Physical Activity Level and Perspectives of Participants Transitioning from Onsite to Virtual Cardiac Rehabilitation during the Early COVID-19 Pandemic: A Mixed-Method Study

Abstract

This mixed-method study aimed to compare physical activity (PA) patterns of a cross-over cardiac rehabilitation (CR) cohort with a center-based CR cohort and to explore barriers and facilitators of participants transitioning and engaging in virtual CR. It included the retrospective self-reported PA of a cross-over CR cohort (n = 75) and a matched center-based CR cohort (n = 75). Some of the participants included in the cross-over cohort (n = 12) attended semi-structured focus group sessions and results were interpreted in the context of the PRECEDE-PROCEED model. Differences between groups were not observed (p > 0.05). The center-based CR cohort increased exercise frequency (p = 0.002), duration (p = 0.007), and MET/minutes (p = 0.007) over time. The cross-over cohort increased exercise duration (p = 0.04) with no significant change in any other parameters. Analysis from focus groups revealed six overarching themes classified under predisposing factors (knowledge), enabling factors (external support, COVID-19 restrictions, mental health, personal reasons/preferences), and reinforcing factors (recommendations). These findings suggest an improvement of the PA levels of center-based CR cohort participants pre-pandemic and mitigated improvement in those who transitioned to a virtual CR early in the pandemic. Improving patients’ exercise-related knowledge, provider endorsements, and the implementation of group videoconferencing sessions could help overcome barriers to participation in virtual CR.

Exercise Adherence in Older and Middle-Aged Adults With Coronary Artery Disease Before and During COVID-19

“…Increased preventative health education and exercise prescriptions for individuals showing early signs of CVD risk factors might help to encourage individuals to begin implementing an active lifestyle before a major cardiac event occurs or, in some cases, reoccurs. Alternative CR education and program delivery modalities need to continue to be trialed and evaluated in communities to include reimbursable remote or telehealth options, as well as mobile communication follow-ups via text or automated calls, especially when community resource access is limited as with the pandemic 23,74,75 . However, considerations for individuals in both low-income households and rural communities that may not have equitable access to technology would need to be addressed.…”

“…Alternative CR education and program delivery modalities need to continue to be trialed and evaluated in communities to include reimbursable remote or telehealth options, as well as mobile communication follow-ups via text or automated calls, especially when community resource access is limited as with the pandemic. 23,74,75 However, considerations for individuals in both low-income households and rural communities that may not have equitable access to technology would need to be addressed.…”