Acceptability of a high-protein Mediterranean-style diet and resistance exercise protocol for cardiac rehabilitation patients: Involving service users in intervention design using a mixed-methods participatory approach

Abstract

BackgroundCurrent cardiac rehabilitation (CR) practices focus on aerobic-style exercise with minimal nutrition advice. This approach may not be optimal for CR patients with reduced muscle mass and elevated fat mass. Higher protein, Mediterranean-style diets combined with resistance exercise (RE) may improve muscle mass and reduce the risk of future cardiovascular events, although such an approach is yet to be trialed in a CR population.ObjectiveWe explored patient perspectives on the proposed design of a feasibility study. Patients reflected on the acceptability of a proposed high-protein Mediterranean-style diet and RE protocol, emphasizing research methodology and the acceptability of the proposed recipes and exercises.DesignWe applied quantitative and qualitative (mixed methods) approaches. The quantitative approach involved an online questionnaire (n = 40) regarding the proposed study methodology and relevance. A subset of participants (n = 12) received proposed recipe guides and were asked to prepare several dishes and complete an online questionnaire regarding their experience. Another subset (n = 18) received links to videos of the proposed RE and completed a questionnaire regarding their impressions of them. Finally, semi-structured interviews (n = 7) were carried out to explore participants’ impressions of the proposed diet and exercise intervention.ResultsQuantitative data indicated a high level of understanding of the intervention protocol and its importance within the context of this research. There was a high degree of willingness to participate in all aspects of the proposed study (>90%). The trialed recipes were enjoyed and found to be easy to make by a majority of participants (79 and 92.1%, respectively). For the proposed exercises 96.5% of responses agreed they would be willing to perform them and, 75.8% of responses agreed they would enjoy them. Qualitative analysis revealed that participants viewed the research proposal, diet, and exercise protocol in a positive light. The research materials were considered appropriate and well explained. Participants suggested practical recommendations for improving recipe guides and requested more individual-focused exercise recommendations, and more information on the specific health benefits of the diet and exercise protocols.ConclusionThe study methodology and the specific dietary intervention and exercise protocol were found to be generally acceptable with some suggested refinements.

Impacto de un programa de rehabilitación cardiaca en la adherencia a la dieta mediterránea y la actividad física en el síndrome coronario agudo

“…La motivación para cambiar los hábitos puede estar relacionada con el desconocimiento de los pacientes sobre los hábitos de vida saludable, y su motivación aumenta cuando se les proponen programas detallados de recomendaciones nutricionales (recetas) o de ejercicio físico (recomendaciones personalizadas de ejercicio) 21 . El grado de motivación predice de manera directamente proporcional los niveles de consumo de oxígeno al final del PRC en pacientes ancianos 22 , y la promoción de la autonomía, la competencia y una buena relación terapéutica motivan al paciente y predicen su adherencia al programa 23 .…”

Exploring high-protein diets in the context of cardiac rehabilitation

“…Multimodal interventions including concurrent exercise training and appropriate nutrition are hypothesised to be the most effective. The current author is leading a study investigating an HPD Mediterraneanstyle diet, the protein Mediterranean-style diet and resistance exercise in cardiac rehabilitation patients with sarcopoenic obesity study (75,76) , which is currently in the pilot phase. The results from this study are anticipated to offer a deeper understanding of a multimodal intervention of an HPD Mediterranean-style diet pattern with RE, and its potential impact on sarcopoenia and CM risk in those attending CR.…”