Objectives: Cardiac rehabilitation programs (CRPs) offer patients access to a variety of services. Nutritional counseling is one facet of cardiac rehabilitation. The amount of counseling a patient receives as part of a formal structure, however, can vary across different CRP options. Our objective was to compare the impact of different CRP tracking options on changes in dietary behaviors from pre- to post-program participation in male and female cardiac patients.
Methods: Participants were 2,695 cardiac patients (73% male; M age = 61) entering 1 of 3 formal 12-week exercise-based CRP options: supervised on-site program (OS), case-managed home program (CS), or unsupervised tailored home program (HP) at the University of Ottawa Heart Institute. Participants completed a questionnaire that included questions regarding dietary habits and demographic variables at baseline and at a 3-month follow-up.
Results: Participants in OS were younger (OS: 73% male; M age = 62; CS: 72% male; M age = 61; HP: 82% male; M age = 60) and reported eating less fat (P = .01) and more fruits and vegetables (P = .05) at baseline than the other 2 groups. Mixed linear modeling revealed meaningful improvements in dietary habits in all 3 CRP groups over the course of the 12-week CRP phase, although participants in the OS seemed to have derived the most benefit. Fat intake was significantly reduced for all 3 groups. Salt intake was reduced for OS and CM, but not for HP. Increases in fish intake were observed for all 3 groups, while the intake of soy/bean products and of fruits and vegetables increased only for OS and CM; similarly, a reduction in the intake of red meat was observed only for OS and CM. Improvements in the frequency of regular meals (ie, 3 complete meals per day) were again observed only in the OS and CM groups.
Conclusions: While all CRP participants have equal access to different program components, it may be that those who are formerly supervised during the rehabilitation phase are more likely to attend nutritional workshops and individual counseling. Our results indicate that group and/or individualized dietary counseling by a registered dietitian or a trained mentor leads to better adherence to dietary recommendations. Future research, ideally in the form of an RCT, should examine the impacts of CRP programs on long-term adherence to dietary recommendations and dietary behavior regulation, and evaluate the relationship between behavioral changes and physiological and clinical endpoints.