An evaluation of nutrition education in outpatient cardiac rehabilitation programs in Victoria

Outpatient cardiac rehabilitation (CR) programs comprise exercise and education, including nutrition education (NE), and are offered after hospitalisation in order to minimise the risk of further cardiac events. A five-part evaluation of NE in outpatient CR programs in Victoria was undertaken. Initially, a survey-based process evaluation of all outpatient programs (N = 74) found that most had a very limited amount of NE. Dietary fat was a topic common to all and most programs used knowledge-based, didactic education that was not based on a specific model of behaviour change. In a second process evaluation, CR participants (n = 317) were surveyed by questionnaire before NE. The majority were older, overweight, English-speaking men who were myocardial infarction and/or cardiac surgery patients. Knowledge of dietary fat was generally poor but attitude to healthy eating was positive and fat intake was relatively low. A quasi-experimental comparison group program trial was used for an impact evaluation of the effectiveness of NE, with one experimental group (n = 80) having one hour of NE, a second experimental group (n = 80) having 41/2 hours of NE, with additional access to the dietitian, and a comparison group (n = 80) having no NE. The 41/2-hour group improved in attitude to healthy eating and had a greater improvement in dietary fat knowledge and a greater reduction in fat intake. In a third survey-based process evaluation, most participants were found to be satisfied with NE but older participants were less satisfied. The amount of NE was weakly associated with satisfaction. A one-year follow-up outcome evaluation of CR participants (n = 44) showed that most were overweight at CR and had increased their BMI at follow-up. Fat knowledge, attitude and intake had not changed and subjects' diets generally accorded with recommendations for patients with heart disease, although mean saturated fat intake was higher. Further research is required to determine the most appropriate behaviour change model for NE in CR programs and the most effective format and educational strategies for facilitating compliance with diets for heart disease.