Exercise Self-efficacy, Perceived Benefits, and Barriers to Exercise Among Patients Following Acute Myocardial Infarction
Authors: Shajrawi Abedalmajeed , Khalil Heba , Al-Sutry Manal , Qader Raghad Abdel , Eid AbuRuz Mohannad 
Published: April 2021

Background
Increasing patient adherence to regular exercise post acute myocardial infarction (AMI) is a major goal after hospitalization. It is therefore essential to identify perceived benefits and barriers to exercise and its association with exercise self-efficacy among patients post AMI.

Aims
The purpose of this study was to identify the perceived benefits and barriers to exercise and the predictors of exercise self-efficacy among patients after AMI.

Methods
A cross-sectional study design was used with a convenience sample of 254 patients, recruited from the 3 main hospitals in Jordan. Instruments included the Exercise Benefits and Barriers Scale and the Exercise Self-Efficacy Scale. Mean scores were computed to determine the perceived benefits and barriers responses. Multiple linear regression was conducted to explore the predictors of exercise self-efficacy. Data were collected over 5 months.

Results
The greatest perceived benefits were related to personal factors, for example, “I enjoy exercise” (2.45 [0.98]), and physical performance, for example, “My muscle tone is improved with exercise” (2.44 [0.86]) and “Exercise increases my stamina” (2.43 [0.86]). The greatest perceived barriers were related to environmental barriers, for example, “Lack of exercise places” (2.67 [0.82]), and internal factors related to physical exertion itself, for example, “Concerned about getting tired during exercise participation” (2.65 [0.72]). The Exercise Self-Efficacy Scale showed that patients post ST-elevation AMI had higher exercise self-efficacy than those with other treatment modalities (AMI, 44.71 [19.07] vs 36.59 [17.34]; P = .001). Patients treated by primary percutaneous coronary intervention had higher exercise self-efficacy, 49.2 (18.61), than patients treated by thrombolysis and percutaneous coronary intervention, 39.28 (18.3), and patients treated by medications other than thrombolytic therapy, 36.59 (17.4) (F
2,251 = 11.612, P = .001). The multiple linear regression model explained approximately 29% of the variance in exercise self-efficacy (F
11,242 = 7.914, P < .001). Five variables contributed significantly to the prediction of self-efficacy: type of AMI (standardized β = −0.173, t = −3.311, P = .01), perceived exercise benefits (standardized β = 0.322, t = 4.912, P = .01), perceived exercise barriers (standardized β = −0.291, t = −4.521, P = .01), being Argela smokers (water pipe smoking) (standardized β = −0.132, t = −2.617, P = .029), and cholesterol level (standardized β = −0.158, t = −2.174, P = .003).

Conclusions
Primary perceived benefits of exercise reported were in the areas of personal factors and improved physical performance. The main perceived barriers to exercise were in the areas of environmental factors and physical exertion. Identification of benefits and barriers to exercise, type of AMI, and treatment modalities of AMI as predictors of exercise self-efficacy is a significant step for developing appropriate interventions that effectively improve exercise self-efficacy and exercise among post-AMI patients.