Barriers to Participation in and Adherence to Cardiac Rehabilitation Programs: A Critical Literature Review

Authors

  • John Daly RN, PhD,

    1. From the University of Western Sydney, Penrith, Australia;1Concord Hospital, Sydney;2University of York, York, United Kingdom;3 and St. George Hospital, Sydney, Australia4
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  • 1 Andrew P. Sindone BMed (Hons), MD, FRACP,

    1. From the University of Western Sydney, Penrith, Australia;1Concord Hospital, Sydney;2University of York, York, United Kingdom;3 and St. George Hospital, Sydney, Australia4
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  • 1,2 David R. Thompson RN, PhD, FRCN,

    1. From the University of Western Sydney, Penrith, Australia;1Concord Hospital, Sydney;2University of York, York, United Kingdom;3 and St. George Hospital, Sydney, Australia4
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  • 3 Karen Hancock BSc (Hons), PhD,

    1. From the University of Western Sydney, Penrith, Australia;1Concord Hospital, Sydney;2University of York, York, United Kingdom;3 and St. George Hospital, Sydney, Australia4
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  • 1 Esther Chang RN, PhD,

    1. From the University of Western Sydney, Penrith, Australia;1Concord Hospital, Sydney;2University of York, York, United Kingdom;3 and St. George Hospital, Sydney, Australia4
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  • and 1 Patricia Davidson RN, Med 1,4

    1. From the University of Western Sydney, Penrith, Australia;1Concord Hospital, Sydney;2University of York, York, United Kingdom;3 and St. George Hospital, Sydney, Australia4
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John Daly, RN, PhD, Head, School of Nursing, Family and Community Health, College of Social and Health Sciences, University of Western Sydney, Parramatta Campus, Locked Bag 1797, Penrith South DC NSW 1797, Australia
E-mail: J.Daly@uws.edu.au

Abstract

Despite the documented evidence of the benefits of cardiac rehabilitation (CR) in enhancing recovery and reducing mortality following a myocardial infarction, only about one third of patients participate in such programs. Adherence to these programs is an even bigger problem, with only about one third maintaining attendance in these programs after 6 months. This review summarizes research that has investigated barriers to participation and adherence to CR programs. Some consistent factors found to be associated with participation in CR programs include lack of referral by physicians, associated illness, specific cardiac diagnoses, reimbursement, self-efficacy, perceived benefits of CR, distance and transportation, self-concept, self-motivation, family composition, social support, self-esteem, and occupation. Factors associated with non-adherence include being older, female gender, having fewer years of formal education, perceiving the benefits of CR, having angina, and being less physically active during leisure time. However, many of the studies have methodologic flaws, with very few controlled, randomized studies, making the findings tentative. Problems in objectively measuring adherence to unstructured, non-hospital-based programs, which are an increasingly popular alternative to traditional programs, are discussed. Suggestions for reducing barriers to participation and adherence to CR programs, as well as for future research aimed at clearly identifying these barriers, are discussed.

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