The effectiveness of a transtheoretical model-based multidisciplinary collaboration on cardiac rehabilitation outcomes in patients with acute myocardial infarction：a quasi-randomized study

The effectiveness of a transtheoretical model-based multidisciplinary collaboration on cardiac rehabilitation outcomes in patients with acute myocardial infarction：a quasi-randomized study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The effectiveness of a transtheoretical model-based multidisciplinary collaboration on cardiac rehabilitation outcomes in patients with acute myocardial infarction：a quasi-randomized study Li Xu, Donghao Guo, Xiyi Wang, Hanfen Chen, Yang Li, Long Shen, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7055275/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Cardiac rehabilitation (CR) has been shown to reduce morbidity and mortality in patients with acute myocardial infarction (AMI), however, the proportion of patients participating in and benefiting from cardiac rehabilitation (CR) remains low in China. This study aims to explore the effects of a trans-theoretical model (TTM)- based multidisciplinary CR program (TTMCR) on behavior change and CR outcomes in AMI patients. Methods This was a pragmatic, nonrandomized trial of 84 patients with AMI, who were enrolled in TTMCR program (TTMCR group, n = 43 ) or standard nursing care and in-hospital CR (control group, n = 41). The primary study outcome was 3-month change in CR outcomes assessed by cardiopulmonary exercise test (CPET) and subjective measures including the Exercise Self-Efficacy Scale (ESES), and the Exercise Social Support Scale (ESSS). The secondary study outcome was 3-month behavior change evaluated by weekly exercise frequency and the Stages of Exercise Behavior Change Scale. Results Characteristics of the 43 patients in TTMCR group and 41 patients in the control group were similar. As compared to the control group, patients in the TTMCR groups achieved greater 3-month gains in ventilation oxygen at the anaerobic threshold per kilogram (AT-VO 2 /kg) (p < 0.001), peak ventilation oxygen per kilogram (VO 2 Peak/kg) (p < 0.001), ESES cores (p < 0.001) and ESSS scores (p < 0.001). 3 months post discharge, the proportion of patients achieving successful behavior change was higher in the TTMCR group, with significantly increased weekly exercise frequency (p < 0.001). Conclusions Patients enrolled in the TTMCR group achieved greater 3-month improvement in CR outcomes and behavior change than those in the control group. Our data suggest the novel TTMCR program is promising in improving CR outcomes in AMI patients during the early post-discharge period. Trial registration: Clinicaltrials.gov, NCT07045220 (Data assigned: 22/6/2025). Retrospectively registered. Health sciences/Cardiology Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Trans-theoretical model Multidisciplinary collaboration Acute myocardial infarction Exercise-based cardiac rehabilitation Behavior change Figures Figure 1 Figure 2 Background According to the "Report on Cardiovascular Health and Diseases in China 2023: an Updated Summary" [ 1 ], the mortality rate of acute myocardial infarction (AMI) in China has been increasing annually since 2005. Exercise-based cardiac rehabilitation (CR) is an effective way to reduce rehospitalization and mortality rates in patients with AMI after percutaneous coronary intervention (PCI). However, the participation of patients in cardiac rehabilitation remains low in China, with engagement rates at only 6–10%, and less than 30% completing the entire program. In contrast, participation rates in Western countries are much higher, ranging from 30–40% [ 2 – 4 ]. The current management of patients' health behaviors is still far from the recommended goals by literature [ 5 ]. Although previous studies showed that a hospital-led home-based cardiac rehabilitation model has the potential to change this situation [ 6 , 7 ], it remains challenging to facilitate the adoption and maintenance of healthy behaviors in AMI patients after PCI when relying on a single-discipline approach. Trans-theoretical model (TTM) has been shown in numerous studies to facilitate health behavior such as medication adherence and physical activity [ 8 – 10 ]. In the context of rehabilitation management, a multidisciplinary collaboration model facilitates the integration and coordination of medical resources, offering significant advantages in the long-term health management and follow-up of patients [ 11 – 13 ]. Whether a combination of TTM and multidisciplinary approach facilitates behavior change and improves CR outcomes in Chinese patients with AMI remain unknown. Here, we designed a quasi-randomized study to explore the effects of a TTM- based multidisciplinary CR program (TTMCR ) on behavior change and CR outcomes in AMI patients after PCI in the early post-discharge period. To our knowledge, no interventional study based on the combination of TTM and multidisciplinary approach has been conducted in AMI patients. Therefore, this study is expected to provide valuable evidence for the future optimization of cardiac rehabilitation programs for Chinese AMI patients. Methods Study design and participants This quasi-randomized intervention study was conducted in Renji Hospital, Sanghai, China (2022). The study was approved by the Ethics Committee of Renji Hospital, School of Medicine, Shanghai Jiao Tong University (KY2021-098-B), and conducted in accordance with the relevant guidelines and regulations. Hospitalized AMI patients admitted from June to July 2022 were assigned to the control group, and hospitalized AMI patients admitted from August to September 2022 were assigned to the TTMCR group. The eligibility criteria were as follows: (1) Aged between 18 and 75 years old; (2) Diagnosed with AMI according to the European Society of Cardiology (ESC) guidelines [ 14 ]; (3) Received standard PCI and drug treatment in hospital; (4) Able to communicate effectively with healthcare providers in Mandarin; (5) Long-term residents of Shanghai who had been living in Shanghai for at least 6 months prior to the study and intended to continue residing in Shanghai for the duration of the intervention and follow-up period (3 months); (6) Voluntary participation in the study with signed informed consent. Exclusion criteria include: (1) Contraindications to cardiac rehabilitation [ 15 ]; (2) History of mental disorders; (3) Withdrawal from the study for any reason; (4) Participating in other intervention research projects. The sample size calculation formula is [ 16 ]: \(\:\text{n}=\frac{2{（{{\mu\:}}_{{\alpha\:}}+{{\mu\:}}_{{\beta\:}}）}^{2}{{\sigma\:}}^{2}}{{\delta\:}^{2}}\) In this formula: µ α represents the µ value corresponding to the Type I error probability. With a test level of α = 0.05 (two-sided) and a significance level of 5%, the corresponding µ α is 1.96. µβ represents the u value corresponding to the Type II error probability. With β set at 0.1, the power(1-β) equals to 0.9, and the corresponding value is 1.28. δ is the expected effect size, which is the absolute value of the difference in means between the two groups. σ² is the population variance, which can be estimated by the sample variance—specifically, the average of the variances of the two groups. Based on relevant literature [ 17 ], δ and σ are set at 2.4 and 3.2, respectively. Assuming a 1:1 sample ratio and a 10–20% dropout rate, each group requires a sample size of 43 cases. Measures and procedure Intervention for the control group Standard nursing care and in-hospital CR and routine nursing care was provided for the control group. After clinical assessment, eligible AMI patients received exercise-based in-hospital CR, including lower limb cycle ergometer in bed or on armchair, upper and lower muscle endurance, and 10–60 meters walking. Standard nursing care included patient education on the importance of exercise, suggestions for appropriate exercises based on the disease progression and physiological status, and advises for regular follow-up in the outpatient clinic. After discharge, telephone follow-up was conducted every 1–2 weeks to evaluate the patients' health stat us. Intervention for the TTMCR group A multidisciplinary CR team comprised of nurse manager, attending physician, rehabilitation therapist and rehabilitation nurses, conducted a retrospective study to identify barriers to exercise-based cardiac rehabilitation among patients with acute myocardial infarction (AMI) [ 18 ]. With an incorporation of a previously reported CR protocol in AMI patients [ 19 ], and a consideration of the expected duration of intervention effects and the real-world clinical feasibility [ 20 , 21 ], the multidisciplinary CR team developed a 12-week TTM based CR program. One day before discharge, physicians, rehabilitation therapists, and nurses jointly developed exercise prescriptions for patients including: exercise frequency, intensity and duration[ 22 ]. The exercise modality was selected based on patients' habitual activities and preferences, aligned with the recommendation of physical activities for Chinese adults [ 23 ]. Nurses assessed and recorded the current stage of change in the patient's exercise behavior, established a personal rehabilitation file, and added the patient and/or family members to the WeChat (a real-time communication platform commonly used in China) group. Nurses and rehabilitation therapists jointly provided patients with cardiac rehabilitation-related health education materials and exercise videos. Physicians recommended that patients use wearable monitoring devices during exercise. After discharge, nurses conducted telephone follow-up once a week for a total of 12 times. The follow-up content mainly included providing sports and medical integration guidance [ 19 ] based on the patient's stage of change in exercise behavior. A detailed flow of the TTMCR intervention is presented in Fig. 1 and Table 1 . Table 1 Interventions for Different Stages of Behavior Changes Behavior Change Stage Interventions Pre-contemplation Stage (Not exercising and not planning to exercise in the next 6 months) ① Obtain patient information; ② Arouse patient interest; ③ Analyze the pros and cons of exercise; ④ Provide diversified health education; ⑤ Share experiences of fellow patients; ⑥ Be guided by patient needs; ⑦ Explain relevant knowledge; ⑧ Understand patients' feelings and perspectives. Contemplation Stage (Not exercising but intending to exercise in the next 6 months) ① Analyze reasons; ② Patient self-analysis; ③ Consciousness awakening; ④ Obstacle removal; ⑤ Information support; ⑥ Effective communication; ⑦ Psychological intervention. Preparation Stage (Not exercising but has a plan to exercise within the next 30 days) ① Develop personalized plans; ② Prepare for challenges; ③ Discuss safe and effective exercise; ④ Family support; ⑤ Prepare for personalized plan execution. Action Stage (Has started exercising but less than 6 months) ① Affirm the patient's behavior change; ② Promote progress through goal setting; ③ Provide and adjust exercise prescriptions; ④ Family involvement; ⑤ Re-evaluate problems; ⑥ Eliminate adverse factors; ⑦ Exercise reminders; ⑧ Timely recording; ⑨ Ensure safety during exercise. Maintenance Stage (Has started exercising for more than 6 months) ① Emotional support; ② Experience the meaning of recovery; ③ Continue to provide and adjust exercise prescriptions; ④ Follow-up management; ⑤ Stimulus control; ⑥ Self-reflection; ⑦ Set and execute advanced goals; ⑧ Reinforcement management. Behavior change The Stages of Exercise Behavior Change Scale, developed by Marcus et al. and translated into Chinese by Yin Bo, consists of five questions. The Cronbach's α coefficient for this scale is 0.95. Before each intervention, patients are asked, "Do you exercise regularly?" to determine their stage of change and provide targeted interventions. This can also be used as an outcome indicator to evaluate the effectiveness of the intervention by assessing the stage of change of both groups three months later. The stages of exercise behavior change are scored from 1 to 5, representing the five stages of change: 1 point for Precontemplation, 2 points for Contemplation, 3 points for Preparation, 4 points for Action, and 5 points for Maintenance. The change in exercise behavior stage is calculated as the score at 3 months post-discharge minus the score before discharge. A difference of "0" indicates no change. A difference of "0" indicates progression [ 24 ]. The weekly exercise frequency was recorded after discharge. Before discharge, nurses instructed patients to record their weekly exercise frequency. Continuous exercise lasting ≥ 30 minutes or multiple sessions totaling ≥ 30 minutes in a day (with each session lasting at least 10 minutes) was counted as one instance of exercise. Patients were informed to bring their records during follow-up visits. Starting from the 8th week of the intervention, following the exercise prescription and achieving an average of ≥ 3 exercise sessions per week was considered a successful change in exercise behavior [ 25 ]. During the outpatient visit, patients’ exercise records were reviewed. Rehabilitation outcomes The cardiopulmonary exercise test (CPET) is considered as the gold standard for assessing overall cardiopulmonary function. Parameters such as VO 2 Peak-/kg and AT-VO 2 /kg reflect the patient's exercise capacity and are important measurement parameters in CPET. The CPET was performed using the Yi De Yuan Jian CPX600 machine, with designated cardiac rehabilitation specialist conducting the tests on the patients. The test employed a symptom-limited maximal exercise protocol. Specifically, the test was to be terminated immediately if the patient exhibited any of the following conditions: angina pectoris, dyspnea, exercise-induced blood pressure drop of ≥ 10 mmHg (1 mmHg = 0.133 kPa), or more than three consecutive ventricular premature beats. The left ventricular ejection fraction (LVEF) value obtained from echocardiography is a commonly used indicator for diagnosing heart function and evaluating cardiac rehabilitation outcomes. Echocardiography was performed using the GE Vivid S6 machine, with designated echocardiologist conducting cardiac function measurements on the patients. During the examination, patients were instructed to assume the left lateral decubitus position and remain as still as possible. Studies indicate that exercise can impact quality of life by altering body fat assessed by body mass index (BMI) and waist circumference [ 26 ]. According to Chinese standards, the normal BMI range is 18.5–23.9, overweight is 24.0–27.9, and obesity is ≥ 28.0. Waist-to-hip ratio (WHR) is an important indicator for determining central obesity, with WHR > 0.9 for men and WHR > 0.8 for women being diagnostic criteria for central obesity. Body fat was measured using the InBody 770 device by designated medical staff. Patients wore hospital gowns during the assessment. The test was scheduled 2–3 hours after meals. Before measurement, patients were instructed to empty their bladders and rest for at least 30 minutes. During the test, patients were asked to remain still, keep their arms straight and close to their body, and avoid touching any other body parts. Subjective measures for rehabilitation outcomes included the Exercise Self-Efficacy Scale (ESES), developed by Bandura to assess patients' confidence in the ability to participate in exercise and overcome difficulties during exercise. The scale consists of 18 items, with a score of 100 indicating full confidence, 50 indicating moderate confidence, and 0 indicating no confidence. The Chinese version of the scale, adapted by Taiwanese scholars, has a Cronbach's α coefficient of 0.96 and a content validity of 0.90. The Exercise Social Support Scale (ESSS), developed by Sallis et al. and simplified by Hankonen et al., has a correlation coefficient of 0.96 between the brief and original versions. The scale consists of 5 items and uses a 5-point Likert scale, where higher scores indicate greater support for the patient's exercise. Domestic scholars have measured the Cronbach's α coefficient of this scale to be 0.866. Quality Control Follow-up management and quality control: (1) Training: Members of the research team receive standardized training in follow-up studies, with regular centralized training sessions. The core content of the training includes follow-up timing, content, and methods (processes). (2) Regular Meetings: Based on the progress of follow-ups, regular work meetings are held every week. The main focus of these meetings is to verify the follow-up lists and related records, share experiences from follow-up work, and provide feedback on issues encountered during follow-ups along with improvement measures. (3) Supervision: A certain proportion of follow-up results are randomly selected for quality checks, including the review of various follow-up documents. Statistical Analysis SPSS (Statistical Package for the Social Sciences) Statistics 23.0 was used for data processing and analysis. The Shapiro-Wilk test was used to assess the normality of the data distribution. Continuous data were presented as mean and standard deviation. Categorical and ordinal data were presented as percentages. Statistical inference was performed using t-tests, rank-sum tests, and chi-square tests. P < 0.05 was considered statistically significant. Results Demographic Characteristics in Both Groups A total of 84 subjects were included in this study, with 41 in the control group (2 lost to follow-up due to untimely post-discharge visits) and 43 in the TTMCR group (0 lost to follow-up). The participant inclusion flowchart is illustrated in Fig. 2 . As shown in Table 2 , baseline characteristics were well-balanced between the two groups ( P > 0.05 for all comparisons). The mean age was 59.34 ± 9.49 years in the control group and 55.40 ± 11.69 years in the TTMCR group ( P = 0.094). The majority of participants were male (80.49% control vs. 86.05% experimental, P = 0.494) and married (95.12% control vs. 95.35% TTMCR, P = 1.000). No significant differences were observed in primary caregiver status (self-care: 53.66% control vs. 62.79% experimental, P = 0.396), religious belief (92.68% vs. 93.02% non-religious, P = 1.000), or employment status (retired: 63.41% control vs. 48.84% experimental, P = 0.179). Additionally, educational background ( P = 0.139), type of medical payment ( P = 0.386), coronary lesion severity ( P = 0.421), and ICU length of stay (5.02 ± 2.26 vs. 5.84 ± 2.75 days, P = 0.144) did not differ significantly between the two groups. Table 2 Comparison of Baseline Characteristics Between Two Groups of Patients (N = 84) Item Control Group (n = 41) Experimental Group (n = 43) Statistic P value Age (years old) 59.34 ± 9.49 55.40 ± 11.69 1.694 1) 0.094 Gender/n(%) 0.467 2) 0.494 Male 33(80.49) 37(86.05) Female 8(19.51) 6(13.95) Marital status/n(%) 0.000 2) 1.000 Married 39(95.12) 41(95.35) Single/Divorced/Widowed 2(4.88) 2(4.65) Primary caregiver/n(%) 0.720 2) 0.396 Self 22(53.66) 27(62.79) Family member 19(46.34) 16(37.21) Religious belief/n(%) 0.000 2) 1.000 None 38(92.68) 40(93.02) Yes 3(7.32) 3(6.98) Educational background/n(%) 3.942 2) 0.139 Junior middle school or below 14(34.14) 8(18.60) High school/Technical secondary school 14(34.14) 13(30.23) College or above 13(31.71) 22(51.16) Employment status/n(%) 1.810 2) 0.179 Employed 15(36.59) 22(51.16) Retired 26(63.41) 21(48.84) Type of medical payment/n(%) 0.753 2) 0.386 Medical insurance 40(97.56) 39(90.70) Out-of-pocket payment 1(2.44) 4(9.30) Coronary lesion condition/n(%) 1.731 2) 0.421 1 vessel 11(26.83) 7(16.28) 2 vessels 12(29.27) 17(39.53) 3 or more vessels 18(43.90) 19(44.19) Number of days in ICU (days) 5.02 ± 2.264 5.84 ± 2.751 -1.475 1) 0.144 Note: 1) represents the t-value, 2) represents the chi-square value. Behavioral changes As shown in Table 3 , significant differences in exercise behavior were observed between the experimental and control groups. The experimental group showed substantially greater improvement in exercise progression ( P < 0.001): 51.16% of the TTMCR group participants advanced their exercise stage, compared to only 4.88% in the control group. Nearly all control group participants (95.12%) remained at their baseline exercise stage, versus 48.84% in the TTMCR group. The TTMCR group maintained a consistently higher exercise frequency across all follow-up periods (1st month: TTMCR = 0.99 ± 0.66 vs. Control = 0.40 ± 0.58, P < 0.001; 2nd month: TTMCR = 2.05 ± 1.00 vs. Control = 1.10 ± 0.87, P < 0.001; 3rd month: TTMCR = 2.69 ± 1.52 vs. Control = 1.41 ± 1.36, P < 0.001). A significantly higher proportion of participants in the TTMCR group achieved successful behavior change compared to the control group (72.09% vs. 34.15%, P < 0.001). Table 3 Comparison of Behavior Changes Between Two Groups Item Control Group (n = 41) Experimental Group (n = 43) P value Change in exercise stage/n(%) <0.001* No change 39(95.12) 21(48.84) Moved forward 2(4.88) 22(51.16) Average weekly exercise frequency (times/week) after discharge First month 0.40 ± 0.58 0.99 ± 0.66 <0.001* Second month 1.10 ± 0.87 2.05 ± 1.00 <0.001* Third month 1.41 ± 1.36 2.69 ± 1.52 <0.001* Successful exercise behavior change/n(%) <0.001* No 14(34.15) 31(72.09) Yes 27(65.85) 12(27.91) Note: 1) represents the t-value, 2) represents the chi-square value, * indicates P < 0.05. Rehabilitation outcomes As shown in Table 4 , the TTMCR group demonstrated significantly better outcomes in key rehabilitation measures compared to controls at 3-month follow-up ( P < 0.01 for all significant results). AT-VO₂/kg was higher in the TTMCR group than the control group (14.58 ± 4.08 vs. 12.31 ± 3.25; P = 0.006), with greater improvement from baseline (3.40 ± 2.98 vs. 1.17 ± 1.58; P < 0.001). For VO₂ Peak/kg, while the 3-month values did not differ significantly between groups ( P = 0.134), the TTMCR group demonstrated significantly greater improvement from baseline compared to controls (6.55 ± 3.23 vs. 1.76 ± 1.52, respectively; P < 0.001). Regarding body composition, the TTMCR group showed a significantly greater reduction in WHR compared to the control group (− 0.03 ± 0.05 vs. −0.01 ± 0.04, respectively; P = 0.021). The analysis revealed no significant differences between the two groups in LVEF ( P = 0.235) and BMI ( P = 0.471). The TTMCR group demonstrated significantly higher exercise self-efficacy (ESES) scores at 3 months (1125.12 ± 312.10 vs. 838.66 ± 384.93; P < 0.001) with greater improvement from baseline (130.47 ± 119.46 vs. 2.44 ± 142.39; P < 0.001). While exercise social support (ESSS) scores showed no between-group difference at 3 months ( P = 0.941), the TTMCR group had significantly greater improvement (0.65 ± 1.25 vs. 0.00 ± 0.74; P = 0.005). Table 4 Comparison of Rehabilitation Outcomes Between Two Groups Item Control Group (n = 41) Experimental Group (n = 43) P value Mean SD Mean SD VO 2 Peak/kg Three months after discharge 23.28 2.57 24.19 2.92 0.134 Mean change 1.76 1.52 6.55 3.23 < 0.001* AT-VO 2 /kg Three months after discharge 12.31 3.25 14.58 4.08 0.006* Mean change 1.17 1.58 3.40 2.98 < 0.001* LVEF value Three months after discharge 44.76 8.73 45.19 5.87 0.793 Mean Change 1.73 3.91 2.79 4.19 0.235 BMI Three months after discharge 23.05 2.65 23.77 2.90 0.233 Mean change -0.23 1.28 -0.41 1.02 0.471 WHR Three months after discharge 0.86 0.10 0.88 0.09 0.442 Mean change -0.01 0.04 -0.03 0.05 0.021* ESES score Three months after discharge 838.66 384.93 1125.12 312.10 < 0.001* Mean change 2.44 142.39 130.47 119.46 < 0.001* ESSS score Three months after discharge 17.32 5.56 17.40 4.08 0.941 Mean change 0.00 0.74 0.65 1.25 0.005* * indicates P < 0.05. SD, Standard deviation. Discussion Our results showed patients enrolled in the TTMCR group demonstrated significantly greater improvements in CR outcomes and behavioral changes at the 3-month follow-up compared to those in the control group. These findings highlight the efficacy of the novel TTMCR program in facilitating meaningful health behavior modifications and enhancing recovery during the critical early post-discharge period after acute myocardial infarction (AMI). The structured, theory-driven approach of TTMCR likely contributes to its success by addressing patients’ readiness to change and providing tailored interventions that support gradual but sustained engagement in rehabilitation activities [ 27 – 29 ]. Studies have shown [ 19 ] that combined aerobic and resistance exercises help improve patients' exercise capacity. In China, residents typically use walking (aerobic exercise) as their main form of exercise, and a multidisciplinary collaboration helps implement center guided home-based cardiac rehabilitation by timely incorporating resistance training based on patients' individual characteristics and the stage of exercise behavior change, allowing patients to benefit from cardiac rehabilitation [ 7 ]. The LVEF value on cardiac ultrasound is a commonly used indicator to evaluate exercise capacity and the effectiveness of cardiac rehabilitation, but the recovery of the LVEF value in AMI patients is greatly influenced by factors such as medication and the patient's underlying disease (creatine kinase isoenzyme peak, N-terminal pro-brain natriuretic peptide peak, total ischemia time). Most patients show no significant change in LVEF value at one to three months after discharge [ 31 , 32 ]. Therefore, improvements in LVEF in the early stages of cardiac rehabilitation may not be immediately noticeable. Previous studies have found that implementing a 12-week training and exercise program for coronary artery disease patients can improve body fat indicators, such as WHR [ 32 ], which aligns with the findings of this study. Abdominal fat accumulation is closely linked to cardiovascular risk factors, including insulin resistance, dyslipidemia, and hypertension. The risk of ischemic heart disease increases with waist circumference, and WHR is a key indicator of central obesity, proving more effective than weight or body fat percentage alone [ 33 ]. In this study, the changes in BMI were not statistically significant ( P > 0.05). This may be due to situations where excessive muscle mass leads to a high BMI or where BMI is normal but visceral fat exceeds the standard [ 34 ]. Combination of TTM and multidisciplinary collaboration helps patients adapt post-emergency PCI in terms of exercise self-efficacy and exercise social support. This may be attributed to the role of nurses in providing support during the follow-up. Some researchers have suggested that nursing plays an important role in chronic disease management by helping individuals integrate internal and external environmental resources to manage chronic diseases and the corresponding treatments on life, ultimately achieving harmony between the individual and the environment [ 35 ]. Other researchers have reported that the process of exercise behavior change can be reflected in the optimization of self-efficacy and social support [ 36 ], and the emphasis on teamwork during the disease adaptation process is similar to the findings of this study. The findings of this study have significant clinical relevance, particularly in the context of improving cardiac rehabilitation outcomes for patients after AMI. Our results suggest that integrating TTM and multidisciplinary collaboration into standard care protocols can provide a more comprehensive and personalized rehabilitation plan. Clinically, this approach can be particularly beneficial in settings where resources are limited, as it leverages existing healthcare teams to deliver effective, home-based rehabilitation programs. The study's findings advocate for the broader adoption of such integrated models in clinical practice, potentially leading to improved quality of life and reduced healthcare costs associated with AMI management. Although this study provides valuable insights into the effectiveness of combining the Trans-theoretical Model (TTM) and multidisciplinary collaboration for early exercise-based cardiac rehabilitation in patients after acute myocardial infarction (AMI), several limitations should be acknowledged. The study was conducted at a single center, which may limit the generalizability of the findings to other settings or populations. The sample size, although calculated to be adequate, was relatively small, and the study duration was limited to 12 weeks, which may not capture long-term outcomes or sustainability of the intervention. Future studies with larger sample sizes and extended follow-up periods could further evaluate its effectiveness in other centers. Conclusion Our TTMCR program, an exercise-based cardiac rehabilitation intervention based on a combination of TTM and multidisciplinary collaboration, demonstrated safety, feasibility, improved CR outcomes and successful behavioral changes for AMI patients after PCI in the early post-discharge period. Although further in-depth, multicenter research is warranted to validate and expand upon these results, the current study is promising in guiding cardiac rehabilitation strategies and improving long-term prognosis for AMI patients in China. Abbreviations AMI: acute myocardial infarction; AT-VO2/kg: ventilation oxygen at the anaerobic threshold per kilogram; CPET: cardiopulmonary exercise test; CR: cardiac rehabilitation; ESES: exercise self-efficacy scale; ESSS: exercise social support scale; LVEF: left ventricular ejection fraction; TTM: transtheoretical model; VO2 Peak/kg: peak ventilation oxygen per kilogram; WHR: waist-to-hip ratio. Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of Renji Hospital, School of Medicine, Shanghai Jiao Tong University (KY2021-098-B). The participant consent was written. Consent for publication Not applicable Availability of data and materials The data that support the findings of this study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study is supported by the National Natural Science Foundation of China (No. 82300366, and No. 72304183), the Shanghai Sailing Program (No. 21YF1422400), Shanghai Pujiang Program (2024PJD843), and Shanghai Jiao Tong University School of Medicine: Nursing Development Program. Authors’ contributions All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas. Yang is the guarantor of the entire manuscript. Xu, Zou, Guo and Wang took part in drafting, revising, or critically reviewing the article and gave final approval of the version to be published; Chen, Li and Shen contributed to the data acquisition, analysis, and interpretation. All authors have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work. Acknowledgments The authors would like to thank all the staff of the Cardiac Rehabilitation Center, including rehabilitation therapists, attending physician and nurses, and all the patients who participated in the study. References National Center for Cardiovascular Diseases. The Writing Committee of the Report on Cardiovascular Health and Diseases in China: Report on Cardiovascular Health and Diseases in China 2023: an Updated Summary. Chin. Circulation J. 39 (7), 625–660 (2024). Ivers, N. M. et al. 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1","display":"","copyAsset":false,"role":"figure","size":131940,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eConceptual framework of the TTMCR intervention.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAMI = acute myocardial infarction; TTMCR = a trans-theoretical model- based multidisciplinary cardiac rehabilitation program\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7055275/v1/aa5f3960b4da2bf5d2c46aa8.jpg"},{"id":96179112,"identity":"9b839675-b3c0-42e0-9ef8-2c9674f7223d","added_by":"auto","created_at":"2025-11-18 12:15:55","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":173213,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStudy flowchart.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAMI = acute myocardial infarction; CR = cardiac rehabilitation; TTMCR = a trans-theoretical model- based multidisciplinary cardiac rehabilitation program\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7055275/v1/44a56134850c4e289a2ba125.jpg"},{"id":108421365,"identity":"3f49a385-7ba3-4d7e-98ff-26e335af0c64","added_by":"auto","created_at":"2026-05-04 12:40:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":782567,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7055275/v1/5046cf78-c06d-42ec-98dd-f5fe5fad107d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe effectiveness of a transtheoretical model-based multidisciplinary collaboration on cardiac rehabilitation outcomes in patients with acute myocardial infarction：a quasi-randomized study\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eAccording to the \"Report on Cardiovascular Health and Diseases in China 2023: an Updated Summary\" [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], the mortality rate of acute myocardial infarction (AMI) in China has been increasing annually since 2005. Exercise-based cardiac rehabilitation (CR) is an effective way to reduce rehospitalization and mortality rates in patients with AMI after percutaneous coronary intervention (PCI). However, the participation of patients in cardiac rehabilitation remains low in China, with engagement rates at only 6\u0026ndash;10%, and less than 30% completing the entire program. In contrast, participation rates in Western countries are much higher, ranging from 30\u0026ndash;40% [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The current management of patients' health behaviors is still far from the recommended goals by literature [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Although previous studies showed that a hospital-led home-based cardiac rehabilitation model has the potential to change this situation [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], it remains challenging to facilitate the adoption and maintenance of healthy behaviors in AMI patients after PCI when relying on a single-discipline approach.\u003c/p\u003e\u003cp\u003eTrans-theoretical model (TTM) has been shown in numerous studies to facilitate health behavior such as medication adherence and physical activity [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In the context of rehabilitation management, a multidisciplinary collaboration model facilitates the integration and coordination of medical resources, offering significant advantages in the long-term health management and follow-up of patients [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Whether a combination of TTM and multidisciplinary approach facilitates behavior change and improves CR outcomes in Chinese patients with AMI remain unknown. Here, we designed a quasi-randomized study to explore the effects of a TTM- based multidisciplinary CR program (TTMCR ) on behavior change and CR outcomes in AMI patients after PCI in the early post-discharge period. To our knowledge, no interventional study based on the combination of TTM and multidisciplinary approach has been conducted in AMI patients. Therefore, this study is expected to provide valuable evidence for the future optimization of cardiac rehabilitation programs for Chinese AMI patients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eStudy design and participants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis quasi-randomized intervention study was conducted in Renji Hospital, Sanghai, China (2022). The study was approved by the Ethics Committee of Renji Hospital, School of Medicine, Shanghai Jiao Tong University (KY2021-098-B), and conducted in accordance with the relevant guidelines and regulations. Hospitalized AMI patients admitted from June to July 2022 were assigned to the control group, and hospitalized AMI patients admitted from August to September 2022 were assigned to the TTMCR group. The eligibility criteria were as follows: (1) Aged between 18 and 75 years old; (2) Diagnosed with AMI according to the European Society of Cardiology (ESC) guidelines [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]; (3) Received standard PCI and drug treatment in hospital; (4) Able to communicate effectively with healthcare providers in Mandarin; (5) Long-term residents of Shanghai who had been living in Shanghai for at least 6 months prior to the study and intended to continue residing in Shanghai for the duration of the intervention and follow-up period (3 months); (6) Voluntary participation in the study with signed informed consent. Exclusion criteria include: (1) Contraindications to cardiac rehabilitation [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]; (2) History of mental disorders; (3) Withdrawal from the study for any reason; (4) Participating in other intervention research projects. The sample size calculation formula is [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]:\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\text{n}=\\frac{2{（{{\\mu\\:}}_{{\\alpha\\:}}+{{\\mu\\:}}_{{\\beta\\:}}）}^{2}{{\\sigma\\:}}^{2}}{{\\delta\\:}^{2}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003cp\u003eIn this formula: \u0026micro;\u003csub\u003eα\u003c/sub\u003e represents the \u0026micro; value corresponding to the Type I error probability. With a test level of α\u0026thinsp;=\u0026thinsp;0.05 (two-sided) and a significance level of 5%, the corresponding \u0026micro;\u003csub\u003eα\u003c/sub\u003e is 1.96. \u0026micro;β represents the u value corresponding to the Type II error probability. With β set at 0.1, the power(1-β) equals to 0.9, and the corresponding value is 1.28. δ is the expected effect size, which is the absolute value of the difference in means between the two groups. σ\u0026sup2; is the population variance, which can be estimated by the sample variance\u0026mdash;specifically, the average of the variances of the two groups. Based on relevant literature [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], δ and σ are set at 2.4 and 3.2, respectively. Assuming a 1:1 sample ratio and a 10\u0026ndash;20% dropout rate, each group requires a sample size of 43 cases.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMeasures and procedure\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eIntervention for the control group\u003c/b\u003e Standard nursing care and in-hospital CR and routine nursing care was provided for the control group. After clinical assessment, eligible AMI patients received exercise-based in-hospital CR, including lower limb cycle ergometer in bed or on armchair, upper and lower muscle endurance, and 10\u0026ndash;60 meters walking. Standard nursing care included patient education on the importance of exercise, suggestions for appropriate exercises based on the disease progression and physiological status, and advises for regular follow-up in the outpatient clinic. After discharge, telephone follow-up was conducted every 1\u0026ndash;2 weeks to evaluate the patients' health stat us.\u003c/p\u003e\u003cp\u003e\u003cb\u003eIntervention for the TTMCR group\u003c/b\u003e A multidisciplinary CR team comprised of nurse manager, attending physician, rehabilitation therapist and rehabilitation nurses, conducted a retrospective study to identify barriers to exercise-based cardiac rehabilitation among patients with acute myocardial infarction (AMI) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. With an incorporation of a previously reported CR protocol in AMI patients [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], and a consideration of the expected duration of intervention effects and the real-world clinical feasibility [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], the multidisciplinary CR team developed a 12-week TTM based CR program. One day before discharge, physicians, rehabilitation therapists, and nurses jointly developed exercise prescriptions for patients including: exercise frequency, intensity and duration[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The exercise modality was selected based on patients' habitual activities and preferences, aligned with the recommendation of physical activities for Chinese adults [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Nurses assessed and recorded the current stage of change in the patient's exercise behavior, established a personal rehabilitation file, and added the patient and/or family members to the WeChat (a real-time communication platform commonly used in China) group. Nurses and rehabilitation therapists jointly provided patients with cardiac rehabilitation-related health education materials and exercise videos. Physicians recommended that patients use wearable monitoring devices during exercise. After discharge, nurses conducted telephone follow-up once a week for a total of 12 times. The follow-up content mainly included providing sports and medical integration guidance [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] based on the patient's stage of change in exercise behavior. A detailed flow of the TTMCR intervention is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eInterventions for Different Stages of Behavior Changes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBehavior Change Stage\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterventions\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePre-contemplation Stage\u003c/b\u003e (Not exercising and not planning to exercise in the next 6 months)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e① Obtain patient information; ② Arouse patient interest; ③ Analyze the pros and cons of exercise; ④ Provide diversified health education; ⑤ Share experiences of fellow patients; ⑥ Be guided by patient needs; ⑦ Explain relevant knowledge; ⑧ Understand patients' feelings and perspectives.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eContemplation Stage\u003c/b\u003e (Not exercising but intending to exercise in the next 6 months)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e① Analyze reasons; ② Patient self-analysis; ③ Consciousness awakening; ④ Obstacle removal; ⑤ Information support; ⑥ Effective communication; ⑦ Psychological intervention.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePreparation Stage\u003c/b\u003e (Not exercising but has a plan to exercise within the next 30 days)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e① Develop personalized plans; ② Prepare for challenges; ③ Discuss safe and effective exercise; ④ Family support; ⑤ Prepare for personalized plan execution.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAction Stage\u003c/b\u003e (Has started exercising but less than 6 months)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e① Affirm the patient's behavior change; ② Promote progress through goal setting; ③ Provide and adjust exercise prescriptions; ④ Family involvement; ⑤ Re-evaluate problems; ⑥ Eliminate adverse factors; ⑦ Exercise reminders; ⑧ Timely recording; ⑨ Ensure safety during exercise.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMaintenance Stage\u003c/b\u003e (Has started exercising for more than 6 months)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e① Emotional support; ② Experience the meaning of recovery; ③ Continue to provide and adjust exercise prescriptions; ④ Follow-up management; ⑤ Stimulus control; ⑥ Self-reflection; ⑦ Set and execute advanced goals; ⑧ Reinforcement management.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eBehavior change\u003c/b\u003e The Stages of Exercise Behavior Change Scale, developed by Marcus et al. and translated into Chinese by Yin Bo, consists of five questions. The Cronbach's α coefficient for this scale is 0.95. Before each intervention, patients are asked, \"Do you exercise regularly?\" to determine their stage of change and provide targeted interventions. This can also be used as an outcome indicator to evaluate the effectiveness of the intervention by assessing the stage of change of both groups three months later. The stages of exercise behavior change are scored from 1 to 5, representing the five stages of change: 1 point for Precontemplation, 2 points for Contemplation, 3 points for Preparation, 4 points for Action, and 5 points for Maintenance. The change in exercise behavior stage is calculated as the score at 3 months post-discharge minus the score before discharge. A difference of \"0\" indicates no change. A difference of \"\u0026lt;0\" indicates regression. A difference of \"\u0026gt;0\" indicates progression [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The weekly exercise frequency was recorded after discharge. Before discharge, nurses instructed patients to record their weekly exercise frequency. Continuous exercise lasting\u0026thinsp;\u0026ge;\u0026thinsp;30 minutes or multiple sessions totaling\u0026thinsp;\u0026ge;\u0026thinsp;30 minutes in a day (with each session lasting at least 10 minutes) was counted as one instance of exercise. Patients were informed to bring their records during follow-up visits. Starting from the 8th week of the intervention, following the exercise prescription and achieving an average of \u0026ge;\u0026thinsp;3 exercise sessions per week was considered a successful change in exercise behavior [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. During the outpatient visit, patients\u0026rsquo; exercise records were reviewed.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRehabilitation outcomes\u003c/b\u003e The cardiopulmonary exercise test (CPET) is considered as the gold standard for assessing overall cardiopulmonary function. Parameters such as VO\u003csub\u003e2\u003c/sub\u003ePeak-/kg and AT-VO\u003csub\u003e2\u003c/sub\u003e/kg reflect the patient's exercise capacity and are important measurement parameters in CPET. The CPET was performed using the Yi De Yuan Jian CPX600 machine, with designated cardiac rehabilitation specialist conducting the tests on the patients. The test employed a symptom-limited maximal exercise protocol. Specifically, the test was to be terminated immediately if the patient exhibited any of the following conditions: angina pectoris, dyspnea, exercise-induced blood pressure drop of \u0026ge;\u0026thinsp;10 mmHg (1 mmHg\u0026thinsp;=\u0026thinsp;0.133 kPa), or more than three consecutive ventricular premature beats.\u003c/p\u003e\u003cp\u003eThe left ventricular ejection fraction (LVEF) value obtained from echocardiography is a commonly used indicator for diagnosing heart function and evaluating cardiac rehabilitation outcomes. Echocardiography was performed using the GE Vivid S6 machine, with designated echocardiologist conducting cardiac function measurements on the patients. During the examination, patients were instructed to assume the left lateral decubitus position and remain as still as possible.\u003c/p\u003e\u003cp\u003eStudies indicate that exercise can impact quality of life by altering body fat assessed by body mass index (BMI) and waist circumference [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. According to Chinese standards, the normal BMI range is 18.5\u0026ndash;23.9, overweight is 24.0\u0026ndash;27.9, and obesity is \u0026ge;\u0026thinsp;28.0. Waist-to-hip ratio (WHR) is an important indicator for determining central obesity, with WHR\u0026thinsp;\u0026gt;\u0026thinsp;0.9 for men and WHR\u0026thinsp;\u0026gt;\u0026thinsp;0.8 for women being diagnostic criteria for central obesity. Body fat was measured using the InBody 770 device by designated medical staff. Patients wore hospital gowns during the assessment. The test was scheduled 2\u0026ndash;3 hours after meals. Before measurement, patients were instructed to empty their bladders and rest for at least 30 minutes. During the test, patients were asked to remain still, keep their arms straight and close to their body, and avoid touching any other body parts.\u003c/p\u003e\u003cp\u003eSubjective measures for rehabilitation outcomes included the Exercise Self-Efficacy Scale (ESES), developed by Bandura to assess patients' confidence in the ability to participate in exercise and overcome difficulties during exercise. The scale consists of 18 items, with a score of 100 indicating full confidence, 50 indicating moderate confidence, and 0 indicating no confidence. The Chinese version of the scale, adapted by Taiwanese scholars, has a Cronbach's α coefficient of 0.96 and a content validity of 0.90. The Exercise Social Support Scale (ESSS), developed by Sallis et al. and simplified by Hankonen et al., has a correlation coefficient of 0.96 between the brief and original versions. The scale consists of 5 items and uses a 5-point Likert scale, where higher scores indicate greater support for the patient's exercise. Domestic scholars have measured the Cronbach's α coefficient of this scale to be 0.866.\u003c/p\u003e\u003cp\u003e\u003cb\u003eQuality Control\u003c/b\u003e Follow-up management and quality control: (1) Training: Members of the research team receive standardized training in follow-up studies, with regular centralized training sessions. The core content of the training includes follow-up timing, content, and methods (processes). (2) Regular Meetings: Based on the progress of follow-ups, regular work meetings are held every week. The main focus of these meetings is to verify the follow-up lists and related records, share experiences from follow-up work, and provide feedback on issues encountered during follow-ups along with improvement measures. (3) Supervision: A certain proportion of follow-up results are randomly selected for quality checks, including the review of various follow-up documents.\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eSPSS (Statistical Package for the Social Sciences) Statistics 23.0 was used for data processing and analysis. The Shapiro-Wilk test was used to assess the normality of the data distribution. Continuous data were presented as mean and standard deviation. Categorical and ordinal data were presented as percentages. Statistical inference was performed using t-tests, rank-sum tests, and chi-square tests. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eDemographic Characteristics in Both Groups\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 84 subjects were included in this study, with 41 in the control group (2 lost to follow-up due to untimely post-discharge visits) and 43 in the TTMCR group (0 lost to follow-up). The participant inclusion flowchart is illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, baseline characteristics were well-balanced between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05 for all comparisons). The mean age was 59.34\u0026thinsp;\u0026plusmn;\u0026thinsp;9.49 years in the control group and 55.40\u0026thinsp;\u0026plusmn;\u0026thinsp;11.69 years in the TTMCR group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.094). The majority of participants were male (80.49% control vs. 86.05% experimental, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.494) and married (95.12% control vs. 95.35% TTMCR, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.000). No significant differences were observed in primary caregiver status (self-care: 53.66% control vs. 62.79% experimental, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.396), religious belief (92.68% vs. 93.02% non-religious, P\u0026thinsp;=\u0026thinsp;1.000), or employment status (retired: 63.41% control vs. 48.84% experimental, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.179). Additionally, educational background (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.139), type of medical payment (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.386), coronary lesion severity (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.421), and ICU length of stay (5.02\u0026thinsp;\u0026plusmn;\u0026thinsp;2.26 vs. 5.84\u0026thinsp;\u0026plusmn;\u0026thinsp;2.75 days, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.144) did not differ significantly between the two groups.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Baseline Characteristics Between Two Groups of Patients (N\u0026thinsp;=\u0026thinsp;84)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl Group (n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExperimental Group (n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStatistic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years old)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59.34\u0026thinsp;\u0026plusmn;\u0026thinsp;9.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55.40\u0026thinsp;\u0026plusmn;\u0026thinsp;11.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.694\u003csup\u003e1)\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.094\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender/n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.467\u003csup\u003e2)\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.494\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33(80.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37(86.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8(19.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(13.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status/n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.000\u003csup\u003e2)\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39(95.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41(95.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle/Divorced/Widowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2(4.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(4.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary caregiver/n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.720\u003csup\u003e2)\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.396\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22(53.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27(62.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily member\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19(46.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16(37.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReligious belief/n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.000\u003csup\u003e2)\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38(92.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40(93.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3(7.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3(6.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational background/n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.942\u003csup\u003e2)\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.139\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJunior middle school or below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14(34.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(18.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh school/Technical secondary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14(34.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13(30.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCollege or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13(31.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22(51.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployment status/n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.810\u003csup\u003e2)\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.179\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15(36.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22(51.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26(63.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21(48.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType of medical payment/n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.753\u003csup\u003e2)\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.386\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedical insurance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40(97.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39(90.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOut-of-pocket payment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(2.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(9.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoronary lesion condition/n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.731\u003csup\u003e2)\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.421\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 vessel\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11(26.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(16.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2 vessels\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12(29.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17(39.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3 or more vessels\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18(43.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19(44.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of days in ICU (days)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.02\u0026thinsp;\u0026plusmn;\u0026thinsp;2.264\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.84\u0026thinsp;\u0026plusmn;\u0026thinsp;2.751\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.475\u003csup\u003e1)\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.144\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: \u003csup\u003e1)\u003c/sup\u003e represents the t-value, \u003csup\u003e2)\u003c/sup\u003e represents the chi-square value.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eBehavioral changes\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, significant differences in exercise behavior were observed between the experimental and control groups. The experimental group showed substantially greater improvement in exercise progression (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001): 51.16% of the TTMCR group participants advanced their exercise stage, compared to only 4.88% in the control group. Nearly all control group participants (95.12%) remained at their baseline exercise stage, versus 48.84% in the TTMCR group. The TTMCR group maintained a consistently higher exercise frequency across all follow-up periods (1st month: TTMCR\u0026thinsp;=\u0026thinsp;0.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66 vs. Control\u0026thinsp;=\u0026thinsp;0.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; 2nd month: TTMCR\u0026thinsp;=\u0026thinsp;2.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.00 vs. Control\u0026thinsp;=\u0026thinsp;1.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; 3rd month: TTMCR\u0026thinsp;=\u0026thinsp;2.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52 vs. Control\u0026thinsp;=\u0026thinsp;1.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.36, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). A significantly higher proportion of participants in the TTMCR group achieved successful behavior change compared to the control group (72.09% vs. 34.15%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Behavior Changes Between Two Groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl Group (n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExperimental Group (n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChange in exercise stage/n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo change\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39(95.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21(48.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMoved forward\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2(4.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22(51.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAverage weekly exercise frequency (times/week) after discharge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFirst month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecond month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThird month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSuccessful exercise behavior change/n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14(34.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31(72.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27(65.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12(27.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eNote: \u003csup\u003e1)\u003c/sup\u003e represents the t-value, \u003csup\u003e2)\u003c/sup\u003e represents the chi-square value, * indicates \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eRehabilitation outcomes\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, the TTMCR group demonstrated significantly better outcomes in key rehabilitation measures compared to controls at 3-month follow-up (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01 for all significant results). AT-VO₂/kg was higher in the TTMCR group than the control group (14.58\u0026thinsp;\u0026plusmn;\u0026thinsp;4.08 vs. 12.31\u0026thinsp;\u0026plusmn;\u0026thinsp;3.25; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006), with greater improvement from baseline (3.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98 vs. 1.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.58; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). For VO₂ Peak/kg, while the 3-month values did not differ significantly between groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.134), the TTMCR group demonstrated significantly greater improvement from baseline compared to controls (6.55\u0026thinsp;\u0026plusmn;\u0026thinsp;3.23 vs. 1.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52, respectively; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Regarding body composition, the TTMCR group showed a significantly greater reduction in WHR compared to the control group (\u0026minus;\u0026thinsp;0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05 vs. \u0026minus;0.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04, respectively; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.021). The analysis revealed no significant differences between the two groups in LVEF (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.235) and BMI (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.471). The TTMCR group demonstrated significantly higher exercise self-efficacy (ESES) scores at 3 months (1125.12\u0026thinsp;\u0026plusmn;\u0026thinsp;312.10 vs. 838.66\u0026thinsp;\u0026plusmn;\u0026thinsp;384.93; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) with greater improvement from baseline (130.47\u0026thinsp;\u0026plusmn;\u0026thinsp;119.46 vs. 2.44\u0026thinsp;\u0026plusmn;\u0026thinsp;142.39; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). While exercise social support (ESSS) scores showed no between-group difference at 3 months (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.941), the TTMCR group had significantly greater improvement (0.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25 vs. 0.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Rehabilitation Outcomes Between Two Groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eControl Group (n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eExperimental Group (n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVO\u003csub\u003e2\u003c/sub\u003e Peak/kg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThree months after discharge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.134\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean change\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAT-VO\u003csub\u003e2\u003c/sub\u003e/kg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThree months after discharge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.006*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean change\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLVEF value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThree months after discharge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e44.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.793\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean Change\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.235\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThree months after discharge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.233\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean change\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.471\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWHR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThree months after discharge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.442\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean change\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.021*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eESES score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThree months after discharge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e838.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e384.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1125.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e312.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean change\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e142.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e130.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e119.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eESSS score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThree months after discharge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.941\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean change\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.005*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e* indicates \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. SD, Standard deviation.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur results showed patients enrolled in the TTMCR group demonstrated significantly greater improvements in CR outcomes and behavioral changes at the 3-month follow-up compared to those in the control group. These findings highlight the efficacy of the novel TTMCR program in facilitating meaningful health behavior modifications and enhancing recovery during the critical early post-discharge period after acute myocardial infarction (AMI). The structured, theory-driven approach of TTMCR likely contributes to its success by addressing patients\u0026rsquo; readiness to change and providing tailored interventions that support gradual but sustained engagement in rehabilitation activities [\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eStudies have shown [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] that combined aerobic and resistance exercises help improve patients' exercise capacity. In China, residents typically use walking (aerobic exercise) as their main form of exercise, and a multidisciplinary collaboration helps implement center guided home-based cardiac rehabilitation by timely incorporating resistance training based on patients' individual characteristics and the stage of exercise behavior change, allowing patients to benefit from cardiac rehabilitation [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The LVEF value on cardiac ultrasound is a commonly used indicator to evaluate exercise capacity and the effectiveness of cardiac rehabilitation, but the recovery of the LVEF value in AMI patients is greatly influenced by factors such as medication and the patient's underlying disease (creatine kinase isoenzyme peak, N-terminal pro-brain natriuretic peptide peak, total ischemia time). Most patients show no significant change in LVEF value at one to three months after discharge [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Therefore, improvements in LVEF in the early stages of cardiac rehabilitation may not be immediately noticeable.\u003c/p\u003e\u003cp\u003ePrevious studies have found that implementing a 12-week training and exercise program for coronary artery disease patients can improve body fat indicators, such as WHR [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], which aligns with the findings of this study. Abdominal fat accumulation is closely linked to cardiovascular risk factors, including insulin resistance, dyslipidemia, and hypertension. The risk of ischemic heart disease increases with waist circumference, and WHR is a key indicator of central obesity, proving more effective than weight or body fat percentage alone [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In this study, the changes in BMI were not statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). This may be due to situations where excessive muscle mass leads to a high BMI or where BMI is normal but visceral fat exceeds the standard [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCombination of TTM and multidisciplinary collaboration helps patients adapt post-emergency PCI in terms of exercise self-efficacy and exercise social support. This may be attributed to the role of nurses in providing support during the follow-up. Some researchers have suggested that nursing plays an important role in chronic disease management by helping individuals integrate internal and external environmental resources to manage chronic diseases and the corresponding treatments on life, ultimately achieving harmony between the individual and the environment [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Other researchers have reported that the process of exercise behavior change can be reflected in the optimization of self-efficacy and social support [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], and the emphasis on teamwork during the disease adaptation process is similar to the findings of this study.\u003c/p\u003e\u003cp\u003eThe findings of this study have significant clinical relevance, particularly in the context of improving cardiac rehabilitation outcomes for patients after AMI. Our results suggest that integrating TTM and multidisciplinary collaboration into standard care protocols can provide a more comprehensive and personalized rehabilitation plan. Clinically, this approach can be particularly beneficial in settings where resources are limited, as it leverages existing healthcare teams to deliver effective, home-based rehabilitation programs. The study's findings advocate for the broader adoption of such integrated models in clinical practice, potentially leading to improved quality of life and reduced healthcare costs associated with AMI management.\u003c/p\u003e\u003cp\u003eAlthough this study provides valuable insights into the effectiveness of combining the Trans-theoretical Model (TTM) and multidisciplinary collaboration for early exercise-based cardiac rehabilitation in patients after acute myocardial infarction (AMI), several limitations should be acknowledged. The study was conducted at a single center, which may limit the generalizability of the findings to other settings or populations. The sample size, although calculated to be adequate, was relatively small, and the study duration was limited to 12 weeks, which may not capture long-term outcomes or sustainability of the intervention. Future studies with larger sample sizes and extended follow-up periods could further evaluate its effectiveness in other centers.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur TTMCR program, an exercise-based cardiac rehabilitation intervention based on a combination of TTM and multidisciplinary collaboration, demonstrated safety, feasibility, improved CR outcomes and successful behavioral changes for AMI patients after PCI in the early post-discharge period. Although further in-depth, multicenter research is warranted to validate and expand upon these results, the current study is promising in guiding cardiac rehabilitation strategies and improving long-term prognosis for AMI patients in China.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAMI: acute myocardial infarction; AT-VO2/kg: ventilation oxygen at the anaerobic threshold per kilogram; CPET: cardiopulmonary exercise test; CR: cardiac rehabilitation; ESES: exercise self-efficacy scale; ESSS: exercise social support scale; LVEF: left ventricular ejection fraction; TTM: transtheoretical model; VO2 Peak/kg: peak ventilation oxygen per kilogram; WHR: waist-to-hip ratio.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved\u0026nbsp;by the Ethics Committee of Renji Hospital, School of Medicine, Shanghai Jiao Tong University (KY2021-098-B).\u0026nbsp;The participant consent was written.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is supported by the National Natural Science Foundation of China (No. 82300366, and No. 72304183), the Shanghai Sailing Program (No. 21YF1422400), Shanghai Pujiang Program (2024PJD843), and Shanghai Jiao Tong University School of Medicine: Nursing Development Program.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas. Yang is the guarantor of the entire manuscript. Xu, Zou, Guo and Wang took part in drafting, revising, or critically reviewing the article and gave final approval of the version to be published; Chen, Li and Shen contributed to the data acquisition, analysis, and interpretation. All authors have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all the staff of the Cardiac Rehabilitation Center, including rehabilitation therapists, attending physician and nurses, and all the patients who participated in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNational Center for Cardiovascular Diseases. The Writing Committee of the Report on Cardiovascular Health and Diseases in China: Report on Cardiovascular Health and Diseases in China 2023: an Updated Summary. \u003cem\u003eChin. Circulation J.\u003c/em\u003e \u003cb\u003e39\u003c/b\u003e (7), 625\u0026ndash;660 (2024).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIvers, N. M. et al. Interventions supporting long term adherence and decreasing cardiovascular events after myocardial infarction (ISLAND): pragmatic randomised controlled trial. \u003cem\u003eBMJ\u003c/em\u003e \u003cb\u003e369\u003c/b\u003e, m1731 (2020).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXu, L., Yang, Y., Chen, H. F., Wang, X. Y. \u0026amp; Ye, Z. H. Study on influencing factors and effect evaluation of patients with acute myocardial infarction in the cardiac rehabilitation center. \u003cem\u003eShanghai Jiao Tong Univ. 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Pneumal Vascular Disease\u003c/em\u003e. \u003cb\u003e28\u003c/b\u003e (1), 116\u0026ndash;120 (2020).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Trans-theoretical model, Multidisciplinary collaboration, Acute myocardial infarction, Exercise-based cardiac rehabilitation, Behavior change","lastPublishedDoi":"10.21203/rs.3.rs-7055275/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7055275/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eCardiac rehabilitation (CR) has been shown to reduce morbidity and mortality in patients with acute myocardial infarction (AMI), however, the proportion of patients participating in and benefiting from cardiac rehabilitation (CR) remains low in China. This study aims to explore the effects of a trans-theoretical model (TTM)- based multidisciplinary CR program (TTMCR) on behavior change and CR outcomes in AMI patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis was a pragmatic, nonrandomized trial of 84 patients with AMI, who were enrolled in TTMCR program (TTMCR group, n\u0026thinsp;=\u0026thinsp;43 ) or standard nursing care and in-hospital CR (control group, n\u0026thinsp;=\u0026thinsp;41). The primary study outcome was 3-month change in CR outcomes assessed by cardiopulmonary exercise test (CPET) and subjective measures including the Exercise Self-Efficacy Scale (ESES), and the Exercise Social Support Scale (ESSS). The secondary study outcome was 3-month behavior change evaluated by weekly exercise frequency and the Stages of Exercise Behavior Change Scale.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eCharacteristics of the 43 patients in TTMCR group and 41 patients in the control group were similar. As compared to the control group, patients in the TTMCR groups achieved greater 3-month gains in ventilation oxygen at the anaerobic threshold per kilogram (AT-VO\u003csub\u003e2\u003c/sub\u003e/kg) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), peak ventilation oxygen per kilogram (VO\u003csub\u003e2\u003c/sub\u003e Peak/kg) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), ESES cores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and ESSS scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). 3 months post discharge, the proportion of patients achieving successful behavior change was higher in the TTMCR group, with significantly increased weekly exercise frequency (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003ePatients enrolled in the TTMCR group achieved greater 3-month improvement in CR outcomes and behavior change than those in the control group. Our data suggest the novel TTMCR program is promising in improving CR outcomes in AMI patients during the early post-discharge period.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e\u003cp\u003eClinicaltrials.gov, NCT07045220 (Data assigned: 22/6/2025). Retrospectively registered.\u003c/p\u003e","manuscriptTitle":"The effectiveness of a transtheoretical model-based multidisciplinary collaboration on cardiac rehabilitation outcomes in patients with acute myocardial infarction：a quasi-randomized study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-18 12:15:50","doi":"10.21203/rs.3.rs-7055275/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c58c8185-888a-477c-aea5-edab5c114d47","owner":[],"postedDate":"November 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":58172327,"name":"Health sciences/Cardiology"},{"id":58172328,"name":"Health sciences/Diseases"},{"id":58172329,"name":"Health sciences/Health care"},{"id":58172330,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-05-04T12:40:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-18 12:15:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7055275","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7055275","identity":"rs-7055275","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}