Attendance analysis in a phase 3 cardiovascular rehabilitation program: can behaviour regulation in exercise predict long-term attendance?
Authors: Borges M , Lemos Pires M , Sa G , Pinto R , Pinto F , Abreu A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
After a phase II cardiovascular rehabilitation (CR) program, cardiovascular disease (CVD) patients ideally continue to a phase III long-term CR program. Enrolment, attendance rates and barriers are well established for phase II or short-term CR programs (≤ 12 weeks). However, keeping CVD patients motivated and with high attendance rates (≥ 80%) in a long-term CR program (over 6 months) is more challenging. Self-Determination Theory states that more internalized types of behaviour regulation lead to feelings of self-determination and a higher behavioural adherence. Therefore, more studies analysing attendance rates and behaviour regulation of CVD patients in long-term CR programs are needed.

Purpose
To compare the attendance of CVD patients enrolled in a long-term CR community-based program between 3, 6 and 12 months and to assess if behavioural regulation in exercise questionnaire (BREQ-2) can predict long term attendance.

Methods
Patients with CVD attending for, at least, 6 months a phase III community-based CR program were selected. Enrolled patients chose to attend 60 minutes exercise CR sessions either 3 or 2 times/week. Attendance rates were calculated at 3 months, 6 months and 12 months of program completion dividing the number of sessions attended by the number of sessions planned. When admitted to the program, each patient was asked to answer BREQ-2 (19 items, 5-point lickert-type scale, 5 groups: amotivated, external, introjected, identified and intrinsic). One way ANOVA for repeated measures, paired sample t test and pearson correlations were used.

Results
One hundred and eighteen CVD patients (61 ± 9 years; 78.8% male; 85% with coronary artery disease) completed at least 6 months of CR exercise sessions. Attendance rates decreased significantly from 3 months to 6 months (73.38 ± 18.09% vs 68.14 ± 17.15%, p-value&lt;0.001) with higher scores in intrinsic motivation being correlated with higher rates of attendance (r= 0.330; p&lt;0.001) and higher scores in external motivation being correlated with lower rates of attendance (r= -0.182; p=0.048) at 6 months. Amotivated, introjected and identified motivation showed no significant correlation. A sub analysis with 92 CVD patients (62 ± 9 years, 78.3% male, 87% with coronary artery disease) that completed 12 months of CR exercise sessions was made and a significant decrease in attendance was found between 3, 6 and 12 months (75.5 ± 17.05%, 70.7 ± 15.93% and 66.8 ± 18.34%; p-value&lt;0.001).

Conclusion
Our results show that attendance rates to exercise CR sessions tend to decrease over the first year of the CR program and that external motivation at baseline is correlated with lower rates of attendance contrary to intrinsic motivation. These findings suggest that BREQ-2 questionnaire might be a good predictor of long-term attendance and help identify CVD patients that could benefit from additional motivational strategies to keep higher attendance rates.