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Updated: May 11, 2026
A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Barriers to cardiac rehabilitation use in Canada versus Brazil
Gabriela Lima de Melo Ghisi1, Paul Oh, Magnus Benetti
1Exercise Sciences Department, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada. Gabriela.meloghisi@utoronto.ca
Purpose:
Despite its well-established benefits, cardiac rehabilitation (CR) is greatly underutilized globally. Barriers to its utilization have been identified in high-income countries. Given the growing epidemic of noncommunicable diseases in low- to middle-income countries, the identification of barriers to use of these low-cost interventions is warranted. The aim of this study was to describe and compare barriers to CR use in Brazilian and Canadian cardiac outpatients.
Methods:
Two cardiac samples consisting of 237 Brazilian (recruited from 2 CR centers in southern Brazil) and 1434 Canadian (recruited from 11 community and academic hospitals in Ontario) outpatients were compared cross-sectionally. Barriers were assessed by using the Cardiac Rehabilitation Barriers Scale, psychometrically validated in English and Portuguese. Mann-Whitney U tests were used to compare barriers between samples.
Results:
Overall, 139 (58.6%) Brazilian and 779 (54.3%) Canadian respondents were enrolled in CR. The mean total barriers score for Brazilian respondents was 1.71 ± 0.63, and 2.37 ± 1.0 (P < .01) for the Canadians. For 17 of 21 barriers, Canadians reported significantly greater barriers than Brazilians (P < .02). As their greatest barriers, Canadians rated already exercising at home or in the community and personal travel, while Brazilians identified distance to and cost of the CR program.
Conclusion:
Despite the significantly lower availability of CR in Brazil and the universal health care system in Canada, cardiac outpatients in Canada perceived significantly greater CR barriers. Arguably, however, these barriers were more modifiable.
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