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J Cardiopulm Rehabil Prev. 2018 Sep;38(5):286-290. doi: 10.1097/HCR.0000000000000288.

Effect of Smoking Status on Exercise Perception and Intentions for Cardiac Rehabilitation Enrollment Among Patients Hospitalized With an Acute Cardiac Condition.

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Division of Cardiovascular Medicine (Dr Pack), Center for Quality of Care Research (Drs Goff, Lindenauer, and Pack), and Department of Internal Medicine (Dr Lindenauer), Baystate Medical Center, Springfield, Massachusetts; Departments of Exercise Science and Sports Studies (Ms Riley and Drs Headley and Mazur) and Psychology (Dr Winter), Springfield College, Springfield, Massachusetts; The Center for Cardiac Fitness, The Miriam Hospital, Providence, Rhode Island (Ms Riley); Department of Psychiatry, University of Vermont, Burlington (Dr Gaalema); and Tufts University School of Medicine, Boston, Massachusetts (Dr Pack).



Cardiac rehabilitation (CR) attendance has been associated with higher smoking cessation (SC) rates. However, for unclear reasons, smokers are consistently less likely to enroll in CR than nonsmokers, and it is uncertain what might encourage them to attend.


We surveyed patients eligible for CR who were cigarette smokers at the time of hospital admission. We assessed patient intention to quit smoking, start exercising, and enroll in CR. We also measured anxiety and depression levels.


Of the 105 patients approached, 81 (77%) completed the survey (69% males, aged 57 ± 10 y, 72% white). Most patients reported interest in SC (80%) and attending CR (78%). Many felt that SC medications (41%), stress management programs (35%), and an exercise program with SC counseling (30%) would increase their likelihood to attend CR; however, 30% stated that they would be less likely to enroll in CR if they continued smoking following discharge. Many patients indicated high levels of anxiety (51%) and depression (27%); many desired to reduce stress following discharge (73%), with 35% stating that stress management programs would increase their likelihood to attend CR.


Hospitalized smokers eligible for CR report significant interest in SC, attending CR, and beginning an exercise program. These patients show high levels of anxiety and depression and indicate a strong interest in stress management programs. These results suggest that messages emphasizing the role of CR in the treatment of depression, anxiety, and stress are likely to resonate with smokers, increase their enrollment in CR, and support long-term SC.

[Available on 2019-09-01]

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