The impact of outpatient cardiovascular rehabilitation on dietary habits: findings from the SwissPR registry

Background/Objectives Cardiac rehabilitation (CR) is a cornerstone of secondary prevention, yet the effectiveness of its nutritional component in enhancing adherence to Mediterranean-style dietary patterns remains uncertain. We aimed to evaluate overall dietary quality and the impact of outpatient CR on adherence to key dietary recommendations in patients undergoing outpatient CR. Subjects/Methods Prospective observational cohort study including 734 consecutive cardiac patients with complete dietary data enrolled in SwissPR between September 2020 and May 2025. Diet quality was assessed using a four-point Healthy Nutrition (HN) Score with a HN-Score ≥3 indicating optimal nutrition. Changes in HN-Score and its individual components were assessed from CR admission to CR discharge and after one year. Results Patients were 63±11 years old and predominantly male (76%). CR resulted in an increase of patients with optimal diet from 50% at admission to 59% at discharge (p <0.0001). Mean HN-Score increased from 2.39 ± 1.00 to 2.63 ± 0.87 at discharge (p <0.0001), largely reflecting increased use of healthy oils and reduced meat consumption, while adherence to the "5-a-day" target for fruit and vegetable consumption remained low and unchanged (22% at admission, 25% at discharge; p = 0.135). At one year, HN-Score remained stable (2.65 ± 0.75; p = 0.494). Despite having suboptimal HN-Scores three out of four patients rated their diet as healthy. Conclusions CR-based dietary counseling improves overall nutrition scores, but has minimal impactt on the "5-a-day" fruit and vegetable target. These results underscore the need for effective strategies that promote pragmatic, evidence-based fruit and vegetable goals in CR settings.