Edinburgh Napier University

  Background: Cardiac rehabilitation (CR) is an effective therapy to reduce the risk of hospital readmission after an acute coronary syndrome (ACS) diagnosis. Despite this, half of eligible individuals do not engage. The reasons for this are complex and include patient-level barriers such as beliefs about being already active. Indeed, up to 40% of eligible individuals report meeting physical activity (PA) guidelines prior to attendance, yet little is known about how this influences CR engagement decisions. Therefore, the aim of this thesis was to provide evidence about how previous experience of PA influenced PA and CR engagement after an ACS diagnosis.

Methods: Firstly, a systematic review of 12 studies, representing 388 participants from six countries, explored how previous PA experience influenced engagement with PA during CR was undertaken. Subsequently, a mixed methods explanatory sequential study included a cross-sectional element examining self-reported PA levels, illness perceptions and physical self-descriptions for 67 participants (mean age 64.2 (±10.53SD)), and a qualitative element involving telephone interviews with 26 previously active ACS survivors (aged 44-77 years).

Results: Systematic review synthesis indicated that perceptions of physical ability, exercise self-reliance, severity of cardiac condition and fitness identity influenced perceived CR need. In the mixed-methods study, perceptions of previous PA levels influenced PA engagement decisions after an ACS diagnosis and during CR. Most participants (n=50, 74.6%) self-reported being at least moderately active and self-concept for being active predicted self-reported PA prior to CR. Participants understood ‘being active’ through the lens of previous PA and self-evaluation of health. CR communication and peer comparisons influenced engagement decisions and motivation for fitness goals. Individuals who self-reported being at least moderately active required CR support to increase PA intensity levels after an ACS diagnosis.

Conclusions: ACS survivors conceptualise “being active” based on previous PA experience and these preconceptions influence future fitness goals.