Patients with Diabetes in Cardiac Rehabilitation: Attendance and Exercise Capacity
Abstract
PURPOSE: 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.
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Exercise adherence is low in individuals with prediabetes.
“Physical activity is key in the prevention of T2D and cardiovascular disease in individuals with prediabetes; yet exercise adherence is low in this population [36].”
From High-Intensity Interval Training as an Efficacious Alternative to Moderate-Intensity Continuous Training for Adults with Prediabetes (2015) · cites this paper as [36]
Cites
The Emerging Risk Factors Collaboration (2010) · The Lancet · doi:10.1016/s0140-6736(10)60484-9 · Cited by 5,125 · see citing works
IDF Diabetes Atlas: Global estimates of the prevalence of diabetes for 2011 and 2030
Whiting, D. R., Guariguata, L., Weil, C., & Shaw, J. E. (2011) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2011.10.029 · Cited by 3,994 · see citing works
Kodama, S. (2009) · JAMA · doi:10.1001/jama.2009.681 · Cited by 3,035 · see citing works
Explaining the decrease in U.S. deaths from coronary disease, 1980–2000
Ford, E. S., Ajani, U. A., Croft, J. B., Critchley, J. A., Labarthe, D. R., Kottke, T. E., Giles, W. H., & Capewell, S. (2007) · New England Journal of Medicine · doi:10.1056/nejmsa053935 · Cited by 2,757 · see citing works
Bruce, R. A., Kusumi, F., & Hosmer, D. W. (1973) · American Heart Journal · doi:10.1016/0002-8703(73)90502-4 · Cited by 2,057 · see citing works
Exercise-based cardiac rehabilitation for coronary heart disease
Heran, B. S., Chen, J. M., Ebrahim, S., Moxham, T., Oldridge, N., Rees, K., Thompson, D. R., & Taylor, R. S. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001800.pub2 · Cited by 1,844 · see citing works
Smith, S. C., Benjamin, E. J., Bonow, R. O., Braun, L. T., Creager, M. A., Franklin, B. A., Gibbons, R. J., Grundy, S. M., Hiratzka, L. F., Jones, D. W., et al. (2011) · Circulation · doi:10.1161/cir.0b013e318235eb4d · Cited by 1,759 · see citing works
Prediction of long-term prognosis in 12 169 men referred for cardiac rehabilitation
Kavanagh, T., Mertens, D. J., Hamm, L. F., Beyene, J., Kennedy, J., Corey, P., & Shephard, R. J. (2002) · Circulation · doi:10.1161/01.cir.0000024413.15949.ed · Cited by 648 · see citing works
Balady, G. J., Ades, P. A., Bittner, V. A., Franklin, B. A., Gordon, N. F., Thomas, R. J., Tomaselli, G. F., & Yancy, C. W. (2011) · Circulation · doi:10.1161/cir.0b013e31823b21e2 · Cited by 607 · see citing works
(2010) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3181eeb61c · Cited by 567 · see citing works
Exercise capacity and body composition as predictors of mortality among men with diabetes
Church, T. S., Cheng, Y. J., Earnest, C. P., Barlow, C. E., Gibbons, L. W., Priest, E. L., & Blair, S. N. (2004) · Diabetes Care · doi:10.2337/diacare.27.1.83 · Cited by 469 · see citing works
Church, T. S., LaMonte, M. J., Barlow, C. E., & Blair, S. N. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.18.2114 · Cited by 445 · see citing works
Peak oxygen intake and cardiac mortality in women referred for cardiac rehabilitation
Kavanagh, T., Mertens, D. J., Hamm, L. F., Beyene, J., Kennedy, J., Corey, P., & Shephard, R. J. (2003) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2003.07.028 · Cited by 380 · see citing works
The Importance of Cardiorespiratory Fitness in the United States: The Need for a National Registry
Kaminsky, L. A., Arena, R. A., Beckie, T. M., Brubaker, P. H., Church, T. S., Forman, D. E., Franklin, B. A., Gulati, M., Lavie, C. J., MYERS, J. N., et al. (2013) · Circulation · doi:10.1161/cir.0b013e31827ee100 · Cited by 364 · see citing works
Self-citationExercise is medicine and physicians need to prescribe it!
Sallis, R. E. (2008) · British Journal of Sports Medicine · doi:10.1136/bjsm.2008.054825 · Cited by 338 · see citing works
Cardiac Rehabilitation Attendance and Outcomes in Coronary Artery Disease Patients
Martin, B., Hauer, T., Arena, R. A., Austford, L. D., Galbraith, P. D., Lewin, A. M., Knudtson, M. L., Ghali, W. A., Stone, J. A., & Aggarwal, S. (2012) · Circulation · doi:10.1161/circulationaha.111.066738 · Cited by 306 · see citing works
Self-citationBarriers to participation in cardiac rehabilitation
Dunlay, S. M., Witt, B. J., Allison, T. G., Hayes, S. N., Weston, S. A., Koepsell, E. E., & Roger, V. L. (2009) · American Heart Journal · doi:10.1016/j.ahj.2009.08.010 · Cited by 262 · see citing works
Ghali, W. A., & Knudtson, M. L. (2000) · PubMed · Cited by 247 · see citing works
Conn, V. S., Taylor, S. G., & Abele, P. (1991) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.1991.tb03362.x · Cited by 159 · see citing works
Cardiopulmonary Exercise Testing: Relevant but Underused
Forman, D. E., MYERS, J. N., Lavie, C. J., Guazzi, M., Celli, B. R., & Arena, R. A. (2010) · Postgraduate Medicine · doi:10.3810/pgm.2010.11.2225 · Cited by 121 · see citing works
Self-citationMILANI, R. V., & Lavie, C. J. (1996) · The American Journal of Medicine · doi:10.1016/s0002-9343(96)00020-4 · Cited by 97 · see citing works
Vergès, B. L., Patois‐Vergès, B., Cohen, M., Lucas, B., Galland-Jos, C., & Casillas, J.-M. (2004) · Diabetic Medicine · doi:10.1111/j.1464-5491.2004.01262.x · Cited by 91 · see citing works
Results of cardiac rehabilitation in patients with diabetes mellitus
Banzer, J. A., Maguire, T. E., Kennedy, C. M., O'Malley, C. J., & Balady, G. J. (2004) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2003.09.017 · Cited by 78 · see citing works
Prediction of Maximal Oxygen Consumption During Handrail-Supported Treadmill Exercise
McConnell, T. R., & Clark, B. A. (1987) · Journal of Cardiopulmonary Rehabilitation · doi:10.1097/00008483-198707000-00002 · Cited by 56 · see citing works
Cardiovascular Rehabilitation in Patients With Diabetes
Mourot, L., Boussuges, A., Maunier, S., Chopra, S., Rivière, F., Debussche, X., & Blanc, P. (2010) · Journal of Cardiopulmonary Rehabilitation and Prevention · doi:10.1097/hcr.0b013e3181c565fe · Cited by 49 · see citing works
Clinical profile and outcomes of diabetic and nondiabetic patients in cardiac rehabilitation
Hindman, L., Falko, J. M., Lalonde, M., Snow, R. J., & Caulin‐Glaser, T. (2005) · American Heart Journal · doi:10.1016/j.ahj.2005.04.002 · Cited by 37 · see citing works
Five-Year Prognosis in an Incident Cohort of People Presenting with Acute Myocardial Infarction
Simpson, C. R., Buckley, B. S., McLernon, D. J., Sheikh, A., Murphy, A. W., & Hannaford, P. C. (2011) · PLoS ONE · doi:10.1371/journal.pone.0026573 · Cited by 34 · see citing works
Svačinová, H., Novàkovâ, M., Placheta, Z., Kohzuki, M., Nagasaka, M., Minami, N., Dobšák, P., & Siègelovà, J. (2008) · The Tohoku Journal of Experimental Medicine · doi:10.1620/tjem.215.103 · Cited by 24 · see citing works
The Prevalence of Impaired Glucose Metabolism in Patients Referred to Cardiac Rehabilitation
Ettefagh, L., Maleki, M., Panahi, A., Abdi, M., Oskuie, M. E., Kermanshahi, T. Z., Jamaloo, M., & Bakhshandeh, H. (2013) · Journal of Cardiopulmonary Rehabilitation and Prevention · doi:10.1097/hcr.0b013e31827415b2 · Cited by 8 · see citing works
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Participation and adherence to cardiac rehabilitation programs. A systematic review
Ruano-Ravina, A., Pena-Gil, C., Abu-Assi, E., Raposeiras, S., van 't Hof, A., Meindersma, E., Bossano Prescott, E. I., & González-Juanatey, J. R. (2016) · International Journal of Cardiology · doi:10.1016/j.ijcard.2016.08.120 · Cited by 413 · see citing works
Jung, M. E., Bourne, J. E., Beauchamp, M. R., Robinson, E., & Little, J. P. (2015) · Journal of Diabetes Research · doi:10.1155/2015/191595 · Cited by 165 · see citing works
Karjalainen, J. J., Kiviniemi, A. M., Hautala, A. J., Piira, O.-P., Lepojärvi, E. S., Perkiömäki, J. S., Junttila, M. J., Huikuri, H. V., & Tulppo, M. P. (2015) · Diabetes Care · doi:10.2337/dc14-2216 · Cited by 60 · see citing works
Armstrong, M. J., Sigal, R. J., Arena, R., Hauer, T. L., Austford, L. D., Aggarwal, S., Stone, J. A., & Martin, B.-J. (2015) · Diabetologia · doi:10.1007/s00125-015-3491-1 · Cited by 60 · see citing works
Self-citation
- Authors
- ARMSTRONG, M. J., MARTIN, B.-J., ARENA, R., HAUER, T. L., AUSTFORD, L. D., STONE, J. A., AGGARWAL, S., & SIGAL, R. J.
- Affiliations
- University of Calgary (CA)
- University of Illinois Chicago (US)
- ORCID
- Venue
- Medicine & Science in Sports & Exercise
- Published
- 2014-05
- Volume
- 46
- Issue
- 5
- Pages
- 845-850
- ISSN
- 0195-9131 (ISSN-L)
- OpenAlex
- W1996869133
- Cited by
- 41
- References
- 29
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 11 · 2021: 4 · 2020: 3 · 2019: 4 · 2018: 2 · 2017: 2 · 2016: 2 · 2015: 5 · 2014: 1
- FWCI
- 1.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medicine & Science in Sports & Exercise (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- diabetes mellitus, cardiac rehabilitation, cardiorespiratory fitness, exercise adherence, sex differences, myocardial infarction, follow-up attendance, metabolic equivalents, exercise testing
- MeSH terms
- Cardiovascular Physiological Phenomena, Energy Metabolism, Exercise Test, Exercise Therapy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction, Patient Compliance, Physical Fitness, Respiration, Retrospective Studies, Sex Factors, Exercise Tolerance, Diabetes Complications
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