Article Text

Download PDFPDF
Long term adherence to dietary recommendations after inpatient rehabilitation: prospective follow up study of patients with coronary heart disease
  1. D Twardella1,
  2. H Merx1,
  3. H Hahmann2,
  4. B Wüsten3,
  5. D Rothenbacher1,
  6. H Brenner1
  1. 1Department of Epidemiology, The German Centre for Research on Aging, Heidelberg, Germany
  2. 2Klinik Schwabenland, Isny-Neutrauchburg, Germany
  3. 3Klinik am Südpark, Bad Nauheim, Germany
  1. Correspondence to:
    Dr Hermann Brenner
    Department of Epidemiology, The German Centre for Research on Aging, Bergheimer Strasse 20, D-69115 Heidelberg, Germany; brenner{at}


Objective: To evaluate the adherence to nutritional recommendations in inpatient rehabilitation and the long term maintenance of dietary changes among patients with coronary heart disease.

Design: Prospective cohort study.

Setting: Two rehabilitation clinics in Germany.

Participants: A cohort of 1206 patients undergoing inpatient rehabilitation after an acute manifestation of coronary heart disease.

Main outcome measures: Self reported dietary intake before, during, and one and three years after rehabilitation measured with a semiquantitative food frequency questionnaire and summarised to a nutritional index, which was used to categorise patients as having a poor, fair, or good diet.

Results: During rehabilitation the proportion of patients whose dietary intake was categorised as good increased strongly from 30% to 91%. One and three years after rehabilitation a still increased proportion of 49% and 42%, respectively, in the good category was observed. The strong increase in intake of low fat and wholemeal products that was achieved during rehabilitation was followed after rehabilitation discharge by a backslide to the intake observed before rehabilitation admission. The avoidance of unfavourable food items, such as French fries or eggs, was at least partly maintained during the follow up period.

Conclusion: During inpatient rehabilitation most patients do have to make major changes in their dietary intake to comply with recommendations. Although some proportion of patients continue to adhere to dietary recommendations in the long run, further research into strategies to improve maintenance of dietary changes is needed to enhance further the long term benefits from cardiac rehabilitation.

  • coronary disease
  • diet
  • guideline adherence
  • rehabilitation

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Published Online First 13 September 2005

  • Funding: This study was supported by grants from the German Federal Ministry of Education and Research, grant number 01 GD 0820/0, and from the Association of German Pension Fund Agencies, grant number 02 7 08.

  • Competing interests: None declared

  • Ethics approval: The study was approved by the ethics boards of the universities of Ulm and Heidelberg and of the medical associations of the states of Baden-Wuerttemberg and Hessen.