Cardiac exercise telerehabilitation is effective and can be cost-effective for managing ischaemic heart disease, but implementation of evidence-based interventions in clinical practice remains a challenge. We aimed to identify factors that cardiac rehabilitation stakeholders perceived could influence the effectiveness of implementing an evidence-based, real-time remotely monitored cardiac exercise telerehabilitation intervention (REMOTE-CR).

Online interviews and focus groups were conducted with cardiac rehabilitation consumers (n = 16, 5 female, 61.1 ± 10.0 years), practitioners (n = 20, 14 female; 36.6 ± 11.8 years), and health service managers (n = 11, 7 female; 46.2 ± 9.2 years) recruited from one metropolitan and three inner-regional healthcare services in Western Victoria, Australia. Discussions were guided by two theoretical frameworks (Non-adoption, Abandonment, Scale-up, Spread, and Sustainability; Consolidated Framework for Implementation Research), and analysed thematically. Factors perceived to influence effective implementation of REMOTE-CR spanned all domains of the theoretical frameworks, related to six major themes (resources, change management, stakeholder targeting, knowledge, intervention design, security) and were largely consistent across study sites; however, the relative importance of each factor may vary between sites.

Effective implementation of exercise telerehabilitation interventions like REMOTE-CR will require a coordinated context-specific approach that considers factors across all levels of the healthcare system and implementation science frameworks. Key requirements include prioritizing resources, managing change, selecting target stakeholders, developing digital health capabilities, and selecting fit-for-purpose technologies that enable programme delivery objectives.

While digital cardiac rehabilitation (CR) is an effective alternative to center-based CR, its components and mechanisms of change remain poorly understood. The Multiphase Optimization Strategy (MOST) provides a framework that allows the effects of individual components of complex interventions to be studied. There is limited guidance within MOST on how to develop a conceptual model. This article describes the development of a conceptual model of digital CR. The conceptual model was developed based on several strands of evidence: (i) a systematic review of 25 randomized controlled trials to identify the behavior change techniques in digital CR interventions, (ii) a qualitative study of patients' (n = 11) perceptions of the mechanisms of digital CR, and (iii) a review of international guidelines. Tools and frameworks from behavioral science, including the Behaviour Change Wheel, Capability, Opportunity, Motivation and Behavior model, and Theoretical Domains Framework were used to integrate the findings. An initial conceptual model of digital CR was developed and then refined through discussion. The conceptual model outlines the causal process through which digital CR can enhance outcomes for patients with cardiovascular disease. The model illustrates the key intervention components (e.g. goal setting and self-monitoring, education, exercise training), targeted outcomes (e.g. physical activity, healthy eating, medication adherence), and theorized mediating variables (e.g. knowledge, beliefs about capability). The article provides an example of how behavioral science frameworks and tools can inform the preparation phase of MOST. The developed conceptual model of digital CR will inform guide decision-making in a future optimization trial.

Cardiac rehabilitation (CR) shows lower effectiveness and higher dropouts among people with a low socioeconomic position (SEP) compared to those with a high SEP. This study evaluated an eHealth intervention aimed at supporting patients with a low SEP during their waiting period preceding CR.

Participants with a low SEP in their waiting period before CR were randomized into an intervention group, receiving guidance videos, patient narratives, and practical tips, or into a control group. We evaluated adherence (usage metrics), acceptance (modified Usefulness, Satisfaction, and Ease of use questionnaire), and changes in feelings of certainty and guidance between the waiting period's start and end. Semi-structured interviews provided complementary insights. The study involved 41 participants [median interquartile range (IQR) age 62 (14) years; 33 males], with 21 participants allocated to the intervention group, using the eHealth intervention for a median (IQR) duration of 16 (10) days, using it on a median (IQR) of 100% (25) of these days, and viewing 88% of the available messages. Key adherence themes were daily routine compatibility and curiosity. Acceptance rates were 86% for usability, 67% for satisfaction, and 43% for usefulness. No significant effects on certainty and guidance were observed, but qualitative data suggested that the intervention helped to inform and set expectations.

The study found the eHealth intervention feasible for cardiac patients with a low SEP, with good adherence, usability, and satisfaction. However, it showed no effect on feelings of certainty and guidance. Through further optimization of its content, the intervention holds promise to improve emotional resilience during the waiting period.

This trial is registered as follows: 'Evaluation of a Preparatory eHealth Intervention to Support Cardiac Patients During Their Waiting Period (PReCARE)' at ClinicalTrials.gov (NCT05698121, https://clinicaltrials.gov/study/NCT05698121).

Background/Objectives: For effective exercise prescription for patients with cardiovascular disease, it is important to determine the target heart rate at the level of the anaerobic threshold (AT-HR). The AT-HR is mainly determined by cardiopulmonary exercise testing (CPET). The aim of this study is to develop a machine learning (ML) model to predict the AT-HR solely from non-exercise clinical features. Methods: From consecutive 21,482 cases of CPET between 2 February 2008 and 1 December 2021, an appropriate subset was selected to train our ML model. Data consisted of 78 features, including age, sex, anthropometry, clinical diagnosis, cardiovascular risk factors, vital signs, blood tests, and echocardiography. We predicted the AT-HR using a ML method called gradient boosting, along with a rank of each feature in terms of its contribution to AT-HR prediction. The accuracy was evaluated by comparing the predicted AT-HR with the target HRs from guideline-recommended equations in terms of the mean absolute error (MAE). Results: A total of 8228 participants included healthy individuals and patients with cardiovascular disease and were 62 ± 15 years in mean age (69% male). The MAE of the AT-HR by the ML-based model was 7.7 ± 0.2 bpm, which was significantly smaller than those of the guideline-recommended equations; the results using Karvonen formulas with the coefficients 0.7 and 0.4 were 34.5 ± 0.3 bpm and 11.9 ± 0.2 bpm, respectively, and the results using simpler formulas, rest HR + 10 and +20 bpm, were 15.9 ± 0.3 and 9.7 ± 0.2 bpm, respectively. The feature ranking method revealed that the features that make a significant contribution to AT-HR prediction include the resting heart rate, age, N-terminal pro-brain natriuretic peptide (NT-proBNP), resting systolic blood pressure, highly sensitive C-reactive protein (hsCRP), cardiovascular disease diagnosis, and β-blockers, in that order. Prediction accuracy with the top 10 to 20 features was comparable to that with all features. Conclusions: An accurate prediction model of the AT-HR from non-exercise clinical features was proposed. We expect that it will facilitate performing cardiac rehabilitation. The feature selection technique newly unveiled some major determinants of AT-HR, such as NT-proBNP and hsCRP.

Adherence to home-based cardiac rehabilitation exercise remains suboptimal, and motivation may be the intrinsic driving force. This study aimed to explore the role of exercise regulatory motivation in mediating the relationship between psychological needs and exercise adherence among chronic heart failure patients, and to develop a mechanism model.

This study adopted an explanatory sequential mixed-methods design. A hypothesized model of adherence behavior was developed. A survey was used to test the theory-driven model. A semi-structured interview delved deeper into chronic heart failure patients' experiences with HBCR exercise, identifying reasons behind significant mediation effects and refining the mechanism model.

A total of 248 eligible chronic heart failure patients participated in the quantitative study. Exercise regulatory motivation partially mediated the relationship between psychological needs and exercise adherence. In the qualitative study, 18 chronic heart failure patients from the quantitative sample were purposefully selected. Five sub-themes emerged from the textual data, which were distilled into two overarching themes: "Specific Functions of Pathway Variables" and "Reasons for Mediation Path Significance." Integrating the qualitative and quantitative results, it was found that satisfying patients' psychological needs for exercise activates regulatory motivation, which in turn triggers sustained exercise behavior. As motivation becomes increasingly internalized, patients are able to set clear goals and maintain or adjust their home-based cardiac rehabilitation exercise over the long term.

From a health psychology perspective, this study is the first to reveal the role of exercise regulatory motivation in linking psychological needs and exercise adherence among chronic heart failure patients, ultimately developing a mechanism model.

Not applicable.

Introduction: Despite an established evidence-base for cardiac rehabilitation (CR) improving functional outcomes and quality of life and reducing re-hospitalisation, there is limited research on CR for older cardiac patients, who require rehabilitation the most, as they are often very deconditioned due to aortic stenosis (AS). CR uptake in the UK is limited to 52% with national variability of provision and accessibility, and it is a national priority to increase uptake to 85%. Frequently, research has excluded older populations as they are deemed to be too frail or generally not suitable for inclusion. This study aimed to explore factors that can impact the uptake of CR in octogenarians. Methods: Qualitative interviews were carried out with 20 AS patients (12 female, 8 male), from a large NHS Trust in the North East of England. Results: Four main themes were identified in the data: Perceptions and Understanding, Delivery and Accessibility, Perceived Impact of Exercise and Health and Life Changes, and Transportation. Discussion: The findings suggested that the major factors were the understanding of the nature, purpose and relevance of CR to older patients, whether CR was offered, and the role of social support. Barriers and facilitators can impact uptake based on the mode of delivery and the individual circumstances identified. Future research could explore how to develop CR programmes that overcome the barriers identified in the research, such as education, monitoring strategies, use of telehealth, and home-based elements to create an acceptable and accessible programme for octogenarians.

This study aimed to generate new qualitative insights to understand the rehabilitation needs of people living with a confirmed or presumed diagnosis of ischaemia with no obstructive coronary arteries (INOCA), explore which aspects of current cardiovascular prevention and rehabilitation programmes could meet the needs of people with INOCA and where adjustments (if any) may be appropriate.

Semistructured qualitative interview study.

Interviews were undertaken (n=17; 88% female, age range 31-69 years) with people with a confirmed or presumed diagnosis of INOCA.

Findings highlighted concerns around a lack of evidence-based guidance for cardiovascular prevention and rehabilitation programmes for patients with INOCA. Participants expressed a desire for modular cardiovascular prevention and rehabilitation programmes that could be accessed flexibly to accommodate episodic fluctuations in symptoms. Participants suggested that existing cardiovascular prevention and rehabilitation programme content needed adjustment including enhanced psychosocial support, supervised low-impact physical activity and specialist dietary advice and medication reviews. Additional elements specific to INOCA should be made available as appropriate including acute care planning and a module to provide information and support for female-specific issues. The importance of involving INOCA patients in the codesign of future programmes and associated training was emphasised.

People with INOCA are willing to engage with cardiovascular prevention and rehabilitation programmes and express a desire for more support. This patient group shares some barriers to rehabilitation programme attendance with other cardiac patient groups, but they also have specific concerns about the need for improved professional knowledge and evidence-based guidance regarding the management of INOCA. Cardiovascular rehabilitation programmes need to be delivered flexibly and individually tailored to ensure the relapsing and remitting nature of INOCA and associated support needs are addressed.

People living with Atrial Fibrillation (AF) often experience symptoms such as irregular heartbeat, shortness of breath, and fatigue, which can significantly limit their physical activity and overall quality of life. The existing approach to managing AF predominantly revolves around medication and medical procedures, and no prescription of tailored rehabilitation program (RP) is currently offered for this population.

This study aims to gauge the perspectives of healthcare professionals regarding the implementation of a personalised RP for individuals living with AF and to identify the barriers hindering the referral process.

A cross-sectional online survey was conducted among healthcare professionals in the UK responsible for caring for adults with AF. The survey consisted of twelve questions designed to uncover healthcare professionals' views on RP for individuals with AF.

A total of 209 respondents participated in the survey, with 57% being female and 43% identifying as specialist arrhythmia nurses. A significant majority (61%) of the participants expressed agreement that an RP could help individuals with AF regain their ability to carry out daily activities, and 58% believed that RP could effectively alleviate symptoms such as breathlessness and palpitations (52%). Virtually all respondents (99%) recommended that a tailored program should encompass education about AF, weight management, and symptom control (94%). Notably, the primary factor influencing their decision to make a referral was the low physical activity levels (80%). Transportation emerged as the chief obstacle to referring patients to the program (62%). A substantial majority (79%) favoured a home-based rehabilitation program as the optimal mean of delivery.

The responses from healthcare professionals reflect a keen interest in implementing a program tailored to individuals with AF, with patients' low physical activity levels being the primary motivator for referrals. Home-based rehabilitation was the preferred mode of delivery, followed by digital interventions.

Many post-myocardial infarction (MI) patients struggle with physical activity behavior change (BC) for life-long secondary prevention. There is limited knowledge about factors influencing long-term physical activity BC among post-MI patients. This qualitative study aimed to explore the beliefs and experiences related to post-MI patients' physical activity BC process following a year's participation in a supervised and self-monitored exercise program: the Norwegian Trial of Physical Exercise After MI (NorEx).

We conducted a qualitative study, performing in-depth semi-structured interviews with a randomly selected sample of NorEx participants when they were scheduled for cardiopulmonary exercise testing after one year of participation. Interviews were transcribed verbatim and the data was analyzed by applying reflexive thematic analysis.

Seventeen participants (n = 4 female [24%]; median age, 61 years; median time since index MI, 4 years) were recruited and interviewed once. Analysis resulted in four main themes (nine sub-themes): (1) Personal responsibility to exercise (Exercise is safe, Health benefits, Habitual exercise); (2) Peer social support for a sense of safety and belonging (Social exercise, Supervision is preferred); (3) Research participation transformed exercise beliefs (High-intensity exercise is superior, Personal Activity Intelligence (PAI) promotes exercise adherence); and (4) Mind the intention-behavior gap (Initial anxiety, Lack of continued follow-up).

Several participants reported that they were able to maintain exercise BC during a year's participation in NorEx. Nevertheless, a perceived lack of continued and individualized follow-up made some participants struggle with motivation and self-regulation, leading to an intention-behavior gap. Therefore, our findings suggest there is a need for individualized and continued social support and supervision from health and exercise professionals to maintain long-term exercise BC for secondary prevention among post-MI patients.

The NorEx study has been registered at ClinicalTrials.gov (NCT04617639, registration date 2020-10-21).

Cardiac rehabilitation programs face the challenge of suboptimal participation, despite being a level Ia recommendation. Cardiac telerehabilitation, with its potential to engage patients who might otherwise not show interest, necessitates the adaption of existing center-based cardiac rehabilitation programs to facilitate rehabilitation at home. REHAB + is a mobile cardiac telerehabilitation program cocreated with patients and rehabilitation centers, aiming to future-proof cardiac rehabilitation and improve accessibility. The REHAB + application enables users to remotely communicate with their coach, receive on-demand feedback on health goal progression, and reduces the need for frequent in-person meetings at the cardiac rehabilitation center. The REHAB + study seeks to compare patient-related outcomes and characteristics of patients between those offered the option to participate in cardiac telerehabilitation and those attending center-based cardiac rehabilitation over a twelve-month period.

The REHAB + study is a multicenter, prospective, matched controlled, observational study that includes (N)STEMI patients eligible for cardiac rehabilitation. We aim to enroll 300 participants for cardiac telerehabilitation and 600 for center-based cardiac rehabilitation. Participants opting for cardiac telerehabilitation (REHAB+) will be matched with center-based cardiac rehabilitation participants. Additionally, characteristics of patients unwilling to participate in either center-based rehabilitation or telerehabilitation but are willing to share their demographics will be collected. The primary endpoint is quality of life measured with the SF-36 questionnaire at three and twelve months, with patient-related characteristics driving intervention choice as the most important secondary endpoint. Secondary endpoints include physical activity, modifiable risk factors, and digital health experience. The trial is registered at clinicaltrials.gov with registration number NCT05207072.

The REHAB + trial is unique by offering patients freedom to choose between cardiac telerehabilitation and center-based rehabilitation. The integration of digital components into cardiac rehabilitation has the potential to complement behavioral change strategies for specific patient groups. Offering patients the option of cardiac telerehabilitation next to center-based rehabilitation could enhance overall cardiac rehabilitation participation rates.

Cardiovascular disease (CVD) continues to be the foremost mortality internationally. Cardiac rehabilitation has proven as an effective program in reducing CVD burden. Participation in cardiac rehabilitation programs is very low. Digital health intervention emerged as an alternative method to deliver Cardiac rehabilitation. This review aimed to investigate the impact of digital health intervention on the outcomes of interest.

the following databases: PubMed, CINAHL, Scopus, and Cochrane Library have been searched to retrieve randomized controlled trials that examine the impact of digital health intervention on blood pressure, body mass index, lipid profile, blood glucose, Six-Minute Walk Test, and peak oxygen consumption. filters were set to include studies published in English between 2000-2023.

Nineteen studies were included in this review. Six-Minute Walk Test (MD = 16.70; 95% CI: 6.00 to 27.39, p = 0.000) and maximal oxygen consumption (SMD = 0.27; 95% CI: 0.08 to 0.45, p = 0.004) significantly improved following digital health intervention, after employing the sensitivity analysis significant improvement was observed in systolic (MD = -2.54; 95% CI: -4.98 to -0.11, p = 0.04) and diastolic blood pressure (SMD = -2.0182; 95% CI: -3.9436 to -0.0928, p = 0.04) favoring experimental groups. Subgroup analysis revealed significant improvement in quality of life after three months of follow-up (SMD = 0.18; 95% CI: 0.05 to 0.31, p = 0.00), no significant differences have been observed in body mass index, lipid profile, and blood glucose.

The findings emphasize the significant impact of digital vs CBCR or usual care on physical capacity, blood pressure, and quality of life. Despite the non-statistically significant differences in body mass index and lipid profile, the comparable effect between the two methods suggests the superiority of digital over CBCR or usual care due to its convenient nature, accessibility, and cost-effectiveness.

Remote cardiac rehabilitation has proven useful in patients with cardiovascular disease; however, the methodology had not been fully validated. This study aimed to investigate the efficacy and safety of remote cardiac rehabilitation (RCR) with real-time monitoring and an ergometer using a bidirectional communication tool during the recovery phase of cardiovascular diseases.

This multicenter, nonrandomized, interventional study was conducted at 29 institutions across Japan and enrolled patients with cardiovascular diseases who met indications for cardiac rehabilitation (CR) after receiving in-hospital treatment. The RCR group exercised at home using an ergometer and was monitored in real-time using interactive video and monitoring tools for 2-3 months. Educational instructions were provided concurrently through e-learning approaches. The safety of the RCR protocol and the improvement in peak oxygen consumption (VO2) were compared with those of the historical control group that participated in center-based CR.

Fifty-three patients from the RCR group were compared with 103 historical controls having similar background characteristics. No patients in RCR experienced significant cardiovascular complications while engaging in exercise sessions. After 2-3 months of RCR, the peak VO2 improved significantly, and the increases in the RCR group did not exhibit any significant differences compared to those in the historical controls. During follow-up, the proportion of patients whose exercise capacity increased by 10% or more was also evaluated; this finding did not indicate a statistically significant distinction between the groups.

RCR during the recovery phase of cardiovascular diseases proved equally efficient and safe as center-based CR.

Sedentary behavior, a key modifiable risk factor for cardiovascular disease, is prevalent among cardiovascular disease patients. However, few interventions target sedentary behavior in this group. This paper describes the protocol of a parallel two-group randomized controlled trial for a novel multi-technology sedentary behavior reduction intervention for cardiovascular disease patients (registered at Clinicaltrial.gov, NCT05534256). The pilot trial (n = 70) will test a 12-week "Sit Less" program, based on Habit Formation theory. The 35 participants in the intervention group will receive an instructional goal-setting session, a Fitbit for movement prompts, a smart water bottle (HidrateSpark) to promote hydration and encourage restroom breaks, and weekly personalized text messages. A control group of 35 will receive the American Heart Association's "Answers by Heart" fact sheets. This trial will assess the feasibility and acceptability of implementing the "Sit Less" program with cardiovascular disease patients and the program's primary efficacy in changing sedentary behavior, measured by the activPAL activity tracker. Secondary outcomes include physical activity levels, cardiometabolic biomarkers, and patient-centered outcomes (i.e. sedentary behavior self-efficacy, habit strength, and fear of movement). This study leverages commonly used mobile and wearable technologies to address sedentary behavior in cardiovascular disease patients, a high-risk group. Its findings on the feasibility, acceptability and primary efficacy of the intervention hold promise for broad dissemination.

Patient- and disease-specific data on cardiac rehabilitation (CR) participation and changes over time are limited. The objective of this study was to describe time trends in CR participation between 2013 and 2019 and provides insights into the utilization of CR components.

Patients with cardiovascular disease (CVD) with an indication for CR were enrolled between 2013 and 2019. Dutch health insurance claims data were used to identify CR participation and its components.

In total, 106 212 patients with CVD were included of which 37% participated in CR. Participation significantly increased from 28% in 2013 to 41% in 2016 but remained unchanged thereafter. Participation was highest in the youngest age groups (<50 yrs 52%; 50-65 yrs 50%), men (48%), patients with ST-segment elevation myocardial infarction (73%), non-ST-segment elevation myocardial infarction (59%), and coronary artery bypass grafting (82%). In contrast, it was the lowest in the oldest age group (≥85 yrs 8%), women (30%), and in patients with heart failure (11%). Most participants in CR received referral plus an admission session (97%) and exercise training (82%), whereas complementary services related to dietary (14%) and mental health counseling (10%) had a low utilization.

CR participation rates increased to 41% in 2016 but remained unchanged thereafter. Participation modulators included age, sex, CVD diagnosis, and undergoing a cardiothoracic procedure. Education and exercise sessions were frequently adopted, but dietary and mental health counseling had a low utilization rate. These findings suggest the need for reinvigorated referral and novel enrollment strategies in specific CVD subgroups to further promote CR participation and its associated underutilized adjunctive services.

Exercise is a class 1A recommendation to improve the lives of patients with heart failure, yet less than one-third adhere to physical activity guidelines, and less than 3% attend cardiac rehabilitation.

The aim of this study was to determine the effect of gentle nonaerobic exercise on initial and long-term adherence in patients with heart failure.

We used a qualitative descriptive approach with qualitative content analysis to analyze previously recorded interview data collected as part of the 6-month GEtting iNTo Light Exercise-Heart Failure study and looked for trends in responses among our sample. Thematic statements, representing salient aspects of the participants' experiences, were created and supported by illustrative excerpts from the data.

Twenty-two interviews were analyzed. Eight participants had ≥80% adherence, and the remaining 14 participants were super-adherers (>100% adherence). Super-adherers tended to be male and 65 years or older, and have no exercise for 3 months before the study, a body mass index ≥ 30, and poor to good Kansas City Cardiomyopathy Questionnaire scores. Participants initially enrolled because they saw the program as an opportunity to improve a health issue and to exercise. Long-term adherence was facilitated by convenience, individualization, experiencing psychological and physical improvements, and peer fellowship.

The GEtting iNTo Light Exercise-Heart Failure study that used home-based gentle nonaerobic exercise had 64% of participants come more than was asked. It is imperative that clinicians incorporate what participants with heart failure have directly stated is important for their initiation and long-term adherence to exercise so that we can work toward bridging sedentary patients to the full exercise guidelines to reduce morbidity and mortality.

This study aimed to translate and cross-culturally adapt the cardiac rehabilitation barriers scale to the Chinese, and examine its reliability and validity among the older population.

An approach comprising translation, cultural adaptation, reliability, and validity examination in the Chinese version was conducted in two hospitals in Jilin, China. The t-tests were used to compare the sex differences between each item. Participants included Chinese individuals >60 who were eligible for the cardiac rehabilitation program.

In total, 325 participants completed the questionnaire with an average age of 61.23 ± 9.68 years. The item-total correlations were 0.432 to 0.678. Factor analysis of CRBS-C (Kaiser Meyer Olkin = 0.867, Bartlett's test p = 0.000) revealed four factors: logistical factors, comorbidities/functional status, perceived need/healthcare factors, and work/time conflict. The confirmatory factor analysis (CFA) indicated a good model fit (χ2/df = 1.84, RMSEA = 0.051, CFI = 0.953, TLI = 0.945, SRMR=0.046). Cronbach's alpha was 0.88 for the scale, ranging from 0.801 to 0.88 for each item, which indicates the internal reliability was acceptable.

The Chinese version of the CRRS has acceptable reliability and validity in the Chinese elderly population.

Increasing numbers of elderly patients experience prolonged decreased functional capacity and impaired quality of life after seemingly successful cardiac surgery. After discharge from hospital, these patients experience a substantial gap in care until centre-based cardiac rehabilitation commences. They may benefit from immediate coaching by means of mobile health technology to overcome psychological and physiological barriers to physical activity. The aim of this study was to explore the usability, acceptability, and relevance of a mobile health application designed to support remote exercise-based cardiac rehabilitation of elderly patients early after cardiac surgery from the perspective of patients, their relatives, and physiotherapists.

We adapted a home-based mobile health application for use by elderly patients early after cardiac surgery. Semi-structured dyadic interviews were conducted with a purposive sample of patients (n = 9), their spouses (n = 5), and physiotherapists (n = 2) following two weeks of the intervention. The transcribed interviews were analysed thematically.

Three themes were identified: 1) creating an individual fit by tailoring the intervention; 2) prioritizing communication and collaboration; and 3) interacting with the mobile health application. Overall, the findings indicate that the mobile health intervention has the potential to promote engagement, responsibility, and motivation among elderly patients to exercise early after surgery. However, the intervention can also be a burden on patients and their relatives when roles and responsibilities are unclear.

The mobile health intervention showed potential to bridge the intervention gap after cardiac surgery, as well as in fostering engagement, responsibility, and motivation for physical activity among elderly individuals. Nevertheless, our findings emphasize the necessity of tailoring the intervention to accommodate individual vulnerabilities and capabilities. The intervention may be improved by addressing a number of organizational and communicational issues. Adaptions should be made according to the barriers and facilitators identified in this study prior to testing the effectiveness of the intervention on a larger scale. Future research should focus on the implementation of a hybrid design that supplements or complements face-to-face and centre-based cardiac rehabilitation.

Danish Data Protection Agency, Central Denmark Region (1-16-02-193-22, 11 August 2022).

Multidisciplinary cardiac rehabilitation (CR) improves the prognosis and quality of life of patients with cardiovascular disease and has therefore received strong recommendations in international guidelines for the treatment of patients with chronic coronary syndromes and chronic heart failure. Aiming to both resolve several barriers that impede participation in CR and to improve the effectiveness of CR, cardiac telerehabilitation (CTR) has emerged as a cost-effective alternative to traditional, centre-based CR. Although the body of evidence for the feasibility and effectiveness of CTR is large and still growing, real-life implementations are scarce, which may be due to insufficient knowledge about CTR interventions and due to the challenges its implementation comes with. Up to now, mainly exercise-related core components of CR and e‑coaching have been investigated in the setting of CTR. Translation of research findings to clinical practice may be hampered by methodological limitations present in most CTR studies, being selection bias of participants, lack of long-term follow-up, heterogeneity of studied interventions and the lack of robust outcome measures. Besides conducting highly needed implementation studies for CTR interventions, their implementation could be facilitated by the development of guideline-based, multidisciplinary and personalised CTR programmes and widespread reimbursement for CTR.

Exercise rehabilitation can improve the prognosis of patients with coronary heart disease. However, a bibliometric analysis of the global exercise rehabilitation for coronary heart disease (CHD) research topic is lacking. This study investigated the development trends and research hotspots in the field of coronary heart disease and exercise rehabilitation. CiteSpace software was used to analyze the literature on exercise therapy for CHD in the Web of Science Core Collection database. We analyzed the data of countries/institutions, journals, authors, keywords, and cited references. A total of 3485 peer-reviewed papers were found, and the number of publications on the topic has steadily increased. The most productive country is the USA (1125), followed by China (477) and England (399). The top 3 active academic institutions are Research Libraries UK (RLUK) (236), Harvard University (152), and the University of California System (118). The most commonly cited journals are Circulation (2596), The most commonly cited references are "Exercise-based cardiac rehabilitation for coronary heart disease" (75), Lavie CJ had published the most papers (48). World Health Organization was the most influential author (334 citations). The research frontier trends in this field are body composition, participation, and function. Research on the effects of physical activity or exercise on patients with CHD is a focus of continuous exploration in this field. This study provides a new scientific perspective for exercise rehabilitation and CHD research and gives researchers valuable information for detecting the current research status, hotspots, and emerging trends for further research.

Despite the well-established benefits of cardiac rehabilitation (CR) for patients with cardiovascular disease (CVD), participation in CR remain low. Virtual CR programs present a unique opportunity to promote utilization. To date, few virtual CR cohorts have been analyzed for compliance. This study aims to determine factors that predict compliance within a large virtual CR program in the United States.

We analyzed 1409 patients enrolled in the Kaiser Permanente Mid-Atlantic States Virtual CR program that consists of 12 CR sessions via telephone. Demographic characteristics, as well as body weight, blood pressure, HbA1c level, and smoking status were collected at admission. Patients were further classified by CVD diagnosis codes. Compliance was defined as at least 75% (9/12 sessions) attendance. Data was analyzed using simple and multiple regression models with significance defined as P < 0.05.

Age was the single strongest predictor for virtual CR compliance (adjusted R2 = 0.58; P < 0.001), and non-compliant patients were younger. HbA1C level, CVD diagnosis codes, and smoking status each moderately predicted compliance (adjusted R2 = 0.48, 0.42, and 0.31, respectively; P < 0.001). Smoking and HbA1C level combined in a multiple regression model significantly improved prediction of compliance (adjusted R2 = 0.79, P < 0.01). Sex, baseline weight or hypertension were not significant predictors of CR compliance.

Age, diabetes, CVD diagnoses, smoking status at admission are independent predictors of compliance in a large virtual CR program. Targeted intervention could be designed accordingly to improve CR compliance.

As we move into a new phase of the COVID-19 pandemic, cardiac and pulmonary services are considering how to sustain telehealth modalities long-term. It is important to learn from services that had greater telehealth adoption and determine factors that support sustained use. We aimed to describe how telehealth has been used to deliver cardiac and pulmonary rehabilitation services across Queensland, Australia.

Semi-structured interviews (n = 8) and focus groups (n = 7) were conducted with 27 cardiac and pulmonary clinicians and managers from health services across Queensland between June and August 2021. Interview questions were guided by Greenhalgh's Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework. Hybrid inductive/deductive framework analysis elicited six main themes: (i) Variable levels of readiness; (ii) Greater telehealth uptake in pulmonary vs. cardiac rehabilitation; (iii) Safety and risk management; (iv) Client willingness-targeted support required; (v) Equity and access; and (vi) New models of care. We found that sustained integration of telehealth in cardiac and pulmonary rehabilitation will require contributions from all stakeholders: consumers (e.g. co-design), clinicians (e.g. shared learning), health services (e.g. increasing platform functionality), and the profession (e.g. sharing resources).

There are opportunities for telehealth programmes servicing large geographic areas and opportunities to increase programme participation rates more broadly. Centralized models of care serving large geographic areas could maximize sustainability with current resource limitations; however, realizing the full potential of telehealth will require additional funding for supporting infrastructure and workforce. Individuals and organizations both have roles to play in sustaining telehealth in cardiac and pulmonary services.

To describe inpatient and outpatient cardiac rehabilitation (CR) utilization patterns over time and by subgroups among patients admitted for acute heart failure (AHF) in Japan.

Cardiac rehabilitation (CR) is a crucial secondary prevention strategy for patients with heart failure. While the number of older patients with AHF continues to rise, trends in inpatient and outpatient CR participation following AHF in Japan have not been described to date.

We conducted a retrospective cohort study of adult patients hospitalized for AHF in Japan between April 2008 and December 2020. Using data from the Medical Data Vision database, we measured trends in inpatient and outpatient CR participation following AHF. Descriptive analyses and summary statistics for AHF patients by CR participation status were reported.

The analytic cohort included 88,052 patients. Among these patients, 37,810 (42.9%) participated in inpatient and/or outpatient CR. Of those, 36,431 (96.4%) participated in inpatient CR only and 1,277 (3.4%) participated in both inpatient and outpatient CR. Rates of inpatient CR rose more than 6-fold over the study period, from 9% in 2009 to 55% in 2020, whereas rates of outpatient CR were consistently low.

The rate of inpatient CR participation among AHF patients in Japan rose dramatically over a 12-year period, whereas outpatient CR following AHF was vastly underutilized. Further study is needed to assess the clinical effectiveness of inpatient CR and to create infrastructure and incentives to support and encourage outpatient CR.

The factors influencing home-based cardiac rehabilitation exercise adherence among patients with chronic heart failure remain unclear. This study aimed to explore predictors of home-based cardiac rehabilitation exercise adherence in these patients, based on the theory of planned behavior.

This theory-driven, cross-sectional study used convenience sampling to recruit patients with chronic heart failure undergoing home-based cardiac rehabilitation. Instruments used included the Home-Based Cardiac Rehabilitation Exercise Adherence Scale, the Multidimensional Self-Efficacy for Exercise Scale, the Perceived Social Support Scale, and the Tampa Scale for Kinesiophobia Heart. Multivariate linear hierarchical regression analysis was employed to examine the factors influencing exercise adherence.

A total of 215 patients with chronic heart failure undergoing home-based cardiac rehabilitation participated in the study. The overall score for home cardiac rehabilitation exercise adherence was (48.73 ± 3.92). Multivariate linear hierarchical regression analysis revealed that age (β=-0.087, p = 0.012), education level (β = 0.080, p = 0.020), fear of movement (β=-0.254, p < 0.001), perceived social support (β = 0.451, p < 0.001), and exercise self-efficacy (β = 0.289, p < 0.001) influenced home-based cardiac rehabilitation exercise adherence. In the second model, fear of exercise explained 23.60% of the total variance, while perceived social support and exercise self-efficacy explained 26.60% of the total variance in the third model.

This study found that home-based cardiac rehabilitation exercise adherence in patients with chronic heart failure was suboptimal, and identified its influencing factors. Targeted interventions addressing these factors, such as tailored education, support, and addressing fear of exercise, may help improve exercise adherence.

Given the under-utilisation of cardiac rehabilitation despite its benefits, there has been a shift towards alternative delivery models. The recent coronavirus disease 2019 (COVID-19) pandemic has accelerated this shift, leading to a growing interest in home-based cardiac rehabilitation including telerehabilitation. There is increasing evidence to support cardiac telerehabilitation, with studies generally demonstrating comparable outcomes and potential cost-benefits. This review aims to provide a synopsis of the current evidence on home-based cardiac rehabilitation with a focus on telerehabilitation and practical considerations.

Cardiac rehabilitation (CR) programs are underutilized globally, especially by women. In this study we investigated sex differences in CR barriers across all world regions, to our knowledge for the first time, the characteristics associated with greater barriers in women, and women's greatest barriers according to enrollment status.

In this cross-sectional study, the English, Simplified Chinese, Arabic, Portuguese, or Korean versions of the Cardiac Rehabilitation Barriers Scale was administered to CR-indicated patients globally via Qualtrics from October 2021 to March 2023. Members of the International Council of Cardiovascular Prevention and Rehabilitation community facilitated participant recruitment. Mitigation strategies were provided and rated.

Participants were 2163 patients from 16 countries across all 6 World Health Organization regions; 916 (42.3%) were women. Women did not report significantly greater total barriers overall, but did in 2 regions (Americas, Western Pacific) and men in 1 (Eastern Mediterranean; all P < 0.001). Women's barriers were greatest in the Western Pacific (2.6 ± 0.4/5) and South East Asian (2.5 ± 0.9) regions (P < 0.001), with lack of CR awareness as the greatest barrier in both. Women who were unemployed reported significantly greater barriers than those not (P < 0.001). Among nonenrolled referred women, the greatest barriers were not knowing about CR, not being contacted by the program, cost, and finding exercise tiring or painful. Among enrolled women, the greatest barriers to session adherence were distance, transportation, and family responsibilities. Mitigation strategies were rated as very helpful (4.2 ± 0.7/5).

CR barriers-men's and women's-vary significantly according to region, necessitating tailored approaches to mitigation. Efforts should be made to mitigate unemployed women's barriers in particular.

At least half of all patients with heart failure (HF) are affected by frailty, a syndrome that limits an individual ability to recover from acute stressors. While frailty affects up to 90% of patients with HF with preserved ejection fraction, it is also seen in ~30-60% of patients with HF with reduced ejection fraction, with ~26% higher prevalence in women compared with men. The relationship between frailty and HF is bidirectional, with both conditions exacerbating the other. Frailty is further complicated by a higher prevalence of sarcopenia (by ~20%) in HF patients compared with patients without HF, which negatively affects outcomes. Several frailty assessment methods have been employed historically including the Fried frailty phenotype and Rockwood Clinical Frailty Scale to classify HF patients based on the severity of frailty; however, a validated HF-specific frailty assessment tool does not currently exist. Frailty in HF is associated with a poor prognosis with a 1.5-fold to 2-fold higher risk of all-cause death and hospitalizations compared to non-frail patients. Frailty is also highly prevalent in patients with worsening HF, affecting >50% of patients hospitalized for HF. Such patients with multiple readmissions for decompensated HF have markedly poor outcomes compared to younger, non-frail cohorts, and it is hypothesized that it may be due to major physical and functional limitations that limit recovery from an acute episode of worsening HF, a care aspect that has not been addressed in HF guidelines. Frail patients are thought to confer less benefit from therapeutic interventions due to an increased risk of perceived harm, resulting in lower adherence to HF interventions, which may worsen outcomes. Multiple studies report that <40% of frail patients are on guideline-directed medical therapy for HF, of which most are on suboptimal doses of these medications. There is a lack of evidence generated from randomized trials in this incredibly vulnerable population, and most current practice is governed by post hoc analyses of trials, observational registry-based data and providers' clinical judgement. The current body of evidence suggests that the treatment effect of most guideline-based interventions, including medications, cardiac rehabilitation and device therapy, is consistent across all age groups and frailty subgroups and, in some cases, may be amplified in the older, more frail population. In this review, we discuss the characteristics, assessment tools, impact on prognosis and impact on therapeutic interventions of frailty in patients with HF.

Although available evidence demonstrates positive clinical outcomes for patients attending and completing cardiac rehabilitation, the effectiveness of interactive cardiac rehabilitation web applications on programme completion has not been systematically examined.

This JBI systematic review of effects included studies measuring effectiveness of interactive cardiac rehabilitation web applications compared to telephone, and centre-based programmes. Outcome data were pooled under programme completion and clinical outcomes (body mass index, low-density lipoproteins, and blood pressure). Databases including MEDLINE (via Ovid), Cochrane Library, Scopus (via Elsevier) and CINAHL (via EBSCO) published in English were searched. Articles were screened and reviewed by two independent reviewers for inclusion, and the JBI critical appraisal tool and Grading of Recommendations Assessment, Development and Evaluation tool were applied to appraise and assess the certainty of the findings of the included studies. A meta-analysis of the primary and secondary outcomes used random effects models.

In total, nine studies involving 1175 participants who participated in web-based cardiac rehabilitation to usual care were identified. The mean critical appraisal tool score was 76 (standard deviation: 9.7) with all (100%) studies scoring >69%, and the certainty of evidence low. Web-based programmes were 43% more likely to be completed than usual care (risk ratio: 1.43; 95% confidence interval: 0.96, 2.13) There was no difference between groups for clinical outcomes.

Despite the relatively small number of studies, high heterogeneity and the limited outcome measures, the results appeared to favour web-based cardiac rehabilitation with regard to programme completion.

The purpose of this scoping review was to summarize the literature on barriers and facilitators that influence the provision and uptake of inpatient cardiac rehabilitation (ICR).

A literature search was conducted using PsycINFO, MEDLINE, EMBASE, CINAHL and AgeLine. Studies were included if they were published in English after the year 2000 and focused on adults who were receiving some form of ICR (eg, exercise counselling and training, education for heart-healthy living). For studies meeting inclusion criteria, descriptive data on authors, year, study design, and intervention type were extracted.

The literature search resulted in a total of 44,331 publications, of which 229 studies met inclusion criteria. ICR programs vary drastically and often focus on promoting physical exercises and patient education. Barriers and facilitators were categorized through patient, provider and system level factors. Individual characteristics and provider knowledge and efficacy were categorized as both barriers and facilitators to ICR delivery and uptake. Team functioning, lack of resources, program coordination, and inconsistencies in evaluation acted as key barriers to ICR delivery and uptake. Key facilitators that influence ICR implementation and engagement include accreditation and professional associations and patient and family-centred practices.

ICR programs can be highly effective at improving health outcomes for those living with CVDs. Our review identified several patient, provider, and system-level considerations that act as barriers and facilitators to ICR delivery and uptake. Future research should explore how to encourage health promotion knowledge amongst ICR staff and patients.

Cardiac rehabilitation in patients with chronic heart failure (CHF) has favourable effects on exercise capacity, the risk at hospital (re-)admission and quality of life. Although cardiac rehabilitation is generally recommended it is still under-utilised in daily clinical practice, particularly in frail elderly patients after hospital admission, mainly due to low referral and patient-related barriers. Cardiac telerehabilitation (CTR) has the potential to partially solve these barriers. The purpose of this study is to evaluate the effects of CTR as compared to standard remote care after hospital admission on physical functional capacity in CHF patients.

In this randomised controlled trial, 64 CHF patients will be recruited during hospitalisation for acute decompensated heart failure, and randomised to CTR combined with remote patient management (RPM) or RPM alone (1:1). All participants will start with RPM after hospital discharge for early detection of deterioration, and will be up titrated to optimal medical therapy before being randomised. CTR will start after randomisation and consists of an 18-week multidisciplinary programme with exercise training by physical and occupational therapists, supported by a (remote) technology-assisted dietary intervention and mental health guiding by a physiologist. The training programme consists of three centre-based and two home-based video exercise training sessions followed by weekly video coaching. The mental health and dietary programme are executed using individual and group video sessions. A wrist-worn device enables remote coaching by the physical therapist. The web application is used for promoting self-management by the following modules: 1) goal setting, 2) progress tracking, 3) education, and 4) video and chat communication. The primary outcome measure is physical functional capacity evaluated by the Short Physical Performance Battery (SPPB) score. Secondary outcome measures include frailty scoring, recovery after submaximal exercise, subjective health status, compliance and acceptance to the rehabilitation programme, and readmission rate.

The Tele-ADHF trial is the first prospective randomised controlled trial designed for evaluating the effects of a comprehensive combined RPM and CTR programme in recently hospitalised CHF patients. We hypothesize that this intervention has superior effects on physical functional capacity than RPM alone.

Netherlands Trial Registry (NTR) NL9619, registered 21 July 2021.

Prehabilitation offers patients the opportunity to actively participate in their perioperative care by preparing themselves for their upcoming surgery. Experiencing barriers may lead to non-participation, which can result in a reduced functional capacity, delayed post-operative recovery and higher healthcare costs. Insight in the barriers and facilitators to participation in prehabilitation can inform further development and implementation of prehabilitation. The aim of this review was to identify patient-experienced barriers and facilitators for participation in prehabilitation.

For this mixed methods systematic review, articles were searched in PubMed, EMBASE and CINAHL. Articles were eligible for inclusion if they contained data on patient-reported barriers and facilitators to participation in prehabilitation in adults undergoing major surgery. Following database search, and title and abstract screening, full text articles were screened for eligibility and quality was assessed using the Mixed Method Appraisal Tool. Relevant data from the included studies were extracted, coded and categorized into themes, using an inductive approach. Based on these themes, the Capability, Opportunity, Motivation, Behaviour (COM-B) model was chosen to classify the identified themes.

Three quantitative, 14 qualitative and 6 mixed methods studies, published between 2007 and 2022, were included in this review. A multitude of factors were identified across the different COM-B components. Barriers included lack of knowledge of the benefits of prehabilitation and not prioritizing prehabilitation over other commitments (psychological capability), physical symptoms and comorbidities (physical capability), lack of time and limited financial capacity (physical opportunity), lack of social support (social opportunity), anxiety and stress (automatic motivation) and previous experiences and feeling too fit for prehabilitation (reflective motivation). Facilitators included knowledge of the benefits of prehabilitation (psychological capability), having access to resources (physical opportunity), social support and encouragement by a health care professional (social support), feeling a sense of control (automatic motivation) and beliefs in own abilities (reflective motivation).

A large number of barriers and facilitators, influencing participation in prehabilitation, were found across all six COM-B components. To reach all patients and to tailor prehabilitation to the patient's needs and preferences, it is important to take into account patients' capability, opportunity and motivation.

Registered in PROSPERO (CRD42021250273) on May 18th, 2021.

The purpose of Cardiac Rehabilitation (CR) is to promote and reduce risk factors in the short and long term, however, the latter has, to date, been poorly evaluated. We explored characteristics associated with provision and outcomes of a long-term assessment in CR.

Data from the UK National Audit of CR between April 2015 and March 2020 was used. Programmes were selected if they had an established mechanism and routine methodology to collect the 12-month assessments. Risk factors pre and post phase II CR and at the 12-month assessment were explored; BMI ≤30, ≥150 min of physical activity per week, hospital anxiety and depression scale (HADS) scores <8. The data came from 32 programmes, 24,644 patients with coronary heart disease. Patients being in at least one optimal risk factor stage throughout phase II CR (OR = 1.43 95% CI 1.28 to 1.59) or successfully reaching an optimal stage during phase II CR (OR = 1.61 95% CI 1.44 to 1.80) had an increased likelihood of being assessed at 12 months compared to those who did not. Patients being in the optimal stage upon completion of phase II CR had an increased likelihood of still being in the optimal stage at 12 months. Most prominent was BMI; (OR = 14.6 (95% CI 11.1 to 19.2) for patients reaching an optimal stage throughout phase II CR.

Being in an optimal stage upon routine CR completion could be an overlooked predictor in the provision of a long-term CR service and prediction of longer-term risk factor status.

Referral to home-based cardiac rehabilitation (HBCR) is low among older and frailer patients due to low expectations regarding adherence by healthcare professionals. The aim of this study was to determine adherence to HBCR when old and frail patients are referred, and to explore any differences in baseline characteristics between adherent and nonadherent patients. Data of the Cardiac Care Bridge were used (Dutch trial register NTR6316). The study included hospitalized cardiac patients ≥ 70 years old and at high risk of functional loss. Adherence to HBCR was confirmed when two-thirds of the intended nine sessions were followed. Of the 153 patients included (age: 82 ± 6 years, 54% female), 29% could not be referred due to death before referral, not returning home, or practical problems. Of the 109 patients who were referred, 67% adhered. Characteristics associated with non-adherence were older age (84 ± 6 vs. 82 ± 6, p = 0.05) and higher handgrip strength in men (33 ± 8 vs. 25 ± 11, p = 0.01). There was no difference in comorbidity, symptoms, or physical capacity. Based on these observations, most older cardiac patients who return home after hospital admission appear to adhere to HBCR after referral, suggesting that most older cardiac patients are motivated and capable of receiving HBCR.

Cardiac rehabilitation (CR) is a standard model of care, and an established component of comprehensive care that has been proven to reduce mortality and morbidity in patients with cardiac diseases. International clinical practice guidelines routinely recommend that cardiac patients participate in CR programs for comprehensive secondary prevention. However, there is scant guidance on how to deliver these programs in low-resourced settings. This dearth of clinical practice guidelines may be an indication of low emphasis placed on CR as a component of cardiac health services in low-income countries, especially in Africa. Indeed, CR programs are almost non-existent in Africa despite the unmet need for CR in patients with ischemic heart disease in Africa reported to be about one million. This figure represents the highest unmet need of any World Health Organization region, and is colossal given the projected accelerated increases in incidence of cardiovascular diseases (CVD) in the region. This narrative review explored the availability of CR programs, potential barriers to CR and strategies that can mitigate such barriers in Africa.

To be able to design telerehabilitation programs targeting the needs and preferences of end-users, patients' in-depth perspectives are needed. To date, such studies are lacking and, therefore, the aim of the present study was to describe patients' perceptions of performing exercise-based cardiac telerehabilitation after a myocardial infarction (MI). Individual semi-structured interviews were performed with 15 patients (3 women, median age 69 years) after an MI who had participated in exercise-based cardiac telerehabilitation for three months. The interviews were transcribed verbatim and analyzed with inductive content analysis. An overall theme was defined as "Cardiac telerehabilitation-a new alternative for exercising that is easily accessible and up to date". Four categories, including "The important role of a physical therapist with expert knowledge", "Prerequisites playing an important role in the willingness to participate", "Making exercise accessible and adjustable" and "Inspiring future exercise", and 15 subcategories were identified. Understanding the patient's perspective is an important key to further improving and successfully implementing exercise-based cardiac telerehabilitation, as an alternative or adjunct to traditional, centre-based programs. The findings can serve to improve patient-physiotherapist interactions and to inform important aspects related to exercise, technology and a sense of security from an exercise-based cardiac telerehabilitation program.

Cardiac rehabilitation (CR) improves health outcomes and quality of life for patients with cardiovascular disease, yet only a quarter of eligible patients enroll. A myriad of CR models that use either an alternative location (ie, home-based) and/or an alternative exercise have been developed to overcome known attendance and physical limitation barriers; however, patient experiences with these models have not been systematically reviewed. Our aim is to review patient experiences with these models of CR.

We conducted a systematic review and thematic analysis of qualitative studies published between 2009 and January of 2022 from CINAHL, PubMed, Web of Science, and PsycINFO.

Twenty-five studies were included, representing the perspectives of 487 individuals who participated in an alternative model of CR. Exercises included walking, tai chi, yoga, aquatic exercise, exergaming, chair-based exercises, aerobics, physical activity trackers, and individualized exercise plans. Nineteen of 25 studies used home-based models and two used live video. Twelve studies included patients with heart failure. Patient perspectives comprised three central themes: exercise benefits, exercise facilitators, and participation barriers. Some thematic categories were reported variably by particular model/study design (eg, home-based) than by others. All alternative models of CR were found to be physically, psychologically, and/or socially beneficial to patients. Participants described facilitators and barriers that were influential in the decision to initiate or continue exercise. These patient insights are critical for innovative delivery of CR that is appealing, accommodates physical limitations, and broadens access to improve health equity.

Cardiac Rehabilitation (CR) is a secondary prevention intervention proven to improve quality of life, yet with low participation. The Cardiac Rehabilitation Barriers Scale (CRBS) was developed to assess multi-level barriers to participation. This study aimed at the translation, and cross-cultural adaptation of the CRBS into the Greek language (CRBS-GR), followed by psychometric validation. Some 110 post-angioplasty patients with coronary artery disease (88.2% men, age 65.3 ± 10.2 years) answered the CRBS-GR. Factor analysis was performed to obtain the CRBS-GR subscales/factors. The internal consistency and 3-week test-retest reliability was evaluated using Cronbach's alpha (α) and intraclass correlation coefficient (ICC), respectively. Construct validity was tested via convergent and divergent validity. Concurrent validity was assessed with the Hospital Anxiety and Depression Scale (HADS). Translation and adaptation resulted in 21 items similar to the original version. Face validity and acceptability were supported. Construct validity assessment revealed four subscales/factors, with acceptable overall reliability (α = 0.70) and subscale internal consistency for all but one factor (α range = 0.56-0.74). The 3-week test-retest reliability was 0.96. Concurrent validity assessment demonstrated a small to moderate correlation of the CRBS-GR with the HADS. The greatest barriers were the distance from the rehabilitation center, the costs, the lack of information about CR, and already exercising at home. The CRBS-GR is a reliable and valid tool for identifying CR barriers among Greek-speaking patients.

A critical aspect of coronary heart disease (CHD) care and secondary prevention is ensuring patients have access to evidence-based information. The purpose of this review is to summarise the guiding principles, content, context and timing of information and education that is beneficial for supporting people with CHD and potential communication strategies, including digital interventions. We conducted a scoping review involving a search of four databases (Web of Science, PubMed, CINAHL, Medline) for articles published from January 2000 to August 2022. Literature was identified through title and abstract screening by expert reviewers. Evidence was synthesised according to the review aims. Results demonstrated that information-sharing, decision-making, goal-setting, positivity and practicality are important aspects of secondary prevention and should be patient-centred and evidenced based with consideration of patient need and preference. Initiation and duration of education is highly variable between and within people, hence communication and support should be regular and ongoing. In conclusion, text messaging programs, smartphone applications and wearable devices are examples of digital health strategies that facilitate education and support for patients with heart disease. There is no one size fits all approach that suits all patients at all stages, hence flexibility and a suite of resources and strategies is optimal.

Exercise-based cardiac rehabilitation (EBCR) is a treatment modality for patients with heart failure (HF) that has withstood the test of time. It has continued to show benefits even in the current era of pharmacotherapeutics for HF. Participation in a multidisciplinary comprehensive EBCR programme reduces mortality and morbidity, has a multitude of physiological benefits, and improves cardiovascular risk factor control and quality of life. Despite this, historical barriers to enrolment and uptake remain. Strategies to overcome these, as well as alternative delivery methods of EBCR in HF patients, are emerging and include telerehabilitation, focus on special groups and emphasis on behavioural change. This review provides oversight on the modalities of exercise training in HF as well as their benefits and gives an overview of barriers to the utilisation of EBCR along with future progress in the field.

The utilization of mobile health (mHealth) devices such as nutrition and fitness tools seems to be promising in facilitating healthy lifestyle behaviors in middle-aged and older adults. As user acceptance plays a decisive role in the successful implementation of mHealth tools, it is vital to examine the target groups' acceptance, particularly their usage behavior and attitudes toward these tools. This qualitative study aimed to explore how far middle-aged as well as older adults accept mobile nutrition and fitness tools and to identify facilitators and barriers shaping their acceptance.

Twenty-one qualitative semi-structured interviews were conducted with German adults aged 50 years and older. Data material was analyzed using Qualitative Content Analysis (Kuckartz).

A comprehensive acceptance typology with three acceptance types could be reconstructed: The Rejection Type, The Selective Acceptance Type, and The Comprehensive Acceptance Type. The target group's acceptance of mobile nutrition and fitness tools appeared to differ considerably across the three acceptance types and between the two different types of mHealth tools - with mobile nutrition tools having been less accepted. Among others, high levels of usability were identified as a key facilitator, while a desire for autonomy and privacy concerns showed to be prominent barriers.

The resulting typology indicates a pronounced heterogeneity among middle-aged and older adults regarding their acceptance of mobile nutrition and fitness tools. The findings highlight a need for more individualized mHealth tools along with respective promotion strategies that are specifically tailored to the needs and expectations of middle-aged and older adults.

Coronary heart disease (CHD) has become a leading cause of morbidity and premature death worldwide. Cardiac rehabilitation (CR) was proved to have substantial benefits for patients with CHD. The CR was divided into three phases. Phase 2 is the important part of CR which involves hospital-based structured and closely monitored exercises and activities. However, CR utilization is low worldwide. The barriers to hospital-based phase 2 CR in China have not been well identified.

To investigate barriers to hospital-based phase 2 cardiac rehabilitation among coronary heart disease patients in China and to explore the reasons.

This study employed an explanatory sequential mixed-methods design. The study was conducted in a university hospital in China from July 2021 to December 2021. Quantitative data was collected through the Cardiac Rehabilitation Barrier Scale. Qualitative data was collected through unstructured face-to-face interviews. Data analysis included descriptive statistics and inductive qualitative content analysis.

One hundred and sixty patients completed the Cardiac Rehabilitation Barrier Scale and 17 patients participated in unstructured face-to-face interviews. The main barriers identified were distance (3.29 ± 1.565), transportation (2.99 ± 1.503), cost (2.76 ± 1.425), doing exercise at home (2.69 ± 1.509) and time constraints (2.48 ± 1.496). Six themes were identified; logistical factors, social support, misunderstanding of cardiac rehabilitation, program and health system-level factors, impression of CR team and psychological distress. The first four themes confirmed the quantitative results and provide a deeper explanation for the quantitative results. The last two themes were new information that emerged in the qualitative phase.

This study provides a better understanding of the barriers to hospital-based phase 2 cardiac rehabilitation among coronary heart disease patients in the Chinese context during the Covid-19 pandemic. Innovative programs such as home-based CR, mobile health, and hybrid programs might be considered to overcome some of these barriers. In addition, psychosocial intervention should be included in these programs to mitigate some of the barriers associated with the impression of CR team and psychological distress.