Patient and practitioner perspectives on reducing sedentary behavior at an exercise-based cardiac rehabilitation program

Abstract

Purpose: To understand the awareness of sedentary behavior, as well as the perceived facilitators and barriers to reducing sedentary behaviors from the perspectives of patients undertaking an exercise-based cardiac rehabilitation program, and from staff involved in supporting patient self-management.

Materials and methods: A qualitative study was conducted at a large cardiac rehabilitation program in a metropolitan city in Canada. Guided by an ecological framework, semi-structured interviews were conducted individually with 15 patients, and in two focus groups with six staff. Transcribed interviews were analyzed by thematic analysis.

Results: Patients placed little importance on reducing sedentary behavior as they were unconvinced of the health benefits, did not perceive themselves to be sedentary, or associated such behaviors with enjoyment and relaxation. While staff were aware of the risks, they saw them as less critical than other health behaviors. Intrapersonal factors (physical and psychosocial health) and environment factors (the information environment, socio-cultural factors) within leisure time, the home, and work, influenced sedentary behavior.

Conclusions: While these findings require further testing, future interventions may be effective if aimed at increasing awareness of the health benefits of reducing sedentary behavior, utilizing existing behavior change strategies, and using a participatory approach to tailor strategies to patients.

Implications for rehabilitation

• Cardiac rehabilitation programs effectively use exercise promotion to improve the health of people with established cardiovascular disease.

• As sedentary lifestyles become more prevalent, recommendations to reduce the health risks of prolonged sedentary behavior that are specific to the characteristics and prognostic profiles of cardiac rehabilitation patients are needed.

• Cardiac rehabilitation programs must consider extending existing behavior change strategies utilized for exercise promotion towards addressing sedentary behaviors in order to be effective at reducing the sedentary time of patients.

• A participatory approach involving both patients and health professionals can support patients in reducing their sedentary behavior by providing a supportive environment for behavior change, increasing awareness and understanding of risks, discussing the feasibility of potential strategies, and setting achievable and actionable goals.

Keywords:

• Cardiac rehabilitation
• cardiovascular diseases
• sedentary lifestyle
• qualitative research
• exercise

Disclosure statement

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. AB is supported by an Ontario Graduate Scholarship. DAA is supported with a Career Investigator Award from the Heart and Stroke Foundation of Canada. GEF is supported with a Canadian Institutes of Health Research-Public Health Agency of Canada (CIHR-PHAC) Chair in Applied Public Health. PIO is supported with a Goodlife Fitness Chair in Cardiovascular Rehabilitation and Prevention, University Health Network-Toronto Rehabilitation Institute.