Associations between behavioral flexibility and health behavior in cardiac patients in the Do CHANGE trials.

Abstract

Objective: Health behaviors (e.g., physical inactivity, poor diet) are associated with poor prognosis and mortality in cardiac patients. Changing these behaviors is challenging and only a minority of patients succeeds in this endeavor. Studies show that behavioral flexibility (defined as responding less habitually to stimuli and having a large behavioral repertoire) is a potentially important facilitator of health behaviors. The current study examines the association between behavioral flexibility and health behaviors (health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, stress management) in patients with cardiac disease. Method: A total of 387 patients with stable cardiac disease were recruited as part of the Do Cardiac Health: Advanced New Generation Ecosystem Trials. Behavioral flexibility (via the Do Something Different Questionnaire) was assessed at baseline and health behaviors including the above described six domains (HPLP-II at baseline, at 3 months, and at 6 months. Linear mixed models were used to answer the research question. Results: The sample consisted of predominantly male patients (n = 274/71%) with a mean age of 62 (SD = 10), diagnosed with hypertension (n = 198/51%), coronary artery disease (n = 114/30%), and/or heart failure (n = 75/19%). The analyses revealed a positive but small (r = .106–.270, B = .00–.31) association between behavioral flexibility and all self-reported health behaviors over time. Conclusions: This is the first study to examine the association between behavioral flexibility and health behaviors in cardiac patients. Current results showed a positive association between behavioral flexibility and health behaviors over time. More research is needed to further examine causal effects of behavioral flexibility on health behaviors.

If not us, who? If not now, when? Paths forward in science, patient care, and training to maximize the impact of cardiovascular behavioral medicine.

“…Our field has identified novel behavioral and psychosocial risk and prognostic factors for multiple CVD presentations and plausible mechanisms through which these factors could influence the development and course of CVD. Examples that reflect the ongoing evolution and expansion of the field’s focus are the articles in this issue on posttraumatic stress disorder and symptoms (Eisenberg et al, 2022; Krantz et al, 2022; Meinhausen et al, 2022), poor sleep quality and quantity (Meinhausen et al, 2022; Park & Kim, 2022), attention-deficit/hyperactivity disorder (Xu et al, 2022), and behavioral flexibility (Habibović et al, 2022)—all of which identify candidate treatment targets for future intervention studies.…”

Value, implementation, and opportunities for cardiovascular behavioral medicine: A special issue commentary.

“…Thus, more work is needed to identify the mechanisms through which neighborhood factors affect health behaviors. Finally, Habibović et al (2022) found that behavioral flexibility (i.e., adaptive behavior change in response to the environment) had a small effect on CVD-related health behaviors (e.g., diet, physical activity, and stress management) among patients with hypertension or CVD.…”