Predicting Exercise Adherence for Patients with Obesity and Diabetes Referred to a Cardiac Rehabilitation and Secondary Prevention Program

Abstract

Cardiac rehabilitation (CR) is associated with mortality and morbidity benefits. Treatment adherence rates of 20% to 60% for patients with diabetes and obesity undermines CR effectiveness. Identification of factors that account for poorer adherence to CR in these populations is needed. Data from 12 003 CR patients from 1995 to 2010 were analyzed. Differences in characteristics were compared between groups of patients classified by the presence or absence of diabetes mellitus and obesity. Sequential logistic regression was conducted to examine the extent to which biopsychosocial factors account for the higher likelihood of CR non-adherence. The proportion of CR non-adherence was 44% for patients without obesity or diabetes, 52% for patients with diabetes and no obesity, 56% for patients with obesity and no diabetes and 59% for patients with diabetes and obesity. After adjustment for all baseline factors, the presence of obesity or diabetes remained associated with an increased risk of CR nonadherence compared to no obesity or no diabetes (diabetes only [odds ratio (OR) 1.22; 95% confidence interval (CI) 1.08-1.38; p=0.001]; obesity only [OR 1.19; 95% CI 1.04-1.36; p=0.01]). The presence of both diabetes and obesity and their relationship to CR nonadherence is not significant (OR 1.14, 95% CI 0.947-1.37; p=0.16) after adjusting for body fat percentage and waist circumference. Diabetes and obesity were independent determinants of CR program nonadherence. The influence of having both diabetes and obesity was moderated by waist circumference and body fat percentage. Patients with diabetes mellitus, obesity or both may require greater attention and consideration with respect to CR delivery.