Education-related differences in the motivation and barriers to exercise in patients with cardiovascular diseases

Introduction As physical exercise has numerous positive effects on cardiovascular risk factors and diseases, it is a crucial pillar of prevention (ESC Guideline on Sports Cardiology). However, the physical activity behaviors of cardiological patients and the influence of education are largely unknown. A better understanding of motivational factors would be essential for planning targeted interventions to improve adherence to exercise goals. Purpose The aim of this study was to investigate the impact of education level on the motivation for physical activity and barriers to exercise in cardiovascularly diseased participants. Methods A total of 88 stable cardiological patients were surveyed using standardised questionnaires regarding exercise behavior, motivations, attitudes, and barriers to exercise. The highest level of education was recorded. Inclusion criteria were cardiovascular disease and age ≥50 years. Exclusion criteria included cardiovascular diseases that contraindicate intense physical activity and other conditions preventing regular exercise. Analysis was stratified by highest school qualification: 'Lower secondary school' (9 years of schooling, n = 43), 'Higher secondary school' (10 years of schooling, n = 23), and 'High school' (n = 22), with ANOVA used for group comparison. Results The cohort had an average age of 68±10 (mean±SD) years with 30% women. The most common cardiovascular diseases were arterial hypertension (81%) and coronary heart disease (71%). Only 33% engaged in regular exercise. Patients with Higher secondary or High school diplomas participated in physical activity significantly more often than those with Lower secondary education (48% and 46% vs. 19%, p=0.020; Fig. A). Health was the primary motivation across all groups (Fig. B). Patients with higher education exhibited better competence in planning and overcoming practical and emotional barriers (Fig. C). No education-dependent differences were found regarding knowledge of exercise benefits or willingness to engage in regular activity. However, patients with Lower secondary education more frequently reported embarrassment, fear of comparison, and uncertainty about exercising with cardiac conditions (Fig. D). No differences were observed in perceived self-efficacy, but higher pessimism and stress levels were noted among patients with Lower secondary education (Fig. E). Conclusion There are significant differences in exercise behavior between cardiovascular patients with different education levels. Despite similar knowledge of exercise benefits, patients with lower education experience greater activity-related fears and have poorer resources for implementing regular exercise. These findings could enhance targeted interventions and improve exercise program implementation for cardiological patients.