Factors influencing participation and engagement in post-stroke cardiac rehabilitation and exercise: an exploratory qualitative study

The secondary prevention benefits of cardiac rehabilitation and similar exercise classes for stroke survivors are well established, however post-stroke exercise participation remains low. This research aimed to explore the factors affecting participation and engagement in UK-based post-stroke cardiac rehabilitation and exercise, from the perspective of the service user and service provider. An exploratory study, using semi-structured interviews, was conducted (n = 8, service user = 4), adopting a phenomenological approach. All interviews applied a topic guide informed by the Health Belief Model and the International Classification of Functioning, Disability and Health, and were analysed using inductive thematic analysis. Post-stroke cardiac rehabilitation and exercise participation was influenced by numerous factors, encompassed into three themes: Accessibility (describing the environmental pre-class limiting factors), Programme Structure (valuing in-class supervision, socialisation and adaptations) and Patient Characteristics (encompassing the influence of the service user's personality and experiences). Effective secondary prevention of stroke through cardiac rehabilitation and other exercise-based rehabilitation requires policy development and commissioning to ensure appropriate delivery. Further research should determine the feasibility of novel exercise class formats, in addition to larger trials investigating their clinical benefit and cost effectiveness.