Cardiac rehabilitation exercise programme. Compliance and compliance-enhancing strategies.

Compliance-enhancing strategies in cardiac rehabilitation should be investigated only if it has been shown that the condition under consideration is an important cause of mortality and premature disability, that the intervention or therapy is effective, and that compliance with the intervention is poor. Coronary artery disease is the leading cause of death and premature disability in industrialized countries. Evidence from randomised controlled trials of supervised exercise rehabilitation after documentation of coronary artery disease suggests a reduction in fatal event rates, and an initial improvement in both exercise tolerance and psychosocial status, although these differences between experimental and control subjects are reduced over time. Poor compliance with supervised exercise programmes is a problem. This suggests that compliance enhancement with programmes of exercise rehabilitation for cardiac patients is an appropriate area of research. A number of issues recur in compliance research including the investigation of compliance-enhancing strategies in exercise rehabilitation. These relate to the specification of definition of compliance, the description of the experimental protocol or strategy, the selection and description of the sample to be studied, the randomisation of the sample, the selection of compliance measures, contamination and co-intervention, monitoring for decay, and various ethical issues. Compliance-enhancing strategies must be designed with these methodological issues in mind. These issues are discussed with specific reference to randomised controlled trials of compliance-enhancing strategies to cardiac exercise rehabilitation.