OBJECTIVES: Guidelines advocate goal setting for promoting lifestyle changes in cardiovascular disease (CVD) patients. This study investigates 1) preferences in health and life goal domains in CVD patients, 2) the impact of linking life goals to health goals on intention-to-change-lifestyle and explores 3) socio-demographic and health-related variables influencing intention-to-change-lifestyle. DESIGN: Online experimental study. METHODS: Patients (N = 629, mean age 66.6; 39% female) were randomized to health-goal-group (HG) or life-and-health-goal-group (LHG). HG set a health goal, and LHG first established a life goal and then set a supporting health goal. Directly after goal setting, the primary outcome, intention-to-change-lifestyle, was measured and analysed using logistic regression (high: 9-10 vs. lower: ≤8.5), as were the secondary outcomes. RESULTS: Exercise goals were most frequently selected in LHG (66.0%) and HG (66.9%). Preference for selecting stress management was significantly higher in LHG (17.3%) than HG (9.3%), χ2(1) = 8.85, p = .003; OR = 2.05, 95%CI [1.27-3.30]. The direct effect of goal-setting condition on intention-to-change-lifestyle was non-significant (OR = .98, 95%CI [.71-1.34], p = .88). In exploratory analyses, lower- and medium-educated patients showed significantly higher intention when life and health goals were linked (OR = 2.55, 95%CI [1.03-6.27], p = .04, and OR = 2.47, 95%CI [1.15-5.30], p = .02, respectively). Perceived meaning in life was positively associated with intention. CONCLUSIONS: No main effect of goal-setting condition on intention-to-change-lifestyle was found. Linking life goals to health goals increased preference for stress management and, in exploratory analyses, was associated with higher intention-to-change-lifestyle among lower- and medium-educated patients. Findings emphasize the relevance of personalized, value-based goal setting within cardiac rehabilitation.

Background
To improve lifestyle guidance within cardiac rehabilitation (CR), a comprehensive understanding of the motivation and lifestyle-supporting needs of patients with cardiovascular disease (CVD) is required.

Objectives
This study's purpose is to evaluate patients’ lifestyle and their motivation, self-efficacy and social support for change when starting CR.

Methods
1782 CVD patients (69 % male, mean age 62 years) from 7 Dutch outpatient CR centers participated between 2020 and 2022. Modifiable risk factors were assessed with a survey and interviews by healthcare professionals during CR intake.

Results
Most patients exhibited an elevated risk in 3–4 domains. Elevated risks were most prominent in domains of (1) waist circumference and BMI (2) physical exercise (3) healthy foods intake and (4) sleep duration. Most patients chose to focus on increasing physical exercise, but about 20 % also wanted to focus on a healthy diet and/or decrease stress levels. Generally, motivation, self-efficacy and social support to reach new lifestyle goals were high. However, patients with an unfavorable risk profile had lower motivation and self-efficacy to work on lifestyle changes, while patients with lower social support had a higher chance to quit the program prematurely.

Conclusions
Our results underscore the need to begin CR with a comprehensive lifestyle assessment and highlight the importance of offering lifestyle interventions tailored to patients’ specific modifiable risk factors and lifestyle-supporting needs, targeting multiple lifestyle domains. Expanding the current scope of CR programs to address diverse patient needs and strengthening support may enhance motivation and adherence and lead to significant long-term benefits for cardiovascular health.

Objective
Communicating risk information and offering lifestyle advice are important goals in cardiac rehabilitation. However, the most effective way and the most effective source to communicate this information are not yet known. Therefore, we examined the effect of source (cardiologist, physiotherapist) and framing (gain, loss) of brief lifestyle advice on patients’ intention-to-change-lifestyle.

Methods
In an online experimental study, 636 cardiac patients (40% female, 67 (10) yrs.) were randomly assigned to one of four textual vignettes. Effect of source and framing on intention-to-change-lifestyle (assessed using a 5-point Likert scale) was analysed using analysis of covariance (ANCOVA).

Results
Patients expressed positive intention-to-change-lifestyle after receiving advice from the cardiologist (M = 4.1) and physiotherapist (M = 3.9). However, patients showed significantly higher intention-to-change-lifestyle after receiving advice from the cardiologist (0.58 [0.54–0.61]) when compared with the physiotherapist (0.52 [0.48–0.56]), (F[1,609] = 7.06, P = 0.01). Gain-framed and loss-framed advice appeared equally effective. However, communicating risks (loss) was remembered by only 9% of patients, whereas 89% remembered benefits (gain).

Conclusions
Our study shows the value of cardiologists and physiotherapists communicating brief lifestyle advice, as cardiac patients expressed positive intention for lifestyle change after receiving advice, irrespective of framing. Lifestyle advice should include benefits due to better recall.