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The development of cardiac rehabilitation in the UK, the evolution of the nursing role as a speciality, and the nursing role within the multidisciplinary team are briefly outlined. The potential impact of different professional backgrounds on the effectiveness of patient care is discussed, with particular reference to the differences between acute cardiac care and rehabilitation. Issues of professional competency are discussed, and core competencies for cardiac rehabilitation as specified by various professional associations are described. Current opportunities for preparation for practice in this field in the UK are outlined. Conclusions point towards the need for clearly specified competencies and an accredited programme of education and training to meet proposed standards for the management and rehabilitation of coronary heart disease (CHD) in the UK.

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QUESTIONWhy do post-myocardial infarction (MI) or revascularisation patients not adhere to home-based or hospital-based cardiac rehabilitation programmes (CRPs)?DESIGN Semi-structured interviews.SETTING 4 hospitals and participant's homes in the UK. PARTICIPANTSPurposive sample of 49 patients (age range 34-87 y, 67% men) who had MI or revascularisation and did not adhere to homebased (n = 21) or hospital-based (n = 28) CRPs were identified from a randomised controlled trial. The home-based CRP included a copy of the Heart Manual (6-wk exercise and walking programme), information tapes, home visits, and telephone calls from nurses. The hospital-based CRP included group or individual exercise based on circuit training, and combined or separate sessions of education and relaxation. METHODSAt 3-20 months after randomisation, participants were individually interviewed for 40-45 minutes about their cardiac event, expectations and experience in CRPs, and lifestyle changes. Interviews were tape recorded, transcribed, and analysed for themes and subthemes. MAIN FINDINGSIn general, reasons for non-adherence to CRPs were multifactorial and individualistic. 4 categories of non-adherence were identified. (1) Alternative exercise and activities. Although participants did not adhere to their CRP, they exercised in other ways that better fit with their lifestyles (eg, walking, housework, or joining a gym). Participants realised that alternate exercises were less vigorous than recommended but felt they were more appropriate for them. Participants reported that their limited participation in CRPs boosted confidence in performing daily activities and other exercises.(2) Other health problems. Many participants had other health problems (eg, emphysema and arthritis) that affected their ability to participate in CRPs. They perceived these health problems as bigger barriers to exercising than their heart condition. However, participants understood the importance of exercise, and some remained active by adapting the programme to fit their needs. (3) Personal reasons. Some people could not attend hospital-based CRPs because they had to care for others who could not be left alone for long periods. 6 participants who did not adhere because they returned to work joined a gym or exercised in other ways. Participants who had recovered from their cardiac event felt it was not necessary or beneficial to attend CRPs. (4) Programmerelated changes. Many participants in home-based CRPs felt that lack of motivation was a major reason for non-adherence. 3 participants in hospital-based CRPs were not offered a specific start date or misunderstood the start date. Some had difficulty accessing hospital-based CRPs because of heavy traffic, lack of parking, irregular bus service, or timing of sessions. Others felt uncomfortable because they thought hospital-based CRPs were attended by ''all old people'' or were overcrowded. CONCLUSIONReasons for non-adherence to home-based or hospitalbased cardiac rehabilitation programmes included lack of motivation to ...

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