We cannot help but agree with Professor Behrens’s comments. Awareness of one’s own risk factors does not necessarily equate to the willingness to change these. Mere provision of information/knowledge in the form of lectures for patients or doctors’ treatment recommendations are hardly suitable for modifying lifestyles. The program studied by us aimed to not only educate patients but also “treat” them. In the sense of Prochaska and DiClemente’s transtheoretical model (1), group interactions and promotion of individual initiatives run through steps for learning new behavioral patterns. The training plan is set out on an individual basis, for example (preparation stage), and patients keep exercise diaries. As a result of three training modules at week-long intervals, initial positive effects and experiences of success can be communicated (action stage). In our study, the efficacy of the training and treatment program was proved by the fact that participants kept up their newly learnt behavioral patterns after an average of 220 days (maintenance stage).
It was not an objective of our study to investigate whether participants were stabilized in a new behavior in the long term.
We thank Falk for pointing out that a training program for coronary heart disease exists for inpatient rehabilitation. We wish to further specify our assertion to make it clear that for outpatient use—for example, in the context of disease management programs—Germany currently has no sufficiently evaluated and published education and treatment programs for patients with coronary heart disease. The fact that in the cited studies (2, 3), the training program provided in the rehab hospitals had a statistically significant effect on lifestyle deserves positive emphasis. The differences remained significant a year later. This further underlines the effectiveness of this form of intervention for the purpose of lifestyle optimization. It is worth noting that the cohort of patients studied by Seekatz et al. consisted of mainly men (93.5%) with a mean age of 53.1 years. The study population we investigated was composed of patients of the type that seeks out GPs or cardiologists every day. The proportion of men was 79% and thus closer to the sex distribution described for Germany (4). The age distribution, with a concentration of 70–79 year olds, in our study mirrored that in “real life.” We see our study as a contribution to healthcare services research, of the sort that can only be delivered by doctors in private practices in everyday routine practice (5).
Dr. med. Martin Dürsch
Kardiologie Frankfurt-Sachsenhausen, Frankfurt am Main
Dr. med. Richard Melamed
Fachbereich Medizin, Goethe-Universität Frankfurt am Main,
Frankfurt am Main
Dr. phil. Tillmann
Studiumdigitale, zentrale E-Learning-Einrichtung,
Goethe-Universität Frankfurt am Main
Conflict of interest statement
The authors of all contributions declare that no conflict of interest exists.
|1.||DiClemente CC, Prochaska JO, Fairhurst SK, et al: The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change. J Consult Clin Psychol 1991; 59: 295–304 CrossRef|
|2.||Seekatz B, Haug G, Mosler G, et al.: Entwicklung und kurzfristige Effektivität eines standardisierten Schulungsprogramms für die Rehabilitation bei koronarer Herzkrankheit. Rehabilitation 2013; 52: 344–5 CrossRef MEDLINE|
|3.||Meng K, Seekatz B, Haug G, et al.: Evaluation of a standardized patient education program for inpatient cardiac rehabilitation: impact on illness knowledge and self-management behaviors up to 1 year. Health Education Research 2014; 29: 235–46 CrossRef MEDLINE|
|4.||Robert-Koch-Institut (eds.): Koronare Herzkrankheit. Faktenblatt zu GEDA 2012: Ergebnisse der Studie: Gesundheit in Deutschland aktuell 2012. RKI, Berlin. www.rki.de/geda (last accessed on 25 October 2014).|
|5.||Melamed RJ, Tillmann A, Kufleitner HE, Thürmer U, Dürsch M: Evaluating the efficacy of an education and treatment program for patients with coronary heart disease—a randomized controlled trial. Dtsch Arztebl Int 2014; 111: 802–8 VOLLTEXT|