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A Comparison of Barriers to Use of Home- Versus Site-Based Cardiac Rehabilitation

Shanmugasegaram, Shamila MSc; Oh, Paul MD, MSc, FRCPC; Reid, Robert D. PhD, MBA; McCumber, Treva MScN; Grace, Sherry L. PhD

Journal of Cardiopulmonary Rehabilitation and Prevention: September/October 2013 - Volume 33 - Issue 5 - p 297–302
doi: 10.1097/HCR.0b013e31829b6e81
Brief Reports

PURPOSE: Despite the established benefits of cardiac rehabilitation (CR), it remains significantly underutilized. It is unknown whether patient barriers to enrollment and adherence are addressed by offering choice of program type. The purpose of this study was to examine barriers to participation in CR by program type (site- vs home-based program) and the relation of these barriers to degree of program participation and exercise behavior.

METHODS: One thousand eight hundred nine cardiac patients from 11 hospitals across Ontario completed a sociodemographic survey inhospital, and clinical data were extracted from medical records. They were mailed a followup survey 1 year later, which included the Cardiac Rehabilitation Barriers Scale and the Physical Activity Scale for the Elderly. Participants were also asked whether they attended CR, the type of program model attended, and the percentage of prescribed sessions completed.

RESULTS: Overall, 939 patients (51.9%) participated in CR, with 96 (10.3%) participating in a home-based program. Home-based participants reported significantly greater CR barriers, including distance, than site-based participants (P < .001). Mean barrier scores were significantly and negatively related to session completion and physical activity among site-based (Ps < .05), but not home-based (NS), CR participants.

CONCLUSION: The barriers to CR are significantly different among patients attending site- versus home-based programs, suggesting appropriate use of alternative models of care. Patient preferences should be considered when allocating patients to program models. Once in CR, programs should work toward identifying and tackling barriers among site-based participants.

This cross-sectional study examined barriers to participation in cardiac rehabilitation (CR) in patients attending home- versus site-based programs. Home-based CR participants reported significantly greater barriers to CR utilization, particularly distance, than site-based CR participants. Results suggest that program model allocation is being appropriately undertaken to promote CR use.

York University, Toronto (Ms Shanmugasegaram and Dr Grace), University Health Network Toronto Rehabilitation Institute, Toronto (Drs Oh and Grace), University of Ottawa Heart Institute, Ottawa (Dr Reid), and Mackenzie Health, Toronto (Ms McCumber and Dr Grace), Ontario, Canada.

Correspondence: Sherry L. Grace, PhD, York University, Bethune 368, 4700 Keele St, Toronto, ON M3J 1P3, Canada (

The authors declare no conflicts of interest.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins