Perceptions of physical activity levels after a diagnosis of acute coronary syndrome and in the context of cardiac rehabilitation

Type of funding sources: None.

Physical activity [PA] is a core component of cardiac rehabilitation [CR] but those who consider themselves active are less likely to participate. It is unclear how CR services can better engage with this group and what support they should offer to encourage a return to PA at appropriate levels.

We aimed to identify individuals from four UK CR services who considered themselves active prior to acute coronary syndrome [ACS] diagnosis and understand their PA support requirements.

A sequential mixed methods study, with data collected between October 2019 and April 2020. A quantitative survey examined self-reported PA levels, illness perceptions, and physical self-concept of ACS patients using validated questionniaires after their event but before the start of CR. Data were analysed via descriptive, correlational, and multiple regression analysis. Qualitative individual semi-structured telephone interviews were conducted with participants who self-reported to be at least moderately active. Data were thematically analysed. Data were integrated during study design and discussion stage.

Sixty-seven participants (male n=53, 79.1%) with a median age of 63 (IQR = 56-71) completed the survey. Of these, 50 (74.6%) self-reported being at least moderately active before starting CR. During regression analysis, only physical self-concept for being physically active (F (9,56)=3.59, p<.005, adjusted R2 0.26) was significantly associated with PA level. Twenty-six participants completed qualitative interviews. Participants who perceived that they were active prior to their event based this on recollections of past PA, and step count monitoring. They made decisions about whether to engage with CR based on pre-CR information and comparison with peers. Despite considering themselves to be active, this group still required support to return to PA at appropriate intensity levels to gain secondary prevention benefits. This included information about how to self-monitor intensity effectively.

CR services should recognise that ACS survivors who consider themselves to be active prior to their event require support to return to PA at appropriate levels. Support should include exploring what patients mean when they say they are active so that CR professionals are better informed to provide indivualised advice.