The Behavioural Research Group focuses on three main themes: 1) developing and implementing systematic approaches to smoking cessation in clinical practice settings; 2) promoting exercise and physical activity in patients with heart disease; and 3) examining the effectiveness and cost-efficiency of different models of delivering primary and secondary prevention services. More recently, the group has taken on the challenge of how best to reduce risk and prevent heart disease in the family members of patients with heart disease.
The Ottawa Model for Smoking Cessation
Hospitalization provides a unique opportunity to identify and engage smokers, initiate cessation treatments and facilitate appropriate follow-up and support. Dr. Reid's research group has developed a systematic approach to the identification, treatment and follow-up of hospitalized smokers, now known as the Ottawa Model for Smoking Cessation (OMSC). The OMSC has now been adopted by more than 200 hospitals across Canada, and Dr. Reid's team oversees the centralized database that tracks long-term outcomes in these programs. Implementation of the OMSC is associated with an approximate doubling in the odds of successful long-term cessation compared to usual care.
The Tracking Exercise After Cardiac Hospitalization (TEACH) Study
The Tracking Exercise After Cardiac Hospitalization (TEACH) Study examined patterns and predictors of physical activity behaviour in more than 800 patients with heart disease. This study is unique because it included not only people who participate in cardiac rehabilitation (where most of the exercise literature in cardiac populations comes from) but also people who choose not to participate. Reid and his colleagues found that physical activity levels initially increase rapidly after hospitalization and then decline over time starting at about two months after hospitalization. Several factors were found to affect physical activity levels, including age, gender, co-morbidities (such as congestive heart failure and diabetes), activity level prior to hospitalization, type of revascularization, self-efficacy (belief in one's abilities) and home exercise equipment. Knowledge of these factors has been incorporated into the design of new interventions to promote physical activity in patients with heart disease.
The CardioFit Expert System for Exercise
One way that patients with heart disease could receive support and assistance for physical activity is via the Internet. Reid's group designed the CardioFit Internet-based expert system to prescribe and track exercise in patients with heart disease who were not participating in traditional cardiac rehabilitation. A randomized controlled trial showed that the CardioFit Expert System significantly increased objectively measured physical activity and heart disease health-related quality of life six months after randomization compared to usual care. The CardioFit program is now being offered as an option for patients discharged from the University of Ottawa Heart Institute.
Efficacy and Economic Evaluations of Different Models of Cardiac Rehabilitation
Secondary prevention through cardiac rehabilitation (CR) has been recommended for most patients with heart disease. Although generally reimbursed for three months, to date, optimal CR program duration and frequency of patient contact has yet to be identified. This study compared standard (33 sessions for three months) versus distributed (33 sessions for 12 months) CR. The data indicated that both groups showed improvements over time in cardiorespiratory fitness, daily physical activity, low-density lipoprotein cholesterol, generic and heart disease HRQL, and depressive symptoms. There were no clinically meaningful or statistically significant between-group differences for outcomes at 12 or 24 months. From a clinical standpoint, this study indicates that both standard and distributed program formats serve patients equally well over the longer term. Programs could use either program delivery model (standard or distributed) depending on patient or program needs. Costs to the cardiac health care system are similar.
Family Heart Health Study
Family members (spouses, siblings, offspring) of patients with coronary heart disease (CHD) may themselves be at increased risk for developing CHD for genetic, biochemical and/or behavioural reasons. Targeted approaches aimed at family members of those with established CHD may be a cost-effective way to identify high-risk persons and link them to effective risk factor modification. Reid's group has developed a 12-week family heart health program featuring a personal plan for achieving risk-factor goals and weekly contact with a heart health educator. The program has proven effective in helping family members reduce their cardiovascular risk by increasing physical activity, improving dietary habits, and quitting smoking. Measures of obesity are also improved through participation in the program. The program has been named the CardioPrevent program and is available to the public with physician referral.
Exercise Maintenance After Cardiac Rehabilitation
This study is investigating the efficacy and cost-effectiveness of a novel intervention to increase long-term exercise maintenance in patients with coronary artery disease (CAD) following the completion of cardiac rehabilitation (CR). The intervention incorporates an exercise ‘facilitator’ to assist in the transition of patients from structured, supervised exercise to self-managed home- or appropriate community-based exercise programs (Heart Wise Exercise programs). This study is being conducted at the University of Ottawa Heart Institute, Peter Munk Cardiac Centre, and Toronto Rehabilitation Institute. A total of 416 patients (224 men and 192 women) completing CR will be randomly allocated to receive either a community exercise facilitator intervention (n=208) or usual care control (n=208). Participants in the intervention group will receive a single face-to-face introductory session, 5 small group counseling teleconferences, community demonstrations of Heart Wise Exercise programs, and 3 personal telephone calls from a trained exercise facilitator over a 50-week intervention period. The usual care group will receive activities and strategies currently in place at UOHI, PMCC, and TRI to transition CR participants to self-care upon program completion. Follow up will continue to 78 weeks post-randomization. The primary outcome will be the proportion of participants in each group that undertake 30 minutes of moderate and vigorous physical activity on five days of a seven-day accelerometer recording period, 26, 52 and 78 weeks after randomization.
Nordic Walking for Patients with Heart Failure
Heart failure (HF) is a serious health problem in Canada. Patients with HF often have markedly reduced exercise tolerance that contributes to difficulties in performing daily activities and reductions in health-related quality of life (HRQL). Guideline-recommended standard exercise therapy in patients with HF, intended to improve exercise tolerance and HRQL, consists of regular walking (or other aerobic training) and resistance exercise training. Nordic walking is a form of exercise in which participants walk with specially designed poles, simultaneously conditioning upper and lower body muscle groups. The effects of Nordic walking in HF patients have not been published. Two hundred and sixteen patients with HF are being randomized to: a) Nordic walking; or b) standard exercise therapy. The Nordic walking group will complete 200-400 minutes of Nordic walking at 60-75% of the heart rate reserve for a 12-week training period. The standard exercise therapy group will complete 200-400 minutes of regular walking at 60-75% of the heart rate reserve and resistance exercise training 3 times per week for a 12-week training period. Measures will be taken at baseline, at the end of intervention (12 weeks) and after a 14-week no-intervention observation period (26 weeks). Group differences in outcomes over the three time points (baseline, 12 weeks and 26 weeks) will be examined.
Improving the Cardiovascular Health of Hospital-Employed Nurses
Regulated nurses (i.e. nurse practitioners ([NPs], registered nurses [RNs], and registered practical nurses [RPNs]) are critical health human resources and pivotal to health care quality and efficiency. Nursing is a physically and psychologically demanding profession and nurses appear to be particularly prone to sickness and injury. Canadian nurses are getting older and their cardiovascular (CV) risk is higher than average. We have developed an e-health intervention program for workplaces called CardioPrevent (CP) that has proven efficacy for improving levels of moderate and vigorous-intensity physical activity (MVPA) and reducing predicted 10-year risk of CV disease. The CP program uses telemedicine (e.g. on-line and telephone health coaching), consumer health informatics (e.g. on-demand educational content), and behaviour monitoring (e.g. a wearable Fitbit monitor with automatic upload capabilities) to create a highly individualized behaviour change intervention that is capable of meeting the needs of nurses. The intervention is now being tested in 10 hospitals in Eastern Ontario.
- Stephanie A. Prince, Travis J. Saunders, Katelin Gresty, Robert D. Reid. A comparison of the effectiveness of physical activity and sedentary behaviour interventions in reducing sedentary time in adults: A systematic review and meta-analysis of controlled trials. Obesity Reviews 2014; 15(11):905-19.
- Kerri Anne Mullen; Douglas Coyle; Douglas Manuel; Hai V Nguyen; Ba' Pham; Andrew L Pipe; Robert D. Reid. Cost-utility analysis of a hospital-initiated intervention for smokers with chronic disease in Ontario, Canada. Tobacco Control 2014; Jun 16.
- Robert D. Reid, Lisa McDonnell, Dana Riley, Amy Mark, Lori Mosca, Louise Gagne, Sophia Papadakis, Chris Blanchard, Heidi Mochari-Greenberger, Patricia O’Farrell, George Wells, Monika Slovinec D’Angelo, Andrew L. Pipe. Effect of an Intervention to Improve the Cardiovascular Health of Family Members of Patients with Heart Disease: A Randomized Trial Can Med Assoc J 2014; 186(1):23-30.
- Jennifer Reed, Alan Gervais, Robert D. Reid. Five things to know about electronic (e) cigarettes. Can Med Assoc J 2013; 185(16):1427.
- Marja-Leena Keast, Monika Slovinec D’Angelo, Chantal Nelson, Scott E Turcotte, Lisa McDonnell, Rebecca Nadler, Jennifer Reed, Andrew L Pipe and Robert D Reid. Randomized trial of Nordic walking in patients with moderate to severe heart failure. Can J Cardiol 2013; 29(11):1470-6.
- Robert D. Reid, Louise I. Morrin, Louise J. Beaton, Sophia Papadakis, Jana Kocourek, Lisa McDonnell, Monika E. Slovinec D’Angelo, Heather Tulloch, Neville Suskin, Karen Unsworth, Chris Blanchard, Andrew L. Pipe. Randomized trial of an internet-based computer tailored expert system for physical activity in patients with heart disease European Journal of Cardiovascular Prevention and Rehabilitation, 2012; 19(6):1357-64.
- Robert D. Reid, Louise I. Morrin, Lyall A.J. Higginson, Andreas Wielgosz, Chris Blanchard, Louise J. Beaton, Chantal Nelson, Lisa McDonnell, Neil Oldridge, George A. Wells, Andrew L. Pipe. Randomized trial of motivational counseling for physical activity in patients with coronary artery disease not participating in cardiac rehabilitation. Eur J Cardiovasc Prev Rehabil 2012; 19(2):161-6.
- Robert D. Reid, Heather Tulloch, Ronald J. Sigal, Glen P. Kenny, Lisa McDonnell, Michelle Fortier, George A. Wells, Normand Boule, Penny Phillips. Effects of Aerobic Exercise, Resistance Exercise, or Both on Patient-Reported Health Status and Well-being in Type 2 Diabetes Mellitus: A Randomised Trial. Diabetologia, 2010; 53(4): 632-40.
- Robert D. Reid, Andrew L. Pipe, Kerri-Anne Mullen, Monika Slovinec D’Angelo, Debbie Aitken, Sophia Papadakis. Smoking Cessation for Hospitalized Smokers: An Evaluation of the “Ottawa Model.” Nicotine and Tobacco Research 2010; 12(1):11-18.
- Robert D. Reid, Louise I. Morrin, Andrew L. Pipe, William A. Dafoe, Lyall A.J. Higginson, Andreas T. Wielgosz, Paul W. McDonald, Ron C. Plotnikoff, Kerry S. Courneya, Neil B. Oldridge, Louise J. Beaton, Sophia Papadakis, Monika E. Slovinec D’Angelo, Heather E. Tulloch, Chris M. Blanchard. Physical activity following hospitalization for coronary artery disease: The Tracking Exercise After Cardiac Hospitalization (TEACH) Study. European J Cardiovasc Prev Rehab 2006;13(4):529-37.
Current Team members
Bob Reid, PhD
Stephanie Prince Ware, PDF
Lisa Cotie, PDF
Novella Martinello (PhD student)
Mina Majd (MSc student)
Andrew Pipe, MD
Chris Blanchard, PhD
Paul Oh, MD
Sherry Grace, PhD
Janine Malcolm, MD
Roanne Segal, MD
Kerry Courneya, PhD
Ron Sigal, MD
Kim Lavoie, PhD
Thais Coutinho, MD
Jennifer Reed, PhD
Lisa Mielniczuk, MD
Kwan Chan, MD
Heather Tulloch, PhD
Kerri Mullen, PhD
Doug Manuel, MD
Doug Coyle, PhD
George Wells, PhD