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Review
. 2025 May 22:18:2825-2844.
doi: 10.2147/JMDH.S511196. eCollection 2025.

Barriers and Facilitators to Adherence to Exercise-Based Cardiac Rehabilitation Among Coronary Artery Disease Patients: A Scoping Review

Xinqi Zhao #  1 , Shi Zhang #  2 , Fan Zhang  2 , Xinyu Wu  1 , Zhe Zhang  1 , Yue Liu  2 , Junwen Jiang  2 , Zheng Li  2 , Siqi Li  2 , Sicheng Zheng  2 , Xiao Yang  3 , Xing Ju  1 , Hang Li  4 , Lihong Gong  2 , DeZhao Kong  2   5   6
Affiliations
Review

Barriers and Facilitators to Adherence to Exercise-Based Cardiac Rehabilitation Among Coronary Artery Disease Patients: A Scoping Review

Xinqi Zhao et al. J Multidiscip Healthc. .

Abstract

Background: Exercise-based Cardiac Rehabilitation (EBCR) is widely recognized as a crucial intervention for improving the health outcomes of patients with coronary artery disease (CAD). However, its implementation remains insufficient in many regions, and patient adherence to EBCR is generally low. This limitation hinders the full potential of rehabilitation, necessitating a deeper exploration of the factors influencing exercise adherence and the development of targeted intervention strategies.

Objective: This study aims to identify the barriers and facilitators affecting ERCR adherence among CAD patients and provide intervention recommendations for clinical practice.

Methods: A systematic search was conducted across nine databases, including PubMed, Cochrane Library, Embase, Web of Science, EBSCO, CNKI, Wanfang, VIP, and CBM. Using the Theoretical Domains Framework and the COM-B model, a thematic analysis was performed to categorize influencing factors identified in the included studies. These factors were mapped onto the Behaviour Change Wheel, and the APEASE criteria were applied to determine appropriate intervention functions. Finally, Behaviour Change Techniques were matched to these intervention functions.

Results: Seventeen studies were included, identifying multiple core domains of the Theoretical Domains Framework influencing EBCR adherence. The most significant domains were social influences, beliefs about consequences, and environmental context and resources. The primary barrier was patients' negative attitudes toward EBCR, whereas the most prominent facilitator was a strong social support network.

Conclusion: This study systematically analyzed the determinants of EBCR adherence based on the Theoretical Domains Framework and COM-B model, constructing theoretically supported intervention strategies and providing new insights for optimizing EBCR implementation. Through precise Behaviour Change Techniques mapping, the proposed personalized interventions can enhance patients' motivation for rehabilitation, improve EBCR adherence, and offer empirical support for future EBCR intervention design and implementation.

Keywords: adherence; barriers; behavior change technique; behavior change wheel; exercise-based cardiac rehabilitation; facilitators; theoretical domain framework.

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Conflict of interest statement

The authors have no conflicts of interest to declare for this work.

Figures

Figure 1
Figure 1
Study Screening Flowchart.
Figure 2
Figure 2
Integration of TDF domains in the COM-B model.
See this image and copyright information in PMC

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