Improving patient compliance in cardiac exercise rehabilitation: Effects of written agreement and self-monitoring

Self-management techniques improve compliance with health programs although their efficacy in exercise rehabilitation programs for patients with coronary heart disease (CHD) is not known. Men with CHD (N = 120) were referred to a six-month exercise program in which they were stratified and randomly allocated to either a control group (N = 57) or an experimental group (N = 63). Control group patients received standard treatment; experimental group patients were asked to sign an agreement to comply for six months and to record in diaries the following information: (1) self-monitored heart rate response to sub-maximal exercise tests, (2) daily physical activity levels, and (3) weight changes and smoking habits. Compliance in the control group was 42% and in the experimental group 54% (NS). However, the 65% compliance rate in the 48 experimental group subjects who had signed the compliance agreement was significantly higher than the 20% compliance rate in the 15 experimental group subjects who had not signed the agreement (P < .005) and was higher than the 42% compliance rate in the control group (P < .01). Self-monitored heart rate response was the item most frequently recorded in diaries. Dropout rates were significantly higher (P < .01) in smokers, in blue collar workers, and in those with inactive leisure habits; younger age was also associated with dropout. The higher compliance rates in those who signed the agreement to comply reinforces the need for further investigation of self-management compliance-improving strategies. © 1983 The American Burn Association.