Maintaining physical activity following myocardial infarction: a qualitative study

Abstract

Background: Outcomes following myocardial infarction (MI) are improved by uptake and maintenance of physical activity (PA), but little is understood regarding patients experience of maintaining an active lifestyle once immediate support, such as cardiac-rehabilitation (CR), has ended. Aim: The purpose of this study was to investigate MI survivors’ attitude and appraisal towards PA and the perceived barriers, motivators and facilitators for maintaining PA long-term. Methods: Semi-structured interviews were carried out with 18 adults (mean age 60.5, range 37–73 years) from England and Scotland, who were a minimum of 5 months post-MI (mean 29 months, range 5–122 months). There were comparatively more male participants (n = 13, 72 %) than female (n = 5, 28 %). Overall 12 (67 %) participants had attended CR. The interviews were transcribed verbatim and thematic analysis was performed using qualitative data analysis software NVivo. Results: Data analysis indicated that the following four core themes influenced MI survivors’ behaviour and attitude towards PA: (1) MI as a teachable moment for behaviour change, (2) affective response to MI: enjoyment versus fear, (3) cognitive response to MI: self-perception, attitude and self-efficacy, and (4) access to support and resources, including PA facilities and social support. Participants highlighted a lack of available guidance on maintaining PA behaviour change following CR and that advice on the frequency and intensity of exercise to follow was often unclear and confusing. Feelings of vulnerability and fear of overexertion were apparent, affecting participants self-efficacy to exercise. Conclusions: Current CR programmes fail to address PA belief systems and perceptions of self-efficacy to exercise. Interventions that address feelings of vulnerability and fear of overexertion may be beneficial. Providing ongoing PA advice and access to social support may facilitate patients to maintain changes in PA.