance of a relapse of said disease. However, the 
Health Promotion Administration revealed that among male 
patients with acute myocardial infarction (AMI), 79.5% had 
smoked and 35.6% continued to smoke after an episode of AMI. 
Although previous studies confirmed that health education and 
exercises can increase smoking cessation rates, patients’ lack of 
motivation to quit smoking has resulted in a failure rate of 
65.5%. Therefore, identifying methods to strengthen patients’ 
motivation to quit smoking is a key to successfully achieving 
smoking cessation. 

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C. Objective(s) 
The purpose of the study is to adopt the Trans-theoretical Model 
to facilitate step-by-step changes in a patient’s smoking 
behavior and explore the effect of “Cognitive-Behavioral 
Education Course” and “Exercise Program” on Smoking 
cessation, physical health, and mental health of smokers with 
CAD. 
 
D. Design and Methods 
There are three stages in our study, we will describe each stage 
as follow. 
a. Stage 1: 
At this stage is a cross-sectional method and will be employed 
to investigate the relationship between smoking status and 
various physiological and psychological indicators in patients 
with CAD. 
 
b. Stage 2: 

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At stage 2, subjects who are at the smoking cessation stage of 
“precontemplation” and “contemplation” will be recruited in 
this stage. A quasi-experimental design will be used to 
determine the effects of a four-week cognitive-behavioral 
education course related to smoking cessation on the 
participants’ smoking cessation behavior, smoking decision-
making, and self-efficacy in smoking cessation. 
 
c. Stage 3: 
Subjects who are at the "preparation " and "action" stage will be 
recruited and randomly divided into experimental or control 
group to identify the effect of a 12-week brisk walking on 
improving the participants’ immediate (short-term), three-
month, and six month (long-term) health status. The primary 
indicator used for health status evaluation is smoking cessation 
success rate; the secondary indicators used are physiological 
status (i.e., nicotine addiction, lung carbon monoxide 
concentration, heart rate variability, and smoking withdrawal 
syndrome) and psychological status (i.e., depression and 

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resilience).  
E. The statistical analysis 
SPSS for Window 24.0 software will be used in statistical 
analysis. The type one error is 0.05. In inferences analysis, chi-
square test, Pearson correlation coefficient, independent t test, 
one-way ANOVA and post hoc comparison (scheffe) test will 
be used to examine the variance among groups. Finally, 
ANCOVA and GEE mode will be used to test the effectiveness 
of intervention respectively.