Encouraging Flow: A State Of Calm and Deep Focus May Improve Exercise Compliance in Cardiac Rehabilitation.

Cardiovascular disease (CVD) accounts for more deaths worldwide than any other illness. Over 80% of CVD can be prevented by lifestyle changes. Improving compliance with exercise requirements and reaching 30 minutes of brisk physical activity (PA) on most days remains a challenge. Only a minority of eligible CVD patients complete cardiac rehabilitation (CR) and fewer sustain PA long term. Changing work environments, urbanization, and virtual engagement foster a sedentary lifestyle in students and healthy adults. Disabilities and comorbidities limit PA in older CVD patients. The Flow phenomenon was described in the 1970s as an intrinsically enjoyable state, typically achieved by highly trained people encountering significant challenge like competitive tennis or writing new music. Siddha Tamil medicine has recognized the importance of this 2,000 years ago, recommending ways to experience flow and engage enthusiastically. We hypothesize that flow can be learned and targeted during CR. Older cardiac patients despite comorbidities can experience some level of flow state during CR. This significantly improves long term PA adherence while also sustainably improving other aspects of lifestyle, including diet, smoking cessation, stress reduction, and medication compliance. Clinicians can estimate flow at baseline, following PA sessions and during clinic visits to encourage a deeper mind-body connection. Once PA becomes enjoyable, compliance and cardiac outcomes may improve in CVD.