title: Impact of Obesity and Other Chronic Conditions on Lifestyle Exercise During the Year After Completion of Cardiac Rehabilitation.
abstract: OBJECTIVE
  Patients who attend cardiac rehabilitation programs have a high prevalence of multiple chronic conditions (MCCs). The extent to which different constellations of MCC influence lifestyle exercise in the year after completion of an outpatient phase 2 cardiac rehabilitation program (CRP) is unknown. Our objective was to examine the effects of MCC on lifestyle exercise in the year after completion of a CRP.
  
  
  METHODS
  The effects of different constellations of comorbidities on objectively measured lifestyle exercise were examined using data from a randomized controlled trial testing lifestyle behavior change interventions in patients with cardiac events (n = 379) who completed a phase 2 CRP. Adjusting for important covariates, the relationships between the primary outcome, exercise amount, and the presence of common chronic conditions (hypertension, obesity, diabetes, and arthritis) were studied using robust linear mixed-effects models.
  
  
  RESULTS
  Diabetes, hypertension, obesity, and their dyads, triads, and quads have a negative impact on amount of exercise. For example, the cooccurrences of obesity and hypertension reduced lifestyle exercise by 2.83 hours per month (95% CI, 1.33-4.33) after adjustment for the effects of covariates. The presence of obesity was a major factor in the comorbid constellations affecting lifestyle exercise.
  
  
  CONCLUSIONS
  The presence of obesity and other chronic conditions negatively impacts lifestyle exercise in the year after a CRP. The magnitude of the effect depends on the comorbidities. Different constellations of comorbid conditions can be used to identify those persons at greatest risk for not exercising after cardiac rehabilitation.
authors.affiliation: School of Medicine, Case Western Reserve University, Cleveland, Ohio (Drs Sattar and Josephson); and Harrington Heart & Vascular Institute, University Hospitals Health System, Cleveland, Ohio (Dr Josephson); Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Abdus
authors.initials: A
authors.lastname: Sattar
authors.forename: Richard
authors.initials: R
authors.lastname: Josephson
authors.forename: Shirley M
authors.initials: SM
authors.lastname: Moore
mesh_terms: D000368:Aged; D000072038:Cardiac Rehabilitation; D002908:Chronic Disease; D048909:Diabetes Complications; D015444:Exercise; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008019:Life Style; D008297:Male; D009765:Obesity / Q000150:complications*; D012307:Risk Factors; D016896:Treatment Outcome