Browsing by Author "Williamson, Tamara Marie"

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    Design and Feasibility of a Behavioural Weight Loss Treatment for Patients with Atrial Fibrillation and Obesity referred to Cardiac Rehabilitation
    (2024-09-17) Williamson, Tamara Marie; Campbell, Tavis; Rouleau, Codie; Wilton, Stephen; Tomfohr-Madsen, Lianne; Alberga, Angela; McDonough, Megan
    Background: Moderate weight loss (i.e., ≥10%) reduces symptom burden and disease progression among patients with atrial fibrillation (AF) and co-morbid obesity (BMI ≥ 30 kg/m2). Cardiac rehabilitation (CR) improves AF risk factors (e.g., hypertension, cardiorespiratory fitness, lipids) and thus represents an ideal multidisciplinary setting for AF management. Yet, few CR programs include targeted behavioural weight loss treatment (BWLT) for patients with cooccurring obesity. Evidence-based approaches to integrating BWLT into CR are needed to encourage sustainable weight loss in this patient group. Purpose: The purpose of this dissertation was to adapt and establish the acceptability of a Small Change BWLT that could be integrated into an existing CR program for patients with AF and obesity prior to efficacy testing in a randomized clinical trial (RCT). Methods: Chapter 2 was a qualitative descriptive exploration of patients’ preferences, barriers, and enablers to participating in a Small Change BWLT in CR. Chapter 3 was a pre-post feasibility study to adapt the BWLT to patients with AF and obesity, and establish the acceptability of the modified program. Chapter 4 was a protocol for an RCT comparing the efficacy of the BWLT + CR in terms of 12-month weight loss relative to the traditional CR program. Results: Barriers and enablers identified in Chapter 2 were used to adapt the BWLT program and included changes to patient education materials and discussion of AF risk factors. In Chapter 3, patients reported strong liking of the adapted program, however weight loss at 6 months was not clinically or statistically significant. The BWLT was further refined using the findings from Chapter 3 to inform the protocol in Chapter 4, which is currently recruiting patients (NCT05230823). Conclusion: While the benefits of a Small Changes BWLT + CR for weight loss among patients with AF and obesity relative to CR-only remain to be seen, the results of this dissertation provide important acceptability and feasibility evidence suggesting that program uptake, adherence, and completion may be favourable in the RCT. Future directions including the potential addition of adjunct pharmacotherapy to BWLT and additional therapeutic BWLT components (e.g., values-based behaviour change, self-compassion) are discussed.
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    A Prospective Proof-of-Concept Study Evaluating the Influence of Patient Education on Knowledge, Attitudes, and Cardiac Rehabilitation Attendance among Patients with Coronary Artery Disease
    (2019-08-23) Williamson, Tamara Marie; Campbell, Tavis S.; Rouleau, Codie R.; King-Shier, Kathryn M.; Doyle-Baker, Patricia K.; von Ranson, Kristin M.
    Patient education (PE), delivered during cardiac rehabilitation (CR), aims to promote CR exercise attendance by imparting knowledge about coronary artery disease (CAD; medication, risk factors, etc.) and enhancing CR-related attitudes. This study evaluated the impact of PE on motivational treatment targets (CAD knowledge, CR attitudes), and CR exercise attendance. Adults (18+) with CAD referred to CR were recruited prior to attending PE. CAD knowledge and CR attitudes (perceived necessity/suitability, exercise concerns, barriers) were assessed pre/post-PE, and at 12-week follow-up. CR exercise attendance was obtained by chart review. Seventy-one patients (87% male) participated. CAD knowledge and perceived CR necessity improved pre- to post-PE; gains persisted at 12-weeks. Greater knowledge gains did not predict larger improvements in CR attitudes or increased exercise attendance. Whereas CR-based PE may be useful for improving CAD-related knowledge and perceived need for CR, more formative work is needed to determine whether PE can promote CR exercise attendance.