Abstract 12461: Strength of Physician Recommendation Increases Home-based Exercise Participation in Patients With Coronary Heart Disease

Abstract

The majority of individuals with coronary heart disease (CHD) do not meet current exercise guidelines and less than half enroll in hospital-based cardiac rehabilitation (CR) exercise programs. Strength of physician referral can positively affect participation in a hospital-based CR program, but it is unknown how the strength of physician referral may impact home exercise in patients with CHD. It was hypothesized that the strength of physician recommendation would positively impact home exercise participation. A total of 251 patients with CHD completed the Cardiac Rehabilitation Exercise Participation Tool 3 months after hospital discharge. Participants were typical of the CHD population, with 165 being male (65.7%) and a mean age of 65 years (SD= 9.8). Of the total sample, 188 (75%) reported receiving physician referral for home exercise, with the mean strength of the referral being 2.9 (SD= 1.9) on a scale of 0 (none) to 5 (strong). One hundred twenty-two patients (48.6%) reported exercising 3 or more days a week at home. Logistic regression was used to evaluate the impact of the strength of physician referral on the likelihood that patients would participate in home exercise after hospital discharge. Covariates included age, sex, race, marital status, employment status, education level, insurance type, cardiac procedure type, history of CHD, history of depression, functional status, and exercise prior to hospitalization. Increased strength of physician referral was predictive of increased home exercise participation (adjusted OR 1.5, 95% CI [1.3-1.7], p< 0.001). Male sex was also predictive, with 58.4% of males, as compared to 40% of females, reporting home exercise (adjusted OR 1.9, 95% CI [1.0-3.6], p= 0.049). Exercise prior to hospitalization was a final predictor, with 58.4% of prior exercisers, as compared to 41.7% of non-exercisers, reporting home exercise participation after hospital discharge (adjusted OR 2.0, 95% CI [1.1-3.6], p= 0.03). These findings demonstrate the beneficial effect of a strong physician recommendation for home-based exercise in patients with CHD. Physician referral is particularly important for women and patients who have not exercised before a cardiac event, as they reported doing less exercise after discharge home.