From "Rational Agent” to "Bounded Rationality”: A Qualitative Study of Decision-Making Biases in Exercise Behavior Among Post-PCI Patients with Coronary Heart Disease

Background: The participation rate of exercise training among post-PCI patients with CHD is low, and their exercise behavior decisions are often influenced by bounded rationality, leading to decision-making biases. However, existing studies lack in-depth exploration. Qualitative research can provide an in-depth understanding of patients’ descriptions of their exercise behaviors and their actual experiences, thereby helping to systematically identify these decision-making biases. Objective: To explore the descriptions and related experiences of post-PCI patients with coronary heart disease regarding their own exercise behaviors, and to systematically identify the types of decision-making biases. Design: A qualitative descriptive study design. Methods: From December 2025 to February 2026, semi-structured face-to-face interviews were conducted with hospitalized post-PCI patients, and thematic analysis was used for coding and theme extraction. Results: This study enrolled 20 patients. Three major bias types (information perception bias, risk perception bias, and self-regulation bias) and eight specific manifestations. These included individual cognitive fixation, authoritative information transformation, autonomous information compensation, somatic state perception, negative reference constraint, exercise risk generalization, subjective will determination, and daily activity replacement. Conclusion: Decision-making biases have a considerable impact on exercise behaviour in post-PCI patients with CHD. This process is profoundly influenced by immediate somatic sensations, reference to others’ experiences, vague concerns about exercise risk, and the replacement of structured exercise with daily activities, leading patients to prefer decisions that afford immediate psychological safety or convenience. Keywords: coronary heart disease, PCI, exercise, behavior decision-making, decision-making bias