Are the benefits of phase II cardiac rehabilitation maintained after 6-months? A mixed-methods investigation into the barriers and facilitators of lifestyle behaviour modification following cardiac rehabilitation program completion.

Abstract

Aim: To investigate whether improvements achieved in Phase II cardiac rehabilitation (CR) are maintained 6 months following program completion and barriers and facilitators to lifestyle behaviour modification adherence. Method: Twenty-four participants who were referred to and completed Phase II CR at Grampians Health Ballarat between 1 January 2022 and 31 March 2023 completed this mixed-methods observational study. The primary outcome was self-reported physical activity (PA). Secondary outcomes were 6-minute walk test (6MWT) distance, depression severity, quality of life (QoL), and barriers and facilitators to lifestyle behaviour modification adherence and dietary behaviours. Results: Self-reported PA improved by 52.3% from CR discharge to 6-months post-CR (2,264.00 minutes, 95%CI [1553.50,2974.50] vs 3448.81 minutes, 95%CI [1679.42,5218.20], respectively; p=0.142). However, a 9% reduction in PA minutes was reported between 1-month and 6-months post-CR. Improvements from CR discharge to 6-months post-CR were also observed in 6MWT distance (482.00 m, 95%CI [446.03,517.97] vs 542.53 m, 95%CI [504.73,580.31], p<0.001) and QoL (90.05%, 95%CI [84.88,95.22] vs 91.16%, 95%CI [88.12,94.20], p=0.785), by 12.6% and 1.2%, respectively. Depression severity improved by 49.2% from baseline to 6-months post-CR (7.79, 95%CI [4.96,10.63] vs 3.96, 95%CI [1.56,6.36], p=0.002). The main barriers to PA adherence were comorbid conditions and their treatments, whilst the main facilitator to continuing healthy eating and exercise behaviours was self-motivation/positive thinking. Conclusion: Positive lifestyle behaviours start to decrease 6-months following CR, primarily due to co-morbid conditions and lack of motivation. Identification of barriers and facilitators to PA and healthy eating during CR would enable individualisation of self-management strategies to improve long-term behaviour modification adherence.