During the 1970’s I became interested in Cardiac Rehabilitation Programs that were being developed and operating in Canada and the USA. In 1976, I was fortunate to obtain sponsorship to complete a study/investigation tour of these programs. At that time in Australia there were no formal Phase two, (Post-hospital), Cardiac Rehabilitation programs operating.

After returning to Australia and liaising with the then Medical Director of the Queensland branch of the National Heart Foundation, I became Exercise Physiologist for their successful “Fit-to-Live” program which we established the following year in 1977. This was an education and exercise program for those at risk of developing Cardiovascular Heart Disease.

A couple of years later, I was Exercise Physiologist for the first Phase two Cardiac Rehabilitation to be established in Australia under the umbrella of the National Heart Foundation. It was called “The 2000 Turtles”. “2000”, because at the time the aim of participants was to live beyond the year 2000. “Turtles”, because of their longevity, and because participants should try to emulate turtles’ slow, relaxed, apparently stress free life style.

In 1992, I worked with the General Practitioners in the Logan Area Division of General Practice (LADGP). We established and ran the first Phase two Cardiac Rehabilitation program to be run by a Division of General Practice in Australia. I was Exercise Physiologist for the program. Since then many more Cardiac Rehabilitation programs have been established.

During the two year period 1997 to 1999, I had a contract to work full time for another Division of General Practice as their Projects Director. The main project I had was to establish and run a Phase two Cardiac Rehabilitation program for the Division in collaboration with a major public hospital. This also was the first program of its kind to operate in Australia.

All of these programs had a strong education component, as well as the exercise component.

There are many factors that lead to Coronary Heart Disease (CHD) over which we have no control. I am referring to factors such as:

• genetic factors
• age
• gender

We can’t choose our parents. They have genes that they have passed onto us. If you have a family history of heart disease, if you have parents, or other relatives who have suffered from CHD, then you are more at risk than those luckier people who do not have a family history.

As we get older, once again we are more at risk of developing Coronary Heart Disease.

Hormonal factors also play a part in the risk of developing CHD. Males have a higher risk than females. However, after menopause, the risk for males and females is about the same.

There are however risk factors associated with Coronary Heart Disease over which we do have control.

These risk factors are known as Life Style factors.

It is these life style factors that are the main part of the education component of all Cardiac Rehabilitation programs.

And, smoking is right up there at the top of the list for these risk factors. 

Quitting Smoking also is more difficult for most people than other life style changes such as exercising more regularly or making healthier changes to the diet.

In my earlier days of working in Cardiac Rehab., I had difficulty understanding why someone who had had a life threatening event such as a heart attack, would continue smoking, although they knew that smoking was a major risk factor leading to that event.

But I learnt to understand it is all to do with behaviours, and the difficulty we often have in changing behaviours.

A lecture from a doctor or another Health Professional on the dangers associated with smoking for many smokers involved in Post Cardiac Rehabilitation programs was not enough. So, I did my own personal research into programs and resources that were available to smokers who wanted to quit and to stay stopped. Many commercial programs which claimed high success rates used statistics before the intervention of the program and immediately afterwards. So, a 90% success rate, (or whatever), is of little benefit if the smoker is going to commence smoking again shortly after the program completion. The most successful long term smoking cessation programs are group programs such as Fresh Start™ which has run successfully in the USA for many years. The program is run in Australia by Quit™ Victoria, who also own the Fresh Start™ trade mark in Australia.

Whilst working in Cardiac Rehabilitation in the 1990’s, I flew to Melbourne to complete the Fresh Start™ facilitators’ program. At the time the program was not available in my part of the world, Queensland, Australia. I liaised with the Queensland Cancer Fund™ who later ran the program in Queensland. Until a year or so ago, I worked with the Tobacco Issues Coordinators from the Queensland Cancer Fund™ to train facilitators for the Fresh Start course throughout Queensland.

This lead me to an interest in the study of behaviour change. The most widely accepted theory of behaviour change is the transtheoretical model espoused by Prochaska and DiClemente. I shall briefly explain their “Stages of Change” theory on the following page, because I do believe that understanding their model will help us understand the difficulty we might have in stopping smoking and staying stopped if we are smokers. It will also help Health Professionals understand why clients may have difficulty stopping and staying stopped. An understanding of this model should also be of assistance in working to make the behaviour change (that is from smoker to nonsmoker), permanent.

The Transtheoretical “stages of change” model of behaviour change, has been widely accepted. It became the basis of the “Motivational Interviewing” techniques developed by Miller and Rollnick, which I shall further discuss on the page for Health Professionals.

Web Design Ian McKenzie

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