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Effect of Case Management With Goal-Setting on Diet Scores and Weight Loss in Cardiac Rehabilitation Patients

Aspry, Karen, MD, MS; Dunsiger, Shira, PhD; Breault, Christopher, BS; Stabile, Loren, MS; DeAngelis, Julianne, MS; Wu, Wen-Chih, MD, MPH

Journal of Cardiopulmonary Rehabilitation and Prevention: November 2018 - Volume 38 - Issue 6 - p 380–387
doi: 10.1097/HCR.0000000000000348
Cardiac Rehabilitation

Purpose: The impact of cognitive-behavioral strategies and clinical factors on diet change during cardiac rehabilitation (CR) is not well studied. The purpose of this study was to examine the effects of collaborative goal-setting and clinical predictors on diet scores and weight loss in a case management model of CR.

Methods: We retrospectively examined the effects of clinical factors and goal-setting facilitated by case managers on diet scores and weight loss in 629 consecutive patients with atherosclerotic cardiovascular disease enrolled in our CR program between 2014 and 2016. The Rate Your Plate (RYP) diet score was used to measure diet quality at baseline and discharge. Logistic regression modeling was used to identify predictors of diet score change in a subsample with goal-setting data (n = 615). Analysis of variance was conducted in the subset with complete weight data (n = 584) to compare weight loss between those who improved their RYP scores versus those who did not.

Results: Participants were 27.9% female, with a mean age of 63.4 ± 11.5 y. The average body mass index at baseline was 30.3 ± 6.8, and 51.7% reported diet change and/or weight loss as a goal. After an average of 33 CR sessions, 27.3% improved their RYP scores by at least 1 risk category (mean score, 54.0 ± 9.0 vs 58.2 ± 7.3, P < .001) and the average weight loss was 1.5 ± 2.9 kg (P < .001). After logistic regression modeling, dietary goal-setting was significantly associated with improvement in diet scores and with greater weight loss (2.2 ± 3.1 kg vs 0.84 ± 2.6 kg, P < .001).

Conclusions: A case management model that incorporates dietary goal-setting is associated with improved measures of diet quality and weight loss during CR.

Diet counseling is a core component of cardiac rehabilitation (CR) programs. However, little is known regarding the impact of behavioral strategies on diet change during CR. This study showed that the use of dietary goal-setting in a case management model of CR significantly improved diet scores and weight loss.

Center for Cardiac Fitness, Cardiovascular Institute, Miriam Hospital, Brown University Alpert Medical School, Providence, Rhode Island (Drs Aspry and Wu and Mss Stabile and DeAngelis); Centers for Behavioral and Preventive Medicine, Providence, Rhode Island (Dr Dunsiger and Mr Breault); and Division of Cardiology, Providence VA Medical Center, Rhode Island (Dr Wu).

Correspondence: Karen Aspry, MD, MS, Lifespan Cardiovascular Institute, 1454 South County Trail, East Greenwich, RI 02818 (

All authors have read and approved the article.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

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