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
ARTICLE HIGHLIGHTS
Research background

Cardiovascular disease remains the largest cause of death globally and rates continue to rise. The exercise component of cardiac rehabilitation (CR) is regarded as an important element of such interventions. Recent statistics have demonstrated that attendance of CR programmes is low, despite continued calls for methods to increase attendance.

Research motivation

Such a study is warranted as low rates of uptake and completion of rehabilitation programmes are a concern. The barriers and facilitators towards CR are still somewhat unknown. Patients should continue to conduct regular exercise and physical activity after completing the rehabilitation programme. Thus, understanding patient perspectives on this area is also necessary. Exploring such topics should allow researchers and health care staff to target specific elements of service delivery to improve attendance in the future.

Research objectives

The aims of the present research study were to identify the barriers and facilitators to CR and physical activity. The study also aimed to explore cardiac patient views around service modification and ideas to increase attendance at such programmes.

Research methods

The data analysed in this study was from a larger cross-sectional survey. Cardiac patients from the North of Scotland, who were referred for standard CR classes at a hospital were sampled. The current study qualitatively analysed the free-text responses to 5 open-ended questions included within a wider survey. A 6-step thematic analysis was used to analyse the data.

Research results

Patient responses were explored under two main topic areas: ”Cardiac rehabilitation experience” and “physical activity”. Patients described barriers to CR including time of day, location, a lack of communication and group dynamics. Patient generated ideas to increase the uptake of such programmes included more available classes, a greater variety of intensities and types of exercise and a change to the location of classes. Patients highlighted various benefits to both mental and physical health as a result of conducting the classes and physical activity.

Research conclusions

It appears based on the findings of the current study that CR increases patients’ self-efficacy through a number of mechanisms. Key barriers to attending CR in this cohort included age and physical health, distance to the classes and the cost of attendance. With regards to these barriers, participants highlighted a range of methods to overcome these including provision of more classes held out with working hours, classes conducted in different locations and the need for a greater variety of exercise classes.

Research perspectives

The study provides several ideas which future research can implement or examine. Future studies should attempt to develop, test, and evaluate methods to increase the uptake and attendance of CR based on the current low statistics of eligible patients’ attendance.