Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Feb 26, 2022; 14(2): 83-95
Published online Feb 26, 2022. doi: 10.4330/wjc.v14.i2.83
Barriers and facilitators to participating in cardiac rehabilitation and physical activity: A cross-sectional survey
Matthew James Fraser, Stephen J Leslie, Trish Gorely, Emma Foster, Ronie Walters
Matthew James Fraser, Division of Biomedical Science, University of the Highlands and Islands, Inverness IV2 3JH, United Kingdom
Stephen J Leslie, Department of Cardiology, NHS Highland, Inverness IV2 3UJ, United Kingdom
Trish Gorely, Ronie Walters, Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness IV2 3JH, United Kingdom
Emma Foster, Cardiac Unit NHSH, NHS Highland, Inverness IV2 3JH, United Kingdom
Author contributions: Foster E, Gorely T and Leslie S designed the research study; Foster E and Leslie S performed the research; Fraser M, Gorely T and Walters R analysed the data; Fraser M, Gorely T, Walters R and Leslie S wrote the manuscript; All authors have read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Bromley Research Ethics Committee (study reference number 17/LO/1389, project number 231385).
Conflict-of-interest statement: All authors declare no conflicts of interest.
Data sharing statement: The codebook containing the participants’ anonymised quotations is provided as supplementary material.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Matthew James Fraser, BSc, MSc, PhD, Postdoc, Division of Biomedical Science, University of the Highlands and Islands, Centre for Health Science, Old Perth Rd, Inverness IV2 3JH, United Kingdom. matthew.fraser@uhi.ac.uk
Received: September 23, 2021
Peer-review started: September 23, 2021
First decision: December 2, 2021
Revised: December 15, 2021
Accepted: January 29, 2022
Article in press: January 29, 2022
Published online: February 26, 2022
Processing time: 146 Days and 17.2 Hours
Abstract
BACKGROUND

Cardiovascular diseases (CVD) have been shown to be the greatest cause of death worldwide and rates continue to increase. It is recommended that CVD patients attend cardiac rehabilitation (CR) following a cardiac event to reduce mortality, improve recovery and positively influence behaviour around CVD risk factors. Despite the recognised benefits and international recommendations for exercise-based CR, uptake and attendance remain suboptimal. A greater understanding of CR barriers and facilitators is required, not least to inform service development. Through understanding current cardiac patients’ attitudes and opinions around CR and physical activity (PA) could inform patient-led improvements. Moreover, through understanding aspects of CR and PA that participants like/dislike could provide healthcare providers and policy makers with information around what elements to target in the future.

AIM

To investigate participants’ attitudes and opinions around CR and PA.

METHODS

This study employed a cross-sectional survey design on 567 cardiac patients. Cardiac patients who were referred for standard CR classes at a hospital in the Scottish Highlands, from May 2016 to May 2017 were sampled. As part of a larger survey, the current study analysed the free-text responses to 5 open-ended questions included within the wider survey. Questions were related to the participants’ experience of CR, reasons for non-attendance, ideas to increase attendance and their opinions on PA. Qualitative data were analysed using a 6-step, reflexive thematic analysis.

RESULTS

Two main topic areas were explored: “Cardiac rehabilitation experience” and “physical activity”. Self-efficacy was increased as a result of attending CR due to exercising with similar individuals and the safe environment offered. Barriers ranged from age and health to distance and starting times of the classes which increased travel time and costs. Moreover, responses demonstrated a lack of information and communication around the classes. Respondents highlighted that the provision of more classes and classes being held out with working hours, in addition to a greater variety would increase attendance. In terms of PA, respondents viewed this as different to the CR experience. Responses demonstrated increased freedom when conducting PA with regards to the location, time and type of exercise conducted.

CONCLUSION

Changes to the structure of CR may prove important in creating long term behaviour change after completing the rehabilitation programme.

Keywords: Cardiovascular disease; Cardiac rehabilitation; Physical activity; Barriers; Facilitators; Patient experience

Core Tip: The exercise component of cardiac rehabilitation (CR) is considered key to the success of the programme. However, attendance of CR is sub-optimal. The current study examines cardiac patients’ opinions and attitudes around several key elements of CR. Participants provided several ideas going forward to get more patients taking part in CR, which at the moment is a real issue. Experiences around physical activity were also explored, and it was found that patients viewed this as contrasting to CR.