Motivational interviewing and skills-based counseling in cardiac rehabilitation: The cardiovascular health initiative and lifestyle education (CHILE) study

Motivating cardiac patients to adopt and maintain the type of lifestyle that may stabilize the atherosclerosis presents a major challenge to medical practitioners. Therefore, the CHILE Study was conducted to assess the impact of motivational interviewing and skills-based counseling on the health-related behaviors of patients attending cardiac rehabilitation. Sixty-one patients who had entered a traditional early outpatient cardiac rehabilitation program were assigned at random to either a control treatment (CT), i.e., the traditional rehabilitation program, or to an experimental treatment (ET). The ET consisted of the traditional program plus a 1-hour motivational interview conducted by a counselor (week 1) and three 30-minute skills-based counseling sessions conducted by a health educator (weeks 2, 3 & 7). The transtheoretical model of behavior change provided the framework for a counseling style that was matched with the patient's stage of readiness to change multiple behaviors simultaneously. MANCOVA indicated that ET resulted in a significantly greater improvement (p =.002) in the linear combination of scores for perceived stress, physical activity and dietary fat intake when compared with CT at 12 weeks. Univariate analysis of covariance identified that the ET group resulted in a significantly greater reduction (p =.005) in perceived stress when compared with the CT group. Perceived stress decreased from a mean score of 16.5 to 9.5 in the ET group, while the CT group decreased from 15.8 to 13.7. Univariate analysis of covariance did not identify significant differences (p > .05) between groups in physical activity and dietary fat intake. ANCOVA identified that ET resulted in a significantly greater increase (p =.033) in exercise participation, and in a significantly greater reduction (p =.047) in saturated fat intake when compared with CT. Exercise participation increased from 9.0 to 30.0 MET-hours/week in the ET group, while the CT group increased from 6.1 to 14.0 MET-hours/week. Saturated fat intake decreased from 5.7% to 4.7% of total calories consumed in the ET group, while the CT group changed from 7.2% to 6.5%. In conclusion, integrating motivational interviewing and skills-based counseling into a traditional early outpatient cardiac rehabilitation program helps motivate patients to adopt a more healthful lifestyle.