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Adherence Behavior in the Prevention and Treatment of Cardiovascular Disease

Miller, Nancy Houston RN, BSN

Journal of Cardiopulmonary Rehabilitation and Prevention: March/April 2012 - Volume 32 - Issue 2 - p 63–70
doi: 10.1097/HCR.0b013e318235c729
Scientific Review

Adherence is critical to the overall management of individuals at risk for and with cardiovascular disease. It forms an interplay between the patient, provider, and health care system and includes barriers that have been encountered within all 3 domains. Improving adherence to exercise, diet, and medication as well as focusing on addictive disorders such as smoking cessation requires patient, provider, and health care system approaches. The use of the cognitive/behavioral elements of health behavior change and communication strategies such as motivational interviewing and coaching serve to enhance overall adherence. Continuous quality improvement initiatives at the system level of change also increase the likelihood that teams will succeed in helping individuals change their behavior. Cardiac rehabilitation programs offer a unique opportunity for health care professionals to play a key role in supporting individuals through the health behavior change process.

Adherence to lifestyle changes is vital to prevention and treatment of cardiovascular and other chronic diseases. It is dependent upon a complex interplay between patient, provider, and the health care system. This article reviews the various barriers to adherence and describes techniques for its improvement through clinical practice and cardiac rehabilitation settings.

Stanford Cardiac Rehabilitation Program, Stanford University School of Medicine, Palo Alto, California.

Correspondence: Nancy Houston Miller, RN, BSN, Falk Cardiovascular Research Building, 300 Pasteur Drive, Stanford, CA 94305 (

Ms Miller serves on the Lifestyle Work Group and Integrated Panel of the NHLBI Risk Reduction Guidelines.

© 2012 Lippincott Williams & Wilkins, Inc.