title: [Adherence to Phase III Cardiac Rehabilitation Programs: A Prospective, Randomized Comparison between a Conventionally Conducted Program and a Tai Chi-Based Program].
abstract: BACKGROUND
  In patients with cardiac diseases, lifestyle changes such as an increase in physical activity are recommended to prevent further cardiac events. In Germany this is possible by attending outpatient heart groups. A problem inherent in these programs is the lack of adherence since more than two thirds of patients stop attending cardiac rehabilitation programs after six months. An alternative to the conventional implementation of heart groups is Tai Chi, which was found to improve adherence to cardiac rehabilitation programs in international studies.
  
  
  METHODS
  Patients were randomly assigned to a conventional heart group or a heart group with Tai Chi exercises. At the beginning of the study, a medical history was taken and physical and instrumental tests were carried out, including an assessment of anxiety/depression (HADS questionnaire) and physical well-being (SD-12). Follow-up tests were performed every three months.
  
  
  RESULTS
  Patients were 62.6 ± 8.5 years old, the mean BMI was 28.6 ± 62 kg/m(2), and the proportion of women was 29.8 %. The groups were different in terms of age (conventional heart group: 65.0 ± 7.5; Tai Chi group: 59.9 ± 8.9 years). Therefore, age-adjusted analyses were performed in addition to the planned analyses. Regarding the primary endpoint of the study, there was no difference between the groups. After twelve months, 50 % of subjects were active in the Tai Chi group and 48 % in the conventional heart group (odds ratio 0.92, p = 0.891). After adjustment for age by logistic regression, the odds ratio was 0.47 (p = 0.285). Furthermore, both the participation period in weeks (Tai Chi group: 43.3 ± 26.0; conventional group: 45.5 ± 24.2, p = 0.766) and the participation rate (Tai Chi group: 66.8 ± 19.2 % Tai Chi, conventional group: 76.3 ± 16.5 %, p = 0.074) did not differ between the two groups. A further analysis showed a non-significant trend for improvement of anxiety, depression and physical well-being in the Tai Chi group compared with the conventional group.
  
  
  CONCLUSIONS
  The insight gained in international studies regarding a better adherence to Tai Chi-guided prevention programs was not transferable to heart group participants from Germany. However, there was a trend regarding a better mental condition in the Tai Chi group.
authors.affiliation: Paracelsus-Harz-Klinik Bad Suderode, Quedlinburg.
authors.forename: G
authors.initials: G
authors.lastname: Wieczorrek
authors.affiliation: Institut für Rehabilitationspädagogik, Philosophische Fakultät III, Erziehungswissenschaften, Martin-Luther-Universität Halle-Wittenberg.
authors.forename: U
authors.initials: U
authors.lastname: Weber
authors.affiliation: Institut für Medizinische Epidemiologie, Biometrie und Informatik, Universitätsklinikum Halle (Saale).
authors.forename: A
authors.initials: A
authors.lastname: Wienke
authors.affiliation: Dao Zentrum, Quedlinburg.
authors.forename: E
authors.initials: E
authors.lastname: Egner
authors.affiliation: Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale).
authors.forename: J
authors.initials: J
authors.lastname: Schröder
authors.affiliation: Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale).
authors.forename: A
authors.initials: A
authors.lastname: Vogt
authors.affiliation: Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale).
authors.forename: U
authors.initials: U
authors.lastname: Müller-Werdan
authors.affiliation: Institut für Gesundheits- und Pflegewissenschaft, Martin-Luther-Universität Halle-Wittenberg.
authors.forename: A
authors.initials: A
authors.lastname: Weber
authors.affiliation: Koordinierungszentrum für Klinische Studien, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg.
authors.forename: J
authors.initials: J
authors.lastname: Steighardt
authors.affiliation: Paracelsus-Harz-Klinik Bad Suderode, Quedlinburg.
authors.forename: C
authors.initials: C
authors.lastname: Girschick
authors.affiliation: Paracelsus-Harz-Klinik Bad Suderode, Quedlinburg.
authors.forename: A
authors.initials: A
authors.lastname: Schlitt
mesh_terms: D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D000072038:Cardiac Rehabilitation / Q000379:methods*; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D026302:Tai Ji / Q000379:methods*; D016896:Treatment Outcome