Family support for physical activity post‐myocardial infarction: a qualitative study exploring the perceptions of cardiac rehabilitation practitioners

Abstract Objective Physical activity and exercise are central components in rehabilitation after a myocardial infarction. Kinesiophobia (fear of movement) is a well-known barrier for a good rehabilitation outcome in these patients; however, there is a lack of studies focusing on the patient perspective. The aim of this study was to explore patients’ perceptions of kinesiophobia in relation to physical activity and exercise 2 to 3 months after an acute myocardial infarction. Methods This qualitative study design used individual semi-structured interviews. Face-to-face interviews were conducted with 21 patients post-myocardial infarction who were screened for kinesiophobia (≥32 on the Tampa Scale for Kinesiophobia Heart). The interviews were transcribed and analyzed according to an inductive content analysis. Results An overarching theme was defined as “coping with fear of movement after a myocardial infarction—a dynamic process over time” comprising 2 subthemes and explaining how coping with kinesiophobia runs in parallel processes integrating the patient’s internal process and a contextual external process. The 2 processes are described in a total of 8 categories. The internal process was an iterative process governed by a combination of factors: ambivalence, hypervigilance, insecurity about progression, and avoidance behavior. The external process contains the categories of relatives’ anxiety, prerequisites for feeling safe, information, and the exercise-based cardiac rehabilitation program. Conclusion Coping with fear of movement after a myocardial infarction is a dynamic process that requires internal and external support. To further improve cardiac rehabilitation programs, person-centered strategies that support the process of each person—as well as new treatment strategies to reduce kinesiophobia—need to be elaborated. Impact Patients with a myocardial infarction were found to be ambivalent about how they expressed their fear of movement; therefore, it is crucial for physical therapists to acknowledge signs of fear by listening carefully to the patient’s full story in addition to using adequate self-reports and tests of physical fitness. These results will inform the design, development, and evaluation of new treatment strategies, with the overall aim of reducing kinesiophobia and increasing physical activity and participation in exercise-based cardiac rehabilitation.

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Prescribed physical activity maintenance following exercise based cardiac rehabilitation: factors predicting low physical activity

European Journal of Cardiovascular Nursing ◽

10.1177/1474515118783936 ◽

2018 ◽

Vol 18 (1) ◽

pp. 21-27 ◽

Cited By ~ 3

Author(s):

Viveka Dagner ◽

Eva K Clausson ◽

Liselotte Jakobsson

Keyword(s):

Physical Activity ◽

Myocardial Infarction ◽

Cardiac Rehabilitation ◽

Binary Logistic Regression ◽

Post Myocardial Infarction ◽

Binary Logistic Regression Analysis ◽

Cardiac Rehabilitation Programme ◽

Quality Registry ◽

National Quality ◽

Exercise Programmes

Background: Physical activity is important to reduce mortality, morbidity and risk factors in patients with coronary heart disease. This report evaluates to what extent patients are still physically active following an exercise-based cardiac rehabilitation programme 12–14 months post-myocardial infarction and factors predicting why not. Methods: Data from the National Quality Registry Swedeheart with post-myocardial infarction patients ( n=368) admitted from July 2012 to November 2014 were collected with outcomes of physical activity after 12–14 months. Baseline data included demographics, clinical variables, participation in exercise programmes, prescribed physical activity, health-related quality of life and self-reported health (EQ-5D-3L/EQ-VAS). A direct binary logistic regression analysis was used to identify indicators of low physical activity. Results: Physical activity frequency per week (PA/week) was low, i.e. zero to three times, in older patients over 64 years ( P=0.00) and in those having problems with pain/discomfort (138 PA/week vs. 195) ( P=0.01), problems with mobility (60 PA/week vs.273) ( P=0.04) and anxiety/depression (128 PA/week vs. 205) ( P=0.04). Conclusion: Indicators predicting low physical activity can be used targeting improved post-myocardial infarction care outlining person-centred rehabilitation programmes and specialist nursing-led programmes.

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