Transient Ischemic Attack and Mild Stroke Participant Perspectives on Barriers and Enablers to Participation in Cardiovascular Rehabilitation

Background Exercise-based cardiac rehabilitation reduces the risk factors and recurrence of cardiovascular disease in patients with coronary heart disease. Despite similar risk factors, people with transient ischemic attack (TIA) and mild stroke do not attend cardiac rehabilitation. Cardiovascular rehabilitation (CVR), including TIA, stroke, and coronary heart disease, could be a solution for increasing participation. Perspectives from TIA and stroke survivors on barriers and enablers to participation in CVR are limited, and implementation strategies for CVR are currently unknown. Objectives We sought to determine (1) What were the perspectives of participants with TIA and mild stroke on barriers and enablers to uptake, engagement, and participation in CVR? and (2) What implementation strategies may influence people with TIA and mild stroke to participate in CVR? Methods In-depth semistructured interviews were conducted with CVR participants. Inductive thematic analysis was completed before deductively mapping themes to implementation frameworks, the Capability, Opportunity, Motivation, and Behavior Model and Theoretical Domains Framework. Results Twenty participants aged 73 ± 11 years were interviewed. Most were men, stroke survivors, tertiary educated, and retired. Six themes were generated to explain the barriers and enablers to CVR participation. Themes and subthemes mapped to 8 Theoretical Domains Framework domains and 5 Capability, Opportunity, Motivation, and Behavior constructs. Prioritizing participants' physical and social opportunities, reflective motivation, and physical and psychological capabilities may improve their participation in CVR. Conclusions Barriers and enablers to CVR participation were similar to those in the coronary heart disease population. Increasing access and availability of CVR for people with TIA and mild stroke should be prioritized for future implementation.