title: Integrated cardiovascular rehabilitation: how do noncardiac and polyvascular disease patients fare?
abstract: BACKGROUND
  The burden of noncommunicable disease is increasing. Preliminary evidence suggests that benefits of cardiovascular rehabilitation (CR) participation are also observed in patients with stroke and diabetes (vascular diseases [VDs]). This study compared (1) CR utilization by clinical indication; (2) sociodemographic and clinical characteristics of VD patients who participate in CR versus those who do not; and (3) change in risk factors, functional capacity, psychosocial well-being, and health behaviors from pre- to postprogram in cardiac versus VD patients who participated in CR.
  
  
  METHODS
  This multisite study invited new CR patients to complete a survey preprogram and again 6 months later. Clinical data including risk factors and exercise test results were extracted from patients' charts at both time points. The surveys included the Duke Activity Status Index, the Godin Leisure-Time Exercise Questionnaire, the Morisky Medication Adherence Survey, and the Patient Health Questionnaire.
  
  
  RESULTS
  Overall, 237 (84.0%) completed the pre-CR survey, and 201 (71.3%) completed the final survey. Cardiac patients (n = 104, 68.9%) were significantly more likely to complete CR than VD patients (n = 37, 54.4%; P = .039). Vascular disease patients who enrolled in CR engaged in more physical activity pre-program (P < .05). Cardiac patients who attended CR achieved significant improvements in activity status, exercise behavior, and nutrition at the posttest (P < .01 for each). Among VD patients, there were trends toward lower depressive symptoms and greater exercise in those who participated in CR by posttest.
  
  
  CONCLUSIONS
  This study of integrated chronic disease management provides preliminary support for the benefits of CR for patients with vascular disease.
authors.affiliation: Kinesiology and Health Science, York University, Toronto, Ontario, Canada (Mr Kowal and Dr Grace); and University Health Network, Toronto, Ontario, Canada (Drs Chessex, Lee, and Grace).
authors.forename: Tomasz P
authors.initials: TP
authors.lastname: Kowal
authors.forename: Caroline
authors.initials: C
authors.lastname: Chessex
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Lee
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
mesh_terms: D000368:Aged; D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000523:psychology; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014652:Vascular Diseases / Q000523:psychology / Q000534:rehabilitation*