Harm Reduction In Male Patients Actively Using Anabolic Androgenic Steroids AAS And Performance-Enhancing Drugs PEDs: A Review

Summary

Title: Factors influencing adherence to home‑based cardiac rehabilitation – A systematic review and meta‑analysis

Journal: International Journal of Cardiology: Heart & Vasculature

Published: 2023 (Vol 22, pp 100–107)

---

Background

Home‑based cardiac rehabilitation (HBCR) is increasingly used to overcome barriers associated with center‑based programs.

Adherence is critical for achieving the proven benefits of cardiac rehab, yet rates remain suboptimal and the determinants of adherence are not fully understood.

Objectives

Quantify overall adherence rates to HBCR.

Identify and synthesize factors (patient-, program‑, system‑related) that predict higher or lower adherence.

Methods

Systematic review according to PRISMA guidelines.

Search of MEDLINE, EMBASE, CINAHL, PsycINFO (Jan 1990–Dec 2023).

Inclusion: Prospective cohort or randomized studies reporting adherence to HBCR; English language.

Data extraction: study design, population, intervention characteristics, adherence definition, predictors examined, effect estimates.

Quality assessment: Newcastle‑Ottawa Scale for observational studies; Cochrane Risk of Bias 2 for RCTs.

Results

Studies included: 28 (16 cohort, 12 RCTs); total N = 6,842 participants.

Adherence definitions: 15%–70%; most defined as proportion of prescribed sessions completed.

Key predictors:

- Age: Older adults (>65) more likely to adhere (OR 1.27; 95% CI 1.12‑1.44).

- Gender: Women had higher adherence (OR 1.18; 95% CI 1.04‑1.34).

- Baseline physical activity level: Active individuals adhered better (OR 1.35; 95% CI 1.20‑1.52).

- Social support: Presence of a workout partner increased adherence (OR 1.42; 95% CI 1.26‑1.60).

- Perceived competence: Higher self-efficacy associated with better adherence (β = .24, p < .001).

Conclusion:

The data indicate that while demographic factors such as age and gender show minimal impact on adherence to a structured exercise program, psychosocial variables—especially baseline activity level, social support, and perceived competence—play a pivotal role. Future interventions should prioritize enhancing self-efficacy and fostering supportive environments to improve long-term adherence.

---

4. Key Takeaways (Bullet-Point Summary)

Adherence Rates:

- ~70% of participants completed ≥75 % of prescribed sessions.

- Drop‑out mainly due to scheduling conflicts or lack of motivation.

Demographic Influences:

- No significant differences across age groups or gender.

- Baseline activity level (moderate vs. low) predicted adherence.

Key Predictors of Success:

- Higher self‑efficacy scores → better compliance.

- Strong social support (family, www.armenianmatch.com friends) → fewer missed sessions.

Clinical Implications:

- Tailor interventions to enhance motivation and flexibility.

- Integrate motivational interviewing or digital reminders for high‑risk groups.

---

Take‑Home Message

When designing or evaluating a health‑related behavioral intervention, focus on:

Defining clear success metrics (e.g., adherence rate).

Collecting data at multiple time points to assess progress and sustainability.

Using statistical tools to detect significant changes over time.

This structured approach provides evidence for whether the program is truly effective, guiding future improvements and resource allocation.