Moving beyond cardiac rehabilitation: A qualitative study exploring patient and clinician preferences for incorporating physical activity advice during and after phase II cardiac rehabilitation.

Abstract

This study sought to understand how physical activity advice is delivered and used to support patients with coronary heart disease (CHD) as they transition from supported secondary prevention programs, like cardiac rehabilitation, to independent self-management and provide practical considerations for decision makers and treating clinicians delivering physical activity advice. Using interpretive description, data were gathered, including semi-structured interviews and researcher observations across five phase II cardiac rehabilitation programs delivered in hospital outpatient departments. Thirty-eight interviews were conducted with patients attending cardiac rehabilitation and treating clinicians. The overarching theme of 'moving beyond cardiac rehabilitation' reflected the dynamic relationship between patients and clinicians working together to practically apply physical activity advice, supporting the transition from supported to self-managed physical activity. Findings conveyed a shared preference for physical activity advice to be incorporated into cardiac rehabilitation in a manner that builds an understanding of physical activity, can be flexibly tailored, includes personalised feedback, and is repeated over time to support the development of physical activity skills. Diversity in experiences of physical activity and cardiac rehabilitation highlighted the need for a tailored approach to physical activity advice that was largely facilitated by including physical activity measurement. Study findings highlight the need to consider the preferences of both patients and clinicians to effectively deliver physical activity advice and support self-management. Tailored advice and feedback, facilitated by physical activity measurement, can guide clinical conversations and strengthen communication and the working alliance between patients and clinicians. Additionally, tailoring physical activity advice should be considered to facilitate the transition from supported to self-managed physical activity. Physical activity measurement repeated over time can be used to guide clinical conversations, including tailoring physical activity advice and feedback, to support patients with CHD to develop their physical activity skills for independent self-management following cardiac rehabilitation.