Exercise adherence in cardiac rehabilitation
Sarah J. Rieselbach
Abstract
In developed nations, heart disease is responsible for one-fourth of all deaths (Daly, Sindone, Thompson, Hancock, Chang & Davidson, 2002). Despite breakthroughs in medical care and prevention research, cardiovascular disease is on the rise in the United States (U.S.). According to Blanchard, Courneya, Rodgers, Daub and Knapik (2002), approximately 1.1 million cases of new or recurring cardiac events occurred in 2000. One of the main contributors to this increase in heart disease is a lack of regular physical activity. Of those individuals who begin an exercise program, few will adhere to a regular exercise regimen beyond the first 6 months (Herbert & Teague, 1989; Loughead, Colman, & Carron, 2001; Rhodes, Martin, Taunton, Rhodes, Donnelly & Elliot, 1999). Lack of adherence to a program of regular exercise is a major concern due to this increase in cardiovascular disease.
Somewhat surprisingly, the above adherence statistics apply to diseased as well as healthy populations. Cardiac rehabilitation (CR) patients come in all ages, shapes, and sizes. Because the majority of these patients tend to be over 65 years of age, it is important for them to understand that exercise is safe for individuals of all ages, especially the elderly (i.e., 70 years of age or older) and that they too can reap the biopsychosocial benefits of exercise (Christmas & Anderson, 2000; Estabrooks & Carron, 1999a; Resnick & Spellbring, 2000; Rhodes et al., 1999). That regular exercise is appropriate for people of all ages is especially important considering the fact that coronary disease will affect 50% of all individuals within the elderly population, and over 70% of these individuals will die from the disease (Rhodes, Morrissey, & Ward, 1992).
The efficacy of CR programs, as measured by reductions in overall mortality, has been shown to range from 20% to 24% in patients who have graduated from a CR program (Suter, Suter, Perkins, Bona & Kendrick, 1996). In addition, those individuals who attend CR programs have a 32% rehospitalization rate compared with 47% for individuals who do not participate in the program (McSweeney, Crane, & Bach, 2001). Despite these statistics, studies indicate that only one-third of eligible patients begin a CR program, and of these patients, only one-third actually remain in the program after 6 months (Carlson, Norman, Feltz, Franklin, Johnson and Lock, 2001; Cooper, Lloyd & Jackson, 1999; Daly et al., 2002).
The proposed study will address adherence to a regular exercise regimen by cardiac rehabilitation patients. The components that comprise two separate frameworks in the exercise psychology literature will be examined for their ability to predict adherence to a CR exercise program among Phase II and Phase III CR patients. The findings of the proposed study may inform the design and delivery of intervention programs to increase exercise adherence in CR programs.
