“What do we think?”: a qualitative exploratory study of acceptability and experiences of individuals with resistant hypertension after completing a physical exercise program (the EnRICH trial)

Abstract

Purpose

Aerobic exercise training programs decrease blood pressure in individuals with resistant hypertension. However, participants’ experiences regarding exercise training participation are unknown and often undervalued. Therefore, participant’s experiences and program acceptability of the exercise arm of the EnRicH trial, a randomized clinical trial investigating the effect of a 12-week aerobic exercise training program in individuals with resistant hypertension were analysed.

Methods

An exploratory qualitative study was conducted with twenty individuals with resistant hypertension (11 males, mean age 58.9 ± 8.9 years), after the exercise program. Four focus group interviews were performed to explore participants’ perspectives. The interviews were digitally audio-recorded, transcribed verbatim, and subjected to thematic analysis.

Results

Five themes emerged from the data analyses: 1) main impacts of participating in the exercise program; 2) facilitators of adherence; 3) perceived barriers; 4) perception of the program structure; and 5) global satisfaction with the program. Positive physical and emotional changes were reported, associated with reduced perceived stress and irritability, and decreased blood pressure. Adherence to the exercise program was facilitated by personalized supervision and feedback, the personal commitment to attend the training sessions, and different schedule options. Lack of motivation, peer support, physical health limitations, and difficulty in conciliating schedules were identified as barriers to the maintenance of exercise training after the program.

Conclusion

The qualitative analysis demonstrates the acceptability of the program. Peer and health professional’s support, commitment to health professionals, and boosting individual-perceived advantages are key-points to promote participants adherence.

IMPLICATIONS FOR REHABILITATION

• Exercising in small groups seems to provide peer support, facilitating maintenance of exercise training

• Providing feedback on the health gains achieved by participants is important to increase adherence to exercise

• Establishing good and empathic communication between health professionals and participants facilitates adherence to exercise training

• Providing personal nutritional counselling may improve patient satisfaction

• Individually tailored exercise programs may facilitate exercising for participants with physical limitations

• Providing different training schedules may increase adherence and maintenance of exercise training.

Graphical Abstract

Keywords:

• acceptability
• exercise training
• resistant hypertension
• qualitative study

Interview script

1. Impact and Changes:

   1. What impact did participating in this exercise program have on your lives? What changed in your lives after participating in the program?

   2. Did you experience any benefits? And downsides? In what ways did these benefits/downsides manifest? Physical, Psychological, Emotional?

   3. By the way, what motivated you to participate in this study/program?

2. Continuing Exercise:

   1. Now that the program has ended, have you continued to engage in physical exercise?

   2. If yes, why? What helps/facilitates/motivates you to continue? Do you think participating in the program was important for maintaining this continuity?

   3. If no, why not? What obstacles do you face?

3. Program Evaluation:

   1. What is your opinion of this program? What did you think of the program’s format in terms of duration, sessions, and where it took place?

   2. What aspects did you particularly like? And dislike? Did you experience any difficulties/awkwardness during the program? If so, what were they?

   3. Suggestions for improvement: If you could change something about the program, what would it be? (e.g., schedule, number of sessions, location, etc.)?

   4. Would you recommend the program to someone in similar circumstances to yours? Why?

   5. If the program were to continue, would you be willing to maintain your participation? Why?

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was funded by the European Union through the European Regional Development Fund Operational Competitiveness Factors Program (COMPETE) and by the Portuguese government through the Foundation for Science and Technology (grants P2020-PTDC/DTP-DES/1725/2014 and POCI-01-0145-FEDER-016710). Susana Lopes was awarded with a Portuguese Foundation for Science and Technology PhD grant (grant SFRH/BD/129454/2017). Institute of Biomedicine (iBiMED; reference No. UID/BIM/04501/2020), Research Centre in Physical Activity, Health, and Leisure (CIAFEL; reference No. UID/DTP/00617/2020), and Research Centre in Sports Sciences, Health and Human Development (CIDESD; reference No. UID/DTP/04045/2020) are research units supported by the Portuguese Foundation for Science and Technology.