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Barriers to Cardiac Rehabilitation: DOES AGE MAKE A DIFFERENCE?

Grace, Sherry L. PhD; Shanmugasegaram, Shamila BSc; Gravely-Witte, Shannon MSc; Brual, Janette MSc; Suskin, Neville MBChB; Stewart, Donna E. MD

Journal of Cardiopulmonary Rehabilitation and Prevention: May-June 2009 - Volume 29 - Issue 3 - p 183–187
doi: 10.1097/HCR.0b013e3181a3333c
Brief Report

PURPOSE To quantitatively investigate age differences in barriers to cardiac rehabilitation (CR) enrollment and participation.

METHODS Cardiac outpatients (N = 1,273, mean age = 65.9 ± 11.2) completed a mailed survey to discern barriers to CR enrollment and participation. Both enrollees and nonenrollees were asked to rate 18 CR barriers on a 5-point Likert scale.

RESULTS Of the respondents, 535 (43%) reported participating in CR at 1 of 40 sites, with younger patients being more likely to participate (P = .002). Older age was positively related to total CR barriers (P < .001). Older patients more strongly endorsed the following CR barriers: already exercising at home (P = .001), confidence in ability to self-manage their condition (P = .003), perception of exercise as tiring or painful (P = .001), not knowing about CR (P = .001), lack of physician encouragement (P < .001), comorbidities (P < .001), and perception that CR would not improve their health (P < .001).

CONCLUSION Given that the benefits of CR are achieved in older patients as well as the young, interventions to overcome these modifiable barriers to enrollment and participation are needed.

Compared with younger patients, older patients more strongly identified several barriers to cardiac rehabilitation (CR) participation including already exercising at home, confidence in ability to self-manage condition, perception of exercise as tiring or painful, not knowing about CR, lack of physician encouragement, comorbidities, and perception that CR is ineffective.

York University, Toronto (Dr Grace and Mss Shanmugasegaram and Gravely-Witte); Queens University, Kingston (Ms Brual); University Health Network, Toronto, and University of Toronto, Toronto (Drs Grace and Stewart); London Health Sciences Center and University of Western Ontario, London (Dr Suskin), Ontario, Canada.

Corresponding Author: Sherry L. Grace, PhD, Bethune 368, York University, 4700 Keele St, Toronto, Ontario, Canada M3J 1P3 (

© 2009 Lippincott Williams & Wilkins, Inc.