Systematic review of physical activity intervention studies after cardiac rehabilitation

Coronary heart disease significantly impacts the morbidity, mortality, and health care economy of our population. Enrollment into cardiac rehabilitation (CR) after cardiac events improves patient outcomes; however, physical activity (PA) behavior decreases significantly in the years following completion of CR. This article reviews the literature regarding interventions to maintain or increase PA after CR. Fourteen interventions studies from North America, Europe, Asia, and Australia used variations of cognitive and/or behavioral strategies. Women and older adults were underrepresented in the reviewed studies. Measurement of PA varied between studies and included self-report, objective pedometer or accelerometer data, or questionnaire format. Common cognitive interventions included self-efficacy enhancement measures, barrier management, and problem solving. Behavioral interventions included self-monitoring, prompting, goal setting, and feedback. Cognitive intervention studies reported inconsistent results, whereas behavioral studies and studies that used combinations of interventions reported more consistent, positive findings. More intervention studies, using rigorous designs and reliable measures of PA on larger, more diverse populations, are needed to improve the understanding of PA-related behavior change after completion of CR.