To qualitatively explore the perceptions and experiences of patients with coronary artery disease regarding discontinuation of home-based exercise rehabilitation.
Design
A qualitative, descriptive design was utilized in this study.
Setting
This study focused on home-based exercise rehabilitation.
Participants
A purposive sample of 24 patients who had voluntarily participated in the home-based exercise rehabilitation program was recruited.
Main measures
Semistructured interviews were undertaken. Data were analyzed using a framework approach.
Results
A total of 24 participants (13 males and 11 females) from 28 to 77 years were recruited for this study to examine the endogenous and exogenous factors that influence withdrawal from exercise rehabilitation. The four major themes identified were (1) “exercise inertia,” (2) “perception deviation,” (3) “disruption of habit loop,” and (4) “weakness in exercise literacy.” These themes were further divided into 12 subthemes.
Conclusions
Sustained implementation of home-based exercise rehabilitation is crucial for patients with coronary heart disease. Discontinuation of exercise regimens frequently stems from patients’ internal perceptions, including exercise inertia, cognitive biases, disruptions in established habit loops, and insufficient exercise literacy. Consequently, enhancing patient awareness of exercise rehabilitation and strengthening supervision of exercise routines are imperative. Establishing a multidisciplinary home-based exercise management system would further facilitate the optimization of exercise-related benefits.
TsaoCWAdayAWAlmarzooqZI, et al.Heart disease and stroke statistics-2023 update: a report from the American Heart Association. Circulation2023; 147: E93–E621.
2.
ShenYCKrumholzHMHsiaRY. Do PCI facility openings and closures affect AMI outcomes differently in high- vs average-capacity markets?JACC Cardiovasc Interv2023; 16: 1129–1140.
3.
TuckerWJFegers-WustrowIHalleM, et al.Exercise for primary and secondary prevention of cardiovascular disease: JACC focus seminar 1/4. J Am Coll Cardiol2022; 80: 1091–1106.
4.
DibbenGOFaulknerJOldridgeN, et al.Exercise-based cardiac rehabilitation for coronary heart disease: a meta-analysis. Eur Heart J2023; 44: 452–469.
5.
SmithSCJr.BenjaminEJBonowRO, et al.AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol2011;58:2432–2446.
6.
ZhongWLiuRChengH, et al.Longer-term effects of cardiac telerehabilitation on patients with coronary artery disease: systematic review and meta-analysis. JMIR Mhealth Uhealth2023; 11: e46359.
7.
EhsaniAAHeathGWHagbergJM, et al.Effects of 12 months of intense exercise training on ischemic ST-segment depression in patients with coronary artery disease. Circulation1981; 64: 1116–1124.
8.
RamachandranHJJiangYTamWWS, et al.Effectiveness of home-based cardiac telerehabilitation as an alternative to phase 2 cardiac rehabilitation of coronary heart disease: a systematic review and meta-analysis. Eur J Prev Cardiol2022; 29: 1017–1043.
9.
WangLLiuJFangH, et al.Factors associated with participation in cardiac rehabilitation in patients with acute myocardial infarction: a systematic review and meta-analysis. Clin Cardiol2023; 46: 1450–1457.
10.
TianYDengPLiB, et al.Treatment models of cardiac rehabilitation in patients with coronary heart disease and related factors affecting patient compliance. Rev Cardiovasc Med2019; 20: 27–33.
11.
BakhshayehSSarbazMKimiafarK, et al.Barriers to participation in center-based cardiac rehabilitation programs and patients’ attitude toward home-based cardiac rehabilitation programs. Physiother Theory Pract2021; 37: 158–168.
12.
XiaoMLiYGuanX. Community-based physical rehabilitation after percutaneous coronary intervention for acute myocardial infarction. Tex Heart Inst J2021; 48: e197103.
13.
PaivaMCCastroAAMCarvalhoPF, et al.Effectiveness of cardiac rehabilitation with mHealth through smartphone functionalities: a systematic review protocol. CJC Open2024; 6: 672–676.
14.
CaneJO’ConnorDMichieS. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci2012; 7: 37.
15.
MichieSvan StralenMMWestR. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci2011; 6: 42.
16.
LeeLSBanksLOhPI, et al.Capturing the perspectives of women with coronary artery disease regarding interval training or continuous exercise in cardiac rehabilitation. Disabil Rehabil2022; 44: 68–78.
17.
TongASainsburyPCraigJ. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care2007; 19: 349–357.
18.
ThorneSKirkhamSRMacDonald-EmesJ. Interpretive description: a noncategorical qualitative alternative for developing nursing knowledge. Res Nurs Health1997; 20: 169–177.
19.
GuestGNameyEChenM. A simple method to assess and report thematic saturation in qualitative research. PLoS ONE2020; 15: e0232076.
20.
NelsonJ. Using conceptual depth criteria: addressing the challenge of reaching saturation in qualitative research. Qual Res2016; 17: 554–570.
21.
DuhiggC. The Power of Habit: Why We Do What We Do in Life and Business. New York, USA: Random House, 2012.
22.
JohnstonDWJohnstonMPollardB, et al.Motivation is not enough: prediction of risk behavior following diagnosis of coronary heart disease from the theory of planned behavior. Health Psychol2004; 23: 533–538.
23.
GodinGValoisPJobinJ, et al.Prediction of intention to exercise of individuals who have suffered from coronary heart disease. J Clin Psychol1991; 47: 762–772.
24.
SunYXuJHeZ, et al.Clinical features of ST-segment elevation myocardial infarction in young Chinese patients. Cardiol J2023; 30: 627–635.
25.
RatanapoSSukonthasarnAPromlikitchaiP, et al.Clinical characteristics and outcomes of percutaneous coronary intervention in octogenarians: real-world data from nationwide Thai PCI registry. BMJ Open2025; 15: e086945.
26.
ThompsonGWilsonIMDavisonGW, et al.“Why would you not listen? It is like being given the winning lottery numbers and deciding not to take them”: semi-structured interviews with post-acute myocardial infarction patients and their significant others exploring factors that influence participation in cardiac rehabilitation and long-term exercise training. Disabil Rehabil2022; 44: 4750–4760.
DingYPanYWangM, et al.Factors influencing kinesiophobia during the “blanking period” after radiofrequency catheter ablation in patients with atrial fibrillation by the fear-avoidance model. Int J Cardiol2022; 363: 49–55.
29.
NiYWenYBaoY, et al.Nurses’ perspectives on the barriers to and facilitators of the implementation of secondary prevention for people with coronary heart disease: a qualitative descriptive study. BMJ Open2022; 12: e063029.
30.
ZhangXSunLXuZ, et al.Research progress on risk-benefit perception in exercise rehabilitation of patients with coronary heart disease. Nurs Res2023; 37: 4071–4074.
31.
WangY. Intergenerational cooperative parenting of urban families in transitional period. Sociol Rev China2020; 8: 85–97.
32.
GigginsOMDoyleJSmithS, et al.Remotely delivered cardiac rehabilitation exercise for coronary heart disease: nonrandomized feasibility study. JMIR Cardio2023; 7: e40283.
33.
MartijnSMaartenFDanielleZ, et al.Psychosocial predictors for cardiac rehabilitation participation for patients with coronary artery disease. Int J Cardiol2023; 376: 18–21.
34.
AchttienRJVromenTStaalJB, et al.Development of evidence-based clinical algorithms for prescription of exercise-based cardiac rehabilitation. Neth Heart J2015; 23: 563–575.
35.
TuomistoSKoivulaMÅstedt-KurkiP, et al.Family involvement in rehabilitation: Coronary artery disease-patients' perspectives. J Clin Nurs2018; 27: 3020–3031.
