Future research

Many studies have examined the factors influencing uptake of and adherence to supervised CR exercise programmes (Oldridge, et al., 1992; Pell and Morrison, 1998; Dorn, et al., 2001). However, the factors that contribute to maintenance of physical activity during and between phases of CR programmes have not been fully explored. Understanding these factors is an important step in the development of interventions to improve maintenance of physical activity and exercise. Further research in this area is warranted. Similarly, few studies have examined the effect of interventions to encourage long-term maintenance of physical activity following completion of phases II and III CR exercise programmes. Thus, research is needed to test different forms of intervention aimed at improving long-term compliance to physical activity.

Areas that are ripe for further research: Can the exercise consultation maintain physical activity for more than 12 months? Are repeat exercise consultations required? Could the exercise consultation be delivered successfully in a group or by post, telephone or World Wide Web?

The possibility of delivering this intervention to patients in a group setting at the end of phases II and III is a promising area for further study. First, delivering this intervention to groups of patients as an alternative to one-to-one consultations would be more feasible for CR services in terms of time and staff resources. In addition, conducting an exercise consultation in a group setting would provide patients with the opportunity to discuss issues with each other, such as potential barriers to remaining active, problem solving for these barriers and identifying high-risk situations for relapse. Furthermore, group discussion on exercise opportunities in the community, such as phase IV classes, might encourage patients to attend these programmes together. In general, patients routinely receive a discharge interview at the end of phase III that provides cardiac rehabilitation staff with an ideal opportunity to review the patients' goals for remaining active, devised during the group consultations. Studies using physical activity counselling in the general population and other clinical groups have successfully delivered this type of intervention in a group setting (Dunn, et al., 1999; Underwood, et al., 2000).

The exercise consultation may be useful between all phases of CR both to improve adherence to supervised exercise programmes and to encourage patients to participate in physical activity outside of the exercise classes. Patients at the start of phase III are likely to be in the contemplation or preparation stages, and the focus of the consultation should be on encouraging these individuals to increase their physical activity. A pilot study found that web-based and one-to-one exercise consultations were equally effective in increasing physical activity in a group of patients participating in a phase III supervised exercise programme (McKay, et al., 2003).

Other strategies could be included in the exercise consultation to increase its efficacy. Recently, physical activity intervention programmes have found the addition of pedometers to be effective in promoting physical activity (Chan, et al., 2004; Tudor-Locke, et al., 2004). Thus, pedometers, in conjunction with exercise consultation, may be a promising strategy for encouraging participation in physical activity.

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