Adherence In Cr Exercise

It is well documented that exercise-based CR accrues many benefits in patients with established coronary artery disease (US Department for Health and

Exercise Leadership in Cardiac Rehabilitation. An Evidence-Based Approach. Edited by Morag Thow. Copyright 2006 by John Wiley & Sons Ltd. ISBN 0-470-01971-9

Human Services and Agency for Health Care Policy and Research, 1995; Balady, et al, 2000; SIGN, 2002; Leon, et al., 2005). Achieving these benefits depends on good adherence to cardiac rehabilitation exercise programmes. In addition, sustaining these benefits requires maintenance of physical activity after phase III programme completion. Evidence suggests that improvements in exercise capacity, physical activity and quality of life decline over time following completion of CR exercise programmes (Bock, et al., 1997, Stahle, et al., 1999). Stahle, et al. (1999) reported a significant improvement in exercise capacity and physical activity in a group of cardiac patients after three months of supervised exercise training, compared with usual care. However, physical activity levels and exercise capacity had declined in the rehabilitation group 12 months after programme completion (Stahle, et al., 1999). Other studies have found that 50% to 75% of patients do not continue to exercise regularly after completion of formal programmes (Lidell and Fridlund, 1996; Bethell, et al., 1999). Thus, it is important for exercise leaders to implement strategies which encourage adherence to long-term exercise for CR participants to benefit from exercise.

Supervised exercise training in phase III is important in teaching patients to self-monitor their exercise intensity and increase their confidence for exercise. It is unlikely that participation in a supervised exercise programme will facilitate independent exercise after programme completion (SIGN, 2002). This is reflected by the low proportion of patients who continue to engage in regular physical activity after completion of supervised exercise programmes. Therefore, cardiac rehabilitation guidelines recommend that participants in supervised exercise programmes should also incorporate moderate intensity activity into their daily lifestyle in order to encourage regular physical activity in the long term, once the formal programme has ended (Balady, et al., 2000; SIGN, 2002). In addition, the transition from phase III exercise-based cardiac rehabilitation to phase IV can be a challenging time for cardiac patients if they do not receive the support and follow-up from cardiac rehabilitation staff that they received during phases I to III. Instead, patients have to remain physically active independently.

Membership of cardiac support groups that offer group exercise or attendance at phase IV community exercise programmes may help patients to remain active in the long term. However, these exercise opportunities are not available in all areas. Furthermore, some patients may not be able to attend community programmes due to barriers associated with supervised exercise training, including transportation problems, access difficulties (especially in rural areas), inconvenient timing of programmes and work and domestic responsibilities. However, research is limited on effective and practical interventions to encourage individuals to remain active in phase IV.

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