What helps cardiac patients exercise after treatment, and when? Understanding physical activity and exercise participation following exercise-based cardiac rehabilitation

Despite evidence suggesting regular exercise (i.e. structured, repetitive and purposeful physical activity) attenuates cardiac patients’ decline in health, our understanding of factors affecting long-term exercise participation among this patient cohort is limited. This problem is pertinent, given that less than half of cardiac patients adhere to exercise following discharge from formal exercise-based rehabilitation programmes. In this study, we explored factors influencing exercise participation after an outpatient cardiac rehabilitation programme. We recruited 15 cardiac patients (average age 63 years) who had completed outpatient cardiac rehabilitation in the past 6 months. Using semi-structured interviews and reflexive thematic analysis, we identified critical factors and events at each phase of cardiac rehabilitation that may affect long-term exercise participation. During the inpatient phase, fragmented communication pathways constrain patients’ early confidence to exercise and support and consistency from staff, affecting long-term exercise participation. During the outpatient phase, crucial factors identified included structural resource barriers, role conflicts and responsibilities and balancing agency and fear and social support for outpatient exercise affect exercise behaviour. Finally, during the post-programme self-directed phase, features of the transition to self-management, establishment of loss of external structure and routine and external program discontinuity undermine exercise maintenance. Our results suggest cardiac patients receive insufficient support during (and following) the outpatient phase (and maintenance phase) to promote long-term exercise.