The STRENGTH Study: Self-management and Theory-based Rehabilitation Encouraging New Gateways To Healthy Hearts

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Coronary heart disease is one of the leading causes of death in the UK and puts significant burden on both the healthcare system and economy. Cardiac rehabilitation programs, which include exercise and healthy lifestyle support, can help people recover and stay healthy after heart problems. The STRENGTH study looked at whether adding extra behaviour change support to cardiac rehabilitation could help people stay more physically active over time. Researchers worked with 96 people attending community-based cardiac rehabilitation classes and compared those receiving standard care with those given additional support to manage their own activity levels.

Physical activity was measured using a wearable activity tracker. After six months, there was no clear difference in activity levels, quality of life, or wellbeing between the two groups. One reason may be that participants were already quite active at the start, and both groups received strong ongoing rehab support, which might have reduced the impact of the added intervention.

This study also explored people’s experiences of taking part in a cardiac rehabilitation program and how different factors influenced their ability to stay physically active over time. Researchers interviewed participants from both the regular rehabilitation group and the group that received added support. They also ran group focus group with those who got the extra help. People in both groups said that support from others, guidance from professionals, and having a structured routine were important motivators.

Many found that exercising with peers and having trainers around made them feel safer and more confident:

“Well eh if I’m honest with you, the instructors fantastic. He makes you want to come back because he’s very, he’s very good, he’s very, he’s top, he’s brilliant at what he does.” P3

“The fact that we are together in a group makes a difference, the sense of social for me is very important. So that’s the difference you know.” P2

Those who received the added behaviour support said it helped by giving them personalised advice, tools to track progress, and a stronger sense of responsibility to stay active. The extra support helped boost confidence and made people more aware of how much they were moving. However, some still felt unsure about exercising on their own, which could hold them back from staying active long-term.

To conclude, while behaviour change strategies may help people feel more engaged in cardiac rehabilitation, their effect on physical health results isn’t always clear. Building confidence and providing good education may be key to helping people keep up long term healthy habits.

Two manuscripts are currently under review, and the team are currently developing further research to explore how best to support the maintenance of physical activity in the cardiac population.