Barriers and facilitators to physical activity after transcatheter aortic valve replacement: A mixed-methods study

Authors

  • Zhiyun Shen Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
  • Xiaojue Qian Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
  • Chenxu Huang Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
  • Daxin Zhou Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
  • Xiaohua Xu Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
  • Jiaying Lv Analytics, Novartis China, Shanghai, China
  • Ying Lin Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
  • Yuxia Zhang Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China

DOI:

https://doi.org/10.2340/jrm.v57.39974

Keywords:

cardiac rehabilitation, exercise, physical activity, transcatheter aortic valve replacement

Abstract

Objective: To evaluate post-transcatheter aortic valve replacement (TAVR) physical activity and explore the factors influencing participation.

Design: A quantitatively driven sequential explanatory mixed-methods study was performed from October 2021 to February 2022 in Shanghai, China.

Patients: The study sample comprised 195 patients who underwent TAVR (58.46% men, mean age = 74.38 years.

Methods: A cross-sectional survey was conducted to assess the extent of physical activity maintenance after TAVR via the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Preliminary factors were identified via Poisson regression. Subsequently, Fogg’s behaviour model-guided targeted qualitative interviews were conducted to confirm and expand on barriers and facilitators to physical activity engagement.

Results: 93.33% of post-TAVR patients lacked regular physical activity. Fourteen barriers and facilitators were identified and grouped into motivation (health expectation, social belonging, feeling after physical activity, kinesiophobia), ability (complex forms of physical activity, misperceptions, scheduling conflicts, traffic and distance, self-regulation), and triggers (surroundings and environment, peer and family support, professional support, mobile health, internalization of exercise habits).

Conclusion: The study findings indicate low adherence to regular physical activity among patients post-TAVR. Intervention strategies that increase patients’ motivation and ability to perform physical activity and provide appropriate triggers should be further developed.

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References

Avvedimento M, Tang GHL. Transcatheter aortic valve replacement (TAVR): recent updates. Prog Cardiovasc Dis 2021; 69: 73–83.

https://doi.org/10.1016/j.pcad.2021.11.003 DOI: https://doi.org/10.1016/j.pcad.2021.11.003

Kumar V, Sandhu GS, Harper CM, Ting HH, Rihal CS. Transcatheter aortic valve replacement programs: clinical outcomes and developments. J Am Heart Assoc 2020; 9: e015921.

https://doi.org/10.1161/jaha.120.015921 DOI: https://doi.org/10.1161/JAHA.120.015921

Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J 2022; 43: 561–632. DOI: https://doi.org/10.1093/ejcts/ezac209

https://doi.org/10.1093/eurheartj/ehab395 DOI: https://doi.org/10.1093/eurheartj/ehab395

Carabello BA, Paulus WJ. Aortic stenosis. Lancet 2009; 373: 956–966.

https://doi.org/10.1016/s0140-6736(09)60211-7 DOI: https://doi.org/10.1016/S0140-6736(09)60211-7

Chung CJ, Kirtane AJ. Habitual physical activity: functional assessment in patients with severe aortic stenosis treated with TAVR. JACC Cardiovasc Interv 2019; 12: 790–792.

https://doi.org/10.1016/j.jcin.2019.03.010 DOI: https://doi.org/10.1016/j.jcin.2019.03.010

Afilalo J, Lauck S, Kim DH, Lefèvre T, Piazza N, Lachapelle K, et al. Frailty in older adults undergoing aortic valve replacement: the FRAILTY-AVR study. J Am Coll Cardiol 2017; 70: 689–700.

https://doi.org/10.1016/j.jacc.2017.06.024 DOI: https://doi.org/10.1016/j.jacc.2017.06.024

Sathananthan J, Lauck S, Piazza N, Martucci G, Kim DH, Popma JJ, et al. Habitual physical activity in older adults undergoing TAVR: insights from the FRAILTY-AVR study. JACC Cardiovasc Interv 2019; 12: 781–789.

https://doi.org/10.1016/j.jcin.2019.02.049 DOI: https://doi.org/10.1016/j.jcin.2019.02.049

Altisent OAJ, Puri R, Regueiro A, Chamandi C, Rodriguez-Gabella T, Del Trigo M, et al. Predictors and association with clinical outcomes of the changes in exercise capacity after transcatheter aortic valve replacement. Circulation 2017; 136: 632–643.

https://doi.org/10.1161/circulationaha.116.026349 DOI: https://doi.org/10.1161/CIRCULATIONAHA.116.026349

Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep 1985; 100: 126–131.

Pressler A, Förschner L, Hummel J, Haller B, Christle JW, Halle M. Long-term effect of exercise training in patients after transcatheter aortic valve implantation: follow-up of the SPORT:TAVI randomised pilot study. Eur J Prev Cardiol 2018; 25: 794–801.

https://doi.org/10.1177/2047487318765233 DOI: https://doi.org/10.1177/2047487318765233

Pressler A, Christle JW, Lechner B, Grabs V, Haller B, Hettich I, et al. Exercise training improves exercise capacity and quality of life after transcatheter aortic valve implantation: a randomized pilot trial. Am Heart J 2016; 182: 44–53.

https://doi.org/10.1016/j.ahj.2016.08.007 DOI: https://doi.org/10.1016/j.ahj.2016.08.007

Ribeiro GS, Melo RD, Deresz LF, Dal Lago P, Pontes MR, Karsten M. Cardiac rehabilitation programme after transcatheter aortic valve implantation versus surgical aortic valve replacement: systematic review and meta-analysis. Eur J Prev Cardiol 2017; 24: 688–697.

https://doi.org/10.1177/2047487316686442 DOI: https://doi.org/10.1177/2047487316686442

Structural Cardiology Professional Committee of Cardiovascular Physicians Branch of Chinese Medical Association. Expert consensus on exercise-based cardiac rehabilitation after transcatheter aortic valve replacement. Chin J Intervent Cardiol 2020; 28: 361–368.

https://doi.org/10.3969/j.issn.1004-8812.2020.07.001

Sibilitz KL, Berg SK, Rasmussen TB, Risom SS, Thygesen LC, Tang L, et al. Cardiac rehabilitation increases physical capacity but not mental health after heart valve surgery: a randomised clinical trial. Heart 2016; 102: 1995–2003.

https://doi.org/10.1136/heartjnl-2016-309414 DOI: https://doi.org/10.1136/heartjnl-2016-309414

Pressler A. Cardiac rehabilitation after transcatheter aortic valve implantation: growing needs in a growing population. Eur J Prev Cardiol 2017; 24: 685–687.

https://doi.org/10.1177/2047487317693953 DOI: https://doi.org/10.1177/2047487317693953

Genta FT. Cardiac rehabilitation for transcatheter aortic valve replacement. Clin Geriatr Med 2019; 35: 539–548.

https://doi.org/10.1016/j.cger.2019.07.007 DOI: https://doi.org/10.1016/j.cger.2019.07.007

Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines. Circulation 2021; 143: e35–e71.

https://doi.org/10.1161/cir.0000000000000932 DOI: https://doi.org/10.1161/CIR.0000000000000932

Guduguntla V, Yaser JM, Keteyian SJ, Pagani FD, Likosky DS, Sukul D, et al. Variation in cardiac rehabilitation participation during aortic valve replacement episodes of care. Circ Cardiovasc Qual Outcomes 2022; 15: e009175.

https://doi.org/10.1161/circoutcomes.122.009175 DOI: https://doi.org/10.1161/CIRCOUTCOMES.122.009175

Foster EJ, Munoz SA, Crabtree D, Leslie SJ, Gorely T. Barriers and facilitators to participating in cardiac rehabilitation and physical activity in a remote and rural population: a cross-sectional survey. Cardiol J 2021; 28: 697–706.

https://doi.org/10.5603/CJ.a2019.0091 DOI: https://doi.org/10.5603/CJ.a2019.0091

Daw P, Wood GER, Harrison A, Doherty PJ, Van Zanten JV, Dalal HM, et al. Barriers and facilitators to implementation of a home-based cardiac rehabilitation programme for patients with heart failure in the NHS: a mixed-methods study. BMJ Open 2022; 12: e060221.

https://doi.org/10.1136/bmjopen-2021-060221 DOI: https://doi.org/10.1136/bmjopen-2021-060221

Lee S, Collins EG. Factors influencing physical activity after cardiac surgery: an integrative review. Heart Lung 2021; 50: 136–145.

https://doi.org/10.1016/j.hrtlng.2020.10.004 DOI: https://doi.org/10.1016/j.hrtlng.2020.10.004

Cacciata MC, Stromberg A, Klompstra L, Jaarsma T, Kuriakose M, Lee JA, et al. Facilitators and challenges to exergaming: perspectives of patients with heart failure. J Cardiovasc Nurs 2022; 37: 281–288.

https://doi.org/10.1097/jcn.0000000000000825 DOI: https://doi.org/10.1097/JCN.0000000000000825

Platz K, Kools S, Howie-Esquivel J. Benefits, facilitators, and barriers of alternative models of cardiac rehabilitation: a qualitative systematic review. J Cardiopulm Rehabil Prev 2023; 43: 83–92.

https://doi.org/10.1097/hcr.0000000000000738 DOI: https://doi.org/10.1097/HCR.0000000000000738

Subedi D. Explanatory sequential mixed method design as the third research community of knowledge claim. Am J Educ Res 2016; 4: 570–577.

https://doi.org/10.12691/education-4-7-10

Fàbregues S, Molina-Azorín JF. Addressing quality in mixed methods research: a review and recommendations for a future agenda. Qual Quant 2017; 51: 2847–2863.

https://doi.org/10.1007/s11135-016-0449-4 DOI: https://doi.org/10.1007/s11135-016-0449-4

O'Cathain A, Murphy E, Nicholl J. The quality of mixed methods studies in health services research. J Health Serv Res Policy 2008; 13: 92–98.

https://doi.org/10.1258/jhsrp.2007.007074 DOI: https://doi.org/10.1258/jhsrp.2007.007074

Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003; 35: 1381–1395.

https://doi.org/10.1249/01.Mss.0000078924.61453.Fb DOI: https://doi.org/10.1249/01.MSS.0000078924.61453.FB

Macfarlane DJ, Lee CC, Ho EY, Chan KL, Chan DT. Reliability and validity of the Chinese version of IPAQ (short, last 7 days). J Sci Med Sport 2007; 10: 45–51.

https://doi.org/10.1016/j.jsams.2006.05.003 DOI: https://doi.org/10.1016/j.jsams.2006.05.003

Fan M, Lyu J, He P. Chinese guidelines for data processing and analysis concerning the international physical activity questionnaire. Zhonghua Liu Xing Bing Xue Za Zhi 2014; 35: 961–964.

Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health 2015; 42: 533–544.

https://doi.org/10.1007/s10488-013-0528-y DOI: https://doi.org/10.1007/s10488-013-0528-y

Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005; 15: 1277–1288.

https://doi.org/10.1177/1049732305276687 DOI: https://doi.org/10.1177/1049732305276687

Fogg BJ. Tiny habits: the small changes that change everything. Boston: Houghton Mifflin Harcourt; 2019.

Creswell JW, Clark VLP. Designing and conducting mixed methods research. Thousand Oaks, CA: Sage; 2017.

Fetters MD, Freshwater D. Publishing a methodological mixed methods research article. J Mix Methods Res 2015; 9: 203–213.

https://doi.org/10.1177/1558689815594687 DOI: https://doi.org/10.1177/1558689815594687

Fetters MD, Curry LA, Creswell JW. Achieving integration in mixed methods designs-principles and practices. Health Serv Res 2013; 48: 2134–2156.

https://doi.org/10.1111/1475-6773.12117 DOI: https://doi.org/10.1111/1475-6773.12117

Dagner V, Clausson EK, Jakobsson L. Prescribed physical activity maintenance following exercise based cardiac rehabilitation: factors predicting low physical activity. Eur J Cardiovasc Nurs 2019; 18: 21–27.

https://doi.org/10.1177/1474515118783936 DOI: https://doi.org/10.1177/1474515118783936

Yang CC, Hsu YL. A review of accelerometry-based wearable motion detectors for physical activity monitoring. Sensors (Basel) 2010; 10: 7772–7788.

https://doi.org/10.3390/s100807772 DOI: https://doi.org/10.3390/s100807772

Thomas RJ, Beatty AL, Beckie TM, Brewer LC, Brown TM, Forman DE, et al. Home-based cardiac rehabilitation: a scientific statement from the american association of cardiovascular and pulmonary rehabilitation, the American heart association, and the American college of cardiology. Circulation 2019; 140: e69–e89.

https://doi.org/10.1161/cir.0000000000000663 DOI: https://doi.org/10.1161/CIR.0000000000000663

Liu X, Fan J, Guo Y, Dai H, Xu J, Wang L, et al. Wearable smartwatch facilitated remote health management for patients undergoing transcatheter aortic valve replacement. J Am Heart Assoc 2022; 11: e023219.

https://doi.org/10.1161/jaha.121.023219 DOI: https://doi.org/10.1161/JAHA.121.023219

Lindman BR, Gillam LD, Coylewright M, Welt FGP, Elmariah S, Smith SA, et al. Effect of a pragmatic home-based mobile health exercise intervention after transcatheter aortic valve replacement: a randomized pilot trial. Eur Heart J Digit Health 2021; 2: 90–103.

https://doi.org/10.1093/ehjdh/ztab007 DOI: https://doi.org/10.1093/ehjdh/ztab007

Batalik L, Pepera G, Su JJ. Cardiac telerehabilitation improves lipid profile in the long term: insights and implications. Int J Cardiol 2022; 367: 117–118.

https://doi.org/10.1016/j.ijcard.2022.08.055 DOI: https://doi.org/10.1016/j.ijcard.2022.08.055

Antoniou V, Davos CH, Kapreli E, Batalik L, Panagiotakos DB, Pepera G. Effectiveness of home-based cardiac rehabilitation, using wearable sensors, as a multicomponent, cutting-edge intervention: a systematic review and meta-analysis. J Clin Med 2022; 11: 3772.

https://doi.org/10.3390/jcm11133772 DOI: https://doi.org/10.3390/jcm11133772

Olsson K, Nilsson J, Hörnsten Å, Näslund U. Patients' self-reported function, symptoms and health-related quality of life before and 6 months after transcatheter aortic valve implantation and surgical aortic valve replacement. Eur J Cardiovasc Nurs 2017; 16: 213–221.

https://doi.org/10.1177/1474515116650342 DOI: https://doi.org/10.1177/1474515116650342

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Published

2025-02-18

How to Cite

Shen, Z., Qian, X., Huang, C., Zhou, D., Xu, X., Lv, J., … Zhang, Y. (2025). Barriers and facilitators to physical activity after transcatheter aortic valve replacement: A mixed-methods study. Journal of Rehabilitation Medicine, 57, jrm39974. https://doi.org/10.2340/jrm.v57.39974

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