Barriers to and motives for engagement in an exercise-based cardiac rehabilitation programme in Ireland: a qualitative study

Abstract

Background Insufficient physical activity (PA) is a leading risk factor for premature death worldwide. Ireland’s public healthcare system, the Health Service Executive (HSE), has supported the development of the National Exercise Referral Framework (NERF) to tackle low levels of PA amongst those with non-communicable diseases (NCDs). ‘NERF centres’ are medically supervised PA programmes across Ireland that have established referral pathways with local hospitals and general practitioners. ULMedX is one such NERF centre offering exercise-based cardiac rehabilitation (EBCR) with the aim of intervention development to reduce early drop-out and maximise adherence for optimal health benefits. Aim The purpose of this research was to identify the major factors influencing participants’ adherence and early drop-out at ULMedX. Exploring areas for future development were also prioritised. Design & setting Qualitative interviews were conducted with long-term attenders and people who have dropped out (PWDO) from ULMedX. Methods Guided by the Theory of Planned Behaviour the 1–1 semi-structured interviews were performed, transcribed, and evaluated through thematic analysis. Results Analysis was performed on 14 participants (50% female; mean age 67.3 years), comprising long-term attenders (n = 7; 13-month duration, 64% of classes) and PWDO (n = 7; 2.8-month duration, 22% of classes). Three major factors affecting adherence and drop-out were identified: social support, perceived outcomes from participation and practical barriers to attendance. Areas for future development included the provision of evening and advanced classes, psychological support, more exercise variety, more educational seminars and new members start as their own group. Conclusion The findings suggest participants at ULMedX are more likely to have had a better experience and commit to the programme if they believed involvement would benefit their physical and mental health, increase their exercise motivation by engendering a positive attitude to exercise, and that the ability to attend was within their control. Future interventions at ULMedX should have their structures centred around these motives for engagement. ULMedX should also test the participant recommendations to overcome the common barriers to adherence.

Adherence, safety, and satisfaction of a cardio-oncology rehabilitation program framework versus community exercise training for cancer survivors: findings from the CORE trial

“…It has been suggested that lifestyle behavioral interventions and the encouragement for exercise beyond supervised sessions, as recommended in CR programs, may increase adherence rates [35]. Furthermore, sessions delivered by the program's psychologist addressing self-efficacy and behavioral skills could also have reinforced participant's motivation [36,37]. Reports suggest that cancer survivors and individuals with CVD may share common conditions such as those related to sleep disorders, fatigue, sexual problems, anxiety, and depression, suggesting that a comprehensive rehabilitation program could be of interest, so these motivational and educational group sessions may have also contributed to improving adherence rates in CBCR [36][37][38].…”

Adherence, safety and satisfaction of a cardio-oncology rehabilitation program framework versus community exercise training for cancer survivors: findings from the CORE trial

“…Finally, it has been suggested that lifestyle behavioral interventions and the encouragement for exercise beyond the supervised sessions, as recommended in CR programs, may increase adherence rates [35]. Furthermore, sessions delivered by the program's psychologist addressing self-e cacy and behavioral skills could also have reinforced participant's motivation [36,37]. Literature has shown that cancer survivors and people with CVD may share common problems, regardless the primary diagnosis, namely disturbances related to sleep disorders, fatigue, sexual problems, anxiety and depression, suggesting that a common comprehensive rehabilitation can be just as suitable, so these motivational and educational group sessions may also have contributed to improving adherence rates in CBCR [36][37][38].…”

Reasons for dropout in the transition from hospital to municipality during exercise-based cardiac rehabilitation in a Danish cross-sectorial setting: a qualitative study

“…Recent qualitative studies on discontinuation have examined dropout from specialised cardiac phase II rehabilitation without involving transitional phases. [21][22][23] As a result the Dropout during a 12-week exCR programme: A cohort study, called AoRTA, was established. 24 Of the 279 individuals who participated in the 12-week exCR programme mentioned above, the AoRTA study identified 103 dropouts, 72 (70%) of whom stopped at the transition point.…”

“…How transition phases influence patient perceived pathways in split CR programmes are deficiently explored. Recent qualitative studies on discontinuation have examined dropout from specialised cardiac phase II rehabilitation without involving transitional phases 21–23…”