title: Patients with diabetes in cardiac rehabilitation: attendance and exercise capacity.
abstract: OBJECTIVE
  Diabetes increases mortality after myocardial infarction, but participation in cardiac rehabilitation (CR) reduces this risk. Our objectives were to examine whether attendance at CR and changes in cardiorespiratory fitness differed according to diabetic status and sex.
  
  
  METHODS
  Retrospective cohort study of patients referred for CR in Calgary between 1996 and 2010. Cardiorespiratory fitness in metabolic equivalents (METs) was estimated by maximal exercise testing at baseline, at the end of the 12-wk CR program, and 1-yr after CR.
  
  
  RESULTS
  Among 7036 nondiabetic and 1546 diabetic patients who started, 84.9% of nondiabetic versus 79.5% of diabetic patients completed CR (P < 0.0001). The difference between diabetic and nondiabetic patients was greater in women (81.7% vs 72.1%, P < 0.0001) than that in men (86.0% vs 82.5%, P = 0.004). Patients without diabetes were more likely to return for the 1-yr assessment (53.7% vs 42.7%, P < 0.0001), and nondiabetic women were more likely than diabetic women to attend the 1-yr follow-up (44.3% vs 31.7%, P < 0.0001). Change in cardiorespiratory fitness from baseline to 12 wk was +1.0 METs in nondiabetic men, +0.9 METS in diabetic men, +0.9 METs in nondiabetic women, and +0.7 METs in diabetic women (within-group change; P = 0.0009). Changes in cardiorespiratory fitness at 1 yr compared with baseline were +0.9, +0.6, +0.9, and +0.5 METS, respectively (within-group change, P = 0.0001).
  
  
  CONCLUSIONS
  Patients with diabetes, especially females, were less likely than patients without diabetes to complete CR and attend follow-up. Among patients who attended 1-yr follow-up, changes in cardiorespiratory fitness were not as well maintained in diabetic patients as in nondiabetic patients. Identifying barriers and targeting CR adherence interventions to patients with diabetes may help improve outcomes.
authors.affiliation: 1Faculty of Medicine, University of Calgary, Calgary AB, CANADA; 2Cardiac Wellness Institute of Calgary, Calgary AB, CANADA; 3Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL; and 4Faculty of Kinesiology, University of Calgary, Calgary AB, CANADA.
authors.forename: Marni J
authors.initials: MJ
authors.lastname: Armstrong
authors.forename: Billie-Jean
authors.initials: BJ
authors.lastname: Martin
authors.forename: Ross
authors.initials: R
authors.lastname: Arena
authors.forename: Trina L
authors.initials: TL
authors.lastname: Hauer
authors.forename: Leslie D
authors.initials: LD
authors.lastname: Austford
authors.forename: James A
authors.initials: JA
authors.lastname: Stone
authors.forename: Sandeep
authors.initials: S
authors.lastname: Aggarwal
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Sigal
mesh_terms: D002320:Cardiovascular Physiological Phenomena; D048909:Diabetes Complications / Q000534:rehabilitation*; D004734:Energy Metabolism; D005080:Exercise Test; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000534:rehabilitation*; D010349:Patient Compliance; D010809:Physical Fitness; D012119:Respiration; D012189:Retrospective Studies; D012737:Sex Factors