Adherence after a coronary event to an aerobic exercise programme greatly improves self confidence, survival and quality of life. Even so, and for reasons largely as yet unexplored, over seventy per cent of survivors of a critical cardiac event fail to adhere to their recovery programme. As a result, there is an avoidable foreshortening and reduced quality of life.

This research looks at reasons why engagement and adherence to a cardiorehab programme is so poor even when longer-term survival from a coronary event and quality of remaining life is at stake.

To explore fatalistic self-beliefs that are activated by a life-threatening event and that interfere with life-enhancing and life-lengthening intervention strategies that can be put in place.

The primary instruments were ISA (Identity Structure Analysis) and mini-COPE, placed within an ADKAR (Awareness, Desire, Knowledge, Ability, Reinforcement) framework of self-management.

All subjects, independent of engagement and clinical outcome, achieved comparable scores in awareness, desire and knowledge about their conditions. Subjects who adhered least well to cardiorehabilitation programmes were stuck in identity states of moratorium or foreclosure. These results are looked at in detail to demostrate the heuristic value of ISA for psychosomatic medicine.

Blanket education programmes for subjects in recovery from a coronary event are mostly ineffectual unless the structural pressures of self-beliefs that contribute to self-handicapping are adequately addressed.