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Background: Additional support services are required to identify and manage poor psychological health symptoms in one in five patients who attend cardiac rehabilitation programs. Meditation has been identified as a low-cost accessible adjunct to conventional therapies and has demonstrated a potential benefit to reducing cardiovascular risk. Aim: This protocol reports on the design and methods of a study that aims to determine the feasibility, acceptability and preliminary efficacy of integrating a meditation intervention into an existing cardiac rehabilitation program for the reduction of depression and anxiety symptoms in people with cardiovascular disease. Methods: This is a mixed methods phase II randomised controlled feasibility pilot study. Sixty patients will be randomised to meditation (1 session weekly for six weeks) and usual cardiac rehabilitation (6 week/12 session outpatient cardiac rehabilitation) or to usual cardiac rehabilitation. Measurements will be conducted at baseline, 6 weeks and 3 months. Preliminary outcomes include feasibility and acceptability of meditation (recruitment, screening, randomisation and attrition rates), and depression, anxiety, stress, salivary cortisol, blood pressure and heart rate outcomes. Participants will be invited to attend a semistructured interview at 6 weeks to explore their experiences of participating in meditation. Health professionals will also be interviewed to ascertain their perspectives of integrating meditation into cardiovascular secondary prevention programs. Discussion: This study will provide preliminary understanding of the feasibility acceptability and preliminary efficacy of meditation as an adjunct therapy for people who may require additional psychological health support. These results may also highlight signals of improvement in psychological health symptoms and inform the development of a future phase III randomised controlled trial.

Background: Cardiac rehabilitation (CR) programs reduce the risk of further cardiac events and improve the ability of people living with cardiovascular disease to manage their symptoms. However, many people who experience a cardiac event do not attend or fail to complete their CR program. Little is known about the characteristics of people who drop out compared to those who complete CR. Aims: To identify subgroups of patients attending a cardiac rehabilitation program who are more likely to dropout prior to final assessment by (1) calculating the dropout rate from the program, (2) quantifying the association between dropout and socio-demographic, lifestyle, and cardiovascular risk factors, and (3) identifying independent predictors of dropout. Methods: The study population is from a large metropolitan teaching hospital in Sydney, Australia, and consists of all participants consecutively enrolled in an outpatient CR program between 2006 and 2017. Items assessed included diagnoses and co-morbidities, quality of life (SF-36), psychological health (DASS-21), lifestyle factors and physical assessment. Dropout was defined as failure to complete the outpatient CR program and post CR assessment. Results: Of the 3,350 patients enrolled in the CR program, 784 (23.4%; 95%CI: 22.0–24.9%) dropped out prior to completion. The independent predictors of dropout were smoking (OR 2.4; 95%CI: 1.9–3.0), being separated or divorced (OR 2.0; 95%CI: 1.5–2.6), younger age (<55 years) (OR 1.9; 95%CI: 1.6–2.4), obesity (OR 1.6; 95%CI: 1.3–2.0), diabetes (OR 1.6; 95%CI: 1.3–2.0), sedentary lifestyle (OR 1.3; 95%CI: 1.1–1.6) and depressive symptoms (OR 1.3; 95%CI: 1.1–1.6). Conclusion: To improve the CR program completion rate, clinicians need to consider the impact of socio-demographic, lifestyle, and cardiovascular risk factors on their patients’ ability to complete CR. Tailored strategies which target the independent predictors of dropout are required to promote adherenc

International guidelines recommend exercise-based cardiac rehabilitation (EBCR) to promote secondary prevention and support recovery following cardiovascular disease (CVD) events [1]. Although the effectiveness of EBCR has been questioned due to poor delivery and participation [2], the efficacy of EBCR for reducing mortality and morbidity has not been challenged given the Class 1A evidence available [3]. However, in January 2018, BMJ Open published a well-performed and well-reported systematic review that questions the efficacy of EBCR for reducing mortality in the contemporary era [4]. Powell et al.’s work is important because shortcomings of previous reviews may have led to overestimates of the benefits of EBCR for current practice given improvements in intervention delivery and the evolving management of CVD and its associated risk factors. The results reported in Powell et al.’s systematic review challenge cardiac health professionals to consider the value of EBCR for CVD patients, however, we encourage readers to consider several important caveats when reflecting on the results and conclusions of the review...

Fifty patients with myocardial infarction were recruited from a hospital based Cardiac Education and Assessment Program (CEAP) in Sydney, Australia. The Exercise Motivation Inventory-2 (EMI-2) and the Depression, Anxiety and Stress Scale (DASS) were administered prior to commencement in the program and re-administered by telephone interview at 5-month followup. Four exercise adherence measures were completed: attendance, exercise stress test, self-report ratings and a 7-day activity recall interview. There was a 46% adherence rate for MI patients during the hospital based CEAP. Of those individuals who completed CEAP, 91% obtained functional improvement on the exercise stress test. For the 38 patients who were followed-up by telephone interview at 5 months, 71% were exercising according to CEAP prescription. Higher levels of anxiety were associated with lower levels of self-reported exercise adherence. The 3 strongest motivations for exercise in this group of MI patients were all health related; wanting to be free from illness, maintaining good health and recovering from the effects of coronary heart disease. The discussion highlights the implications of these findings for cardiac rehabilitation programs and the need for empirically driven guidelines for measuring exercise adherence.

Fifty patients with myocardial infarction were recruited from a hospital based Cardiac Education and Assessment Program (CEAP) in Sydney, Australia. The Exercise Motivation Inventory-2 (EMI-2) and the Depression, Anxiety and Stress Scale (DASS) were administered prior to commencement in the program and re-administered by telephone interview at 5-month followup. Four exercise adherence measures were completed: attendance, exercise stress test, self-report ratings and a 7-day activity recall interview. There was a 46% adherence rate for MI patients during the hospital based CEAP. Of those individuals who completed CEAP, 91% obtained functional improvement on the exercise stress test. For the 38 patients who were followed-up by telephone interview at 5 months, 71% were exercising according to CEAP prescription. Higher levels of anxiety were associated with lower levels of self-reported exercise adherence. The 3 strongest motivations for exercise in this group of MI patients were all health related; wanting to be free from illness, maintaining good health and recovering from the effects of coronary heart disease. The discussion highlights the implications of these findings for cardiac rehabilitation programs and the need for empirically driven guidelines for measuring exercise adherence.

Fifty patients with myocardial infarction were recruited from a hospital based Cardiac Education and Assessment Program (CEAP) in Sydney, Australia. The Exercise Motivation Inventory-2 (EMI-2) and the Depression, Anxiety and Stress Scale (DASS) were administered prior to commencement in the program and re-administered by telephone interview at 5-month followup. Four exercise adherence measures were completed: attendance, exercise stress test, self-report ratings and a 7-day activity recall interview. There was a 46% adherence rate for MI patients during the hospital based CEAP. Of those individuals who completed CEAP, 91% obtained functional improvement on the exercise stress test. For the 38 patients who were followed-up by telephone interview at 5 months, 71% were exercising according to CEAP prescription. Higher levels of anxiety were associated with lower levels of self-reported exercise adherence. The 3 strongest motivations for exercise in this group of MI patients were all health related; wanting to be free from illness, maintaining good health and recovering from the effects of coronary heart disease. The discussion highlights the implications of these findings for cardiac rehabilitation programs and the need for empirically driven guidelines for measuring exercise adherence.