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Purpose: Exercise-based rehabilitation programs have been associated with decreased morbidity and mortality after myocardial infarction. Unfortunately, attendance is often poor, and information is limited regarding predictors of long-term compliance to such programs. This study examined factors associated with exercise session compliance over 3 yr in male myocardial infarction (MI) survivors., Methods: Subjects were participants in the National Exercise and Heart Disease Project, a 3-yr (1976-1979) multicenter, randomized clinical trial (N = 651); 308 men, 30-64 yr of age, were randomized to the exercise treatment group, that met three times/week throughout the study. Compliance was defined as the number of sessions attended/number of sessions conducted. Patient characteristics at enrollment were considered as possible predictors of compliance., Results: Compliance decreased as time since enrollment increased with the largest decrease observed after the first 8 wk. Compliance correlated positively with exercise test measures [last completed stage (r = 0.17, P < 0.01), peak heart rate (r = 0.11, P = 0.06)], high density lipoprotein (HDL) cholesterol (r = 0.15, P = 0.10), age (r = 0.11, P = 0.07), and inversely with body mass index (r = -0.19, P = 0.001), sum of three skinfolds (r = -0.15, P < 0.01), total cholesterol (r = -0.18, P < 0.01), triglycerides (r = -0.16, P < 0.01), and depression (r = -0.09, P < 0.11). Current smokers were less compliant than former and nonsmokers (r = -0.21, P < 0.001). The correlations with last completed stage, BMI, skinfolds, total cholesterol, and smoking status were statistically significant. The model explained 22.2% of the variance in compliance (r2 = 0.222). Baseline work capacity was among the most consistent predictors of early and late compliance., Conclusion: Compliance decreased over time. Men already at high risk for repeat events due to elevated risk factors were less compliant. These findings have important clinical implications regarding screening, intervention, and participation in potential cardiac rehabilitation program dropouts.

This study examined the association between peak exercise systolic blood pressure and other exercise test parameters and the long-term (19-year) survival of 625 patients with myocardial infarction who were original participants of the National Exercise and Heart Disease Project, a 3-year (1976 to 1979) multicenter randomized exercise clinical trial. Results show that low peak exercise systolic blood pressure (< or =140 mm Hg) was associated with increased mortality throughout the 19 years of follow-up, and men with this finding obtained no survival benefit from participating in an exercise program.

Background: This study examined whether a supervised exercise program improved 19-year survival in 30- to 64-year-old male myocardial infarction patients., Methods and Results: The men (n=651) were participants in the National Exercise and Heart Disease Project, a 3-year multicenter randomized clinical trial conducted in the United States (1976-1979). The treatment group (n=315) exercised for 8 weeks in a laboratory. Thereafter, they jogged, cycled, or swam in a gymnasium/pool setting guided by an individualized target heart rate. Participants in the control group (n=319) were to maintain normal routines but not participate in any regular exercise program. Participants were followed up until their death or December 31, 1995. Cox proportional hazards analysis revealed the all-cause mortality risk estimates (95% CIs) in the exercise group compared with controls to be 0.69 (0.39 to 1.25) after an average follow-up of 3 years, 0.84 (0.55 to 1.28) after 5 years, 0.95 (0.71 to 1.29) after 10 years, 1.02 (0.79 to 1.32) after 15 years, and 1.09 (0.87 to 1. 36) after 19 years. Cardiovascular disease (CVD) mortality risk estimates (95% CI) for the same follow-up periods were 0.73 (0.37 to 1.43), 0.98 (0.60 to 1.61), 1.21 (0.79 to 1.60), 1.14 (0.84 to 1.54), and 1.16 (0.88 to 1.52). However, each 1-MET increase in work capacity from baseline to the end of the original trial resulted in consistent reductions in all-cause and CVD mortality risk at each follow-up period, regardless of initial work-capacity level., Conclusions: These findings indicate exercise-program participation resulted in nonsignificantly reduced mortality risks early in the follow-up period. Benefits diminished as time since participation increased, which suggests that the protective mechanisms associated with the program may be short term. Contamination between groups over time could also explain the diminished effects, because increased work capacity provided survival benefits up to 19 years.