ORIGINAL RESEARCH article
Front. Rehabil. Sci.
Sec. Strengthening Rehabilitation in Health Systems
Volume 6 - 2025 | doi: 10.3389/fresc.2025.1659925
This article is part of the Research TopicMotivations For Physical Activity - Volume IVView all 18 articles
Barriers to Physical Activity and Patient Profiling in the Lifelong Maintenance Phase of Coronary Artery Disease: A Territorial Mixed-Methods Pilot Study
Provisionally accepted
- ESPACE DEV, Universite de Perpignan Via Domitia, Perpignan, France
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Introduction: Despite proven benefits, adherence to physical activity (PA) during the lifelong maintenance phase of cardiac rehabilitation (CR) remains suboptimal. Understanding territorial-specific barriers is essential for developing targeted interventions. This pilot study aimed to (1) identify principal barriers to PA among coronary artery disease (CAD) patients in lifelong maintenance Phase CR in a specific territory of southern France, and (2) characterize distinct patient profiles using unsupervised machine learning. Methods: Socio-demographic data, completion of a full Phase II CR and behavioral characteristics related to PA during the lifelong maintenance Phase were collected with a LimeSurvey questionnaire. A modified Delphi method was employed with CAD patients (n=26, subsequently, n=13 in round 2) who had completed a supervised Phase II CR. Barriers were categorized and ranked using Likert scales. K-means clustering analysis was then applied to identify homogeneous patient subgroups based on barrier patterns. Results: Nine barrier categories emerged, with environment (8.3±1.0), motivation (7.7±1.4), and exercise tolerance (6.3±1.2) ranking highest. Kendall's W=0.64 (p<0.001) indicated a significant consensus. Three cluster were identified: Cluster 1 (38.46%) characterized by physical deconditioning; Cluster 2 (23.07%) by environmental and motivational constraints; Cluster 3 (38.46%) by organizational limitations. Significant between-cluster differences were observed for: environmental barriers (H = 7.82, p = 0.02), motivation (H = 8.14, p = 0.017), and professional obligations (H = 6.93, p = 0.031). Conclusion: This mixed-methods approach revealed complex, interrelated barriers to PA maintenance. The identification of distinct CAD patient profiles suggests that personalized intervention strategies, rather than one-size-fits-all approaches, may enhance long-term adherence to PA in lifelong maintenance Phase CR.
Keywords: cardiac rehabiliation, physical activity, lifelong maintenance phase, Coronary Artery Disease, machine learning, Delphi method
Received: 07 Jul 2025; Accepted: 15 Sep 2025.
Copyright: © 2025 Molina, Durand and Meric. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Fabienne Durand, fdurand@univ-perp.fr
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