title: Medical, psychological, and sociodemographic factors associated with adherence to cardiac rehabilitation programs: a systematic review.
abstract: OBJECTIVE
  Cardiac rehabilitation (CR) programs have been shown to reduce mortality and morbidity rates among coronary heart disease patients, but adherence to these classes has been found to be poor. This review aims to summarize and integrate research findings investigating the possible sociodemographic, medical, and psychological variables that influence patient adherence to CR programs. It also aims to address the methodological failings of past reviews conducted in this area.
  
  
  METHODS
  Several databases were systematically searched for studies published between 1990 and 2009. Studies examining CR program adherence or completion, using data based on participant's actual recorded attendance were included.
  
  
  RESULTS
  Eighteen studies were identified that met inclusion criteria. Low mood, participant's age, and certain cardiac risk factors were found to be most consistently associated with poor adherence to CR. A good understanding of the consequences of heart disease was found to be associated with good adherence. Results were relatively inconsistent across studies because of differences in methods used.
  
  
  CONCLUSIONS
  Certain risk factors for poor adherence to CR should be assessed and monitored by health professionals. Future studies should address the methodological difficulties present in previous research. Recommendations are made for standardizing methods in future research.
authors.affiliation: NHS Greater Glasgow and Clyde, Glasgow, Scotland, United Kingdom. gavin.taylor@ggc.scot.nhs.uk
authors.forename: Gavin H
authors.initials: GH
authors.lastname: Taylor
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Wilson
authors.forename: John
authors.initials: J
authors.lastname: Sharp
mesh_terms: D000223:Adaptation, Psychological; D000339:Affect; D003327:Coronary Disease / Q000534:rehabilitation*; D006304:Health Status; D006801:Humans; D010349:Patient Compliance / Q000523:psychology; D020377:Self Efficacy; D012959:Socioeconomic Factors