Personality-related and social influences on barriers to exercise in cardiac patients

Background Due to its positive effects on cardiovascular risk factors, exercise is an important preventive measure for cardiac patients, reflected in guideline recommendations for physical activity. However, the role of personality-related and social influences on exercise behaviour is largely unknown. A better understanding of these influences would be essential for planning targeted interventions to increase adherence to exercise goals. Methods 88 cardiology outpatients (all-comers) were surveyed using standardised questionnaires on exercise behaviour, barriers to exercise (DPAQ), stress (PSS10), self-efficacy (SWE) and social support (FSozU) (inclusion criteria: stable cardiological disease and age ≥50 years; exclusion criteria: physician-attested contraindication for physical exercise). Variables were compared using linear regressions. In addition, the subjects were divided according to the median of the respective scale (low vs. high stress level, etc.) and the amount of exercise in MET minutes (≙minutes of physical activity with a metabolic equivalent) and the proportion of subjects who exercised regularly were determined. Results The patients were 68±10 years old and 30% were female. The most common cardiovascular diseases were arterial hypertension (81%) and coronary heart disease (71%). Only 33% of patients exercised regularly (>once a week). Many of the potential barriers to exercise identified in the survey correlated significantly with actual physical activity (Fig A; 14 of 25 barriers correlated significantly with the amount of exercise; for the sake of simplicity, only 6 are shown here.). It is interesting to note that the three factors stress, self-efficacy and social support also correlated with almost all of these barriers (Fig A). Knowledge of the health-promoting effects of sport correlates positively with sporting activity, but is weakened by high stress levels, low self-efficacy and low social support. Fear of exercise due to concerns about cardiac problems in general and compatibility with one's own cardiac condition are associated with a significant reduction in physical activity. This was more pronounced with high stress levels, low self-efficacy and poor social support. High stress levels were associated with lower levels of physical activity (Fig B), while greater social support was associated with higher levels of physical activity (Fig C). Self-efficacy had no significant influence on physical activity behaviour (Fig D). Conclusion Fear of heart problems and a lack of knowledge about safe exercise for heart disease are major barriers to regular physical activity for patients with cardiovascular disease, and are exacerbated by stress and a lack of social support. Appropriate education and individualized patient communication is therefore essential to achieve sufficient adherence.