Determinants of physical activity behaviour in the cardiac population: a systematic review

Abstract

Background: Physical inactivity is one of the most detrimental modifiable cardiovascular risk factors. Despite the well-established benefits of physical activity (PA) on the overall health of people with cardiovascular disease (CVD), challenges remain in maintaining heart-healthy PA behaviour after completing a cardiac rehabilitation programme. This study aimed to collect and analyse observational data on the relative importance of determinants for heart-healthy PA levels in people with CVD, to inform behaviour change research and intervention development in CVD secondary prevention. Methods: This systematic review included studies reporting bivariate association statistics of determinants and PA behaviour in adults fulfilling the medical indications for cardiac rehabilitation. Included were peer-reviewed journal articles published in English, Dutch, or German since 2005. Five electronic databases (CINAHL, Embase, MEDLINE via PubMed, PsycINFO, Web of Science Core Collection) were last searched in April 2023. Risk of bias of included studies was assessed using the National Heart, Lung, and Blood Institute's Study Quality Assessment Tool for Observational Studies. Data were analysed using descriptive analysis and narrative synthesis. Results:Included were 57 articles reporting on 54 primary studies from 23 countries, with the majority from North America (n=22), Europe (n=18) and Asia (n=10). Twenty-nine studies were rated good quality and 25 studies fair quality. The studies report on altogether 17,639 individual participants, providing collated empirical evidence for 51 determinants and their patterns of association with PA behaviour in the cardiac population. Those determinants showing distinct positive associations with PA behaviour are self-efficacy, life attitude, intention, exercise belief, education, weather, exercise behaviour, habit formation, social support, psychological wellbeing and employment; whereas those determinants showing distinct negative associations with PA behaviour are age, emotion (including anxiety and kinesiophobia), depression and comorbidity. Conclusions: This systematic review has identified determinants of PA behaviour that bear particular relevance for the cardiac population. Developers of behaviour change interventions may draw on these findings to inform intervention concepts, methods and designs. Further research in underrepresented geographic regions, and studies into underrepresented determinants of PA and dynamic changes of PA behaviours over time are warranted. Systematic review registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42020206637