ABSTRACT
By definition, cardiac rehabilitation is conducted in three sequential program segments: (1) an in-hospital based phase; (2) a supervised outpatient or a medically directed home exercise program; and (3) an ongoing lifetime maintenance plan aimed at sustaining physical fitness and risk factor reduction. Thus, adherence/ compliance, the extent to which the participant follows the health professionals’ advice (1), may be considered at two levels, to the organized program and to the recommended lifestyle. The first level, program adherence, has been the target of adherence-enhancing interventions (2, 3). The second level, lifestyle adherence, includes maintaining the recommended behaviors. An important distinction between the two types of adherence is that one may be present in the absence of the other (i.e., an individual may discontinue attending the exercise sessions but adhere to the lifestyle changes, or the participant may attend the exercise sessions regularly but implement none of the lifestyle recommendations). The cardiac rehabilitation professional has to be cognizant of these differences to adequately prevent or remediate either type of nonadherence.
