Related Experiment Video
Updated: May 7, 2026
A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Perceptions of barriers to cardiac rehabilitation use in Brazil
Gabriela Lima de Melo Ghisi1, Rafaella Zulianello dos Santos, Eduardo Eugênio Aranha
1Exercise Sciences Department, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada. Gabriela.meloghisi@utoronto.ca
Insights
Barriers to cardiac rehabilitation (CR) enrollment and participation are higher for nonattendees compared to attendees in Brazil. Addressing these barriers, such as distance and work conflicts, is crucial for increasing CR access.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Cardiovascular diseases (CVD) are a leading cause of mortality in middle-income nations like Brazil.
- Access to cardiac rehabilitation (CR), a proven CVD service, is inconsistent due to Brazil's diverse healthcare systems.
Purpose of the Study:
- To identify and contrast multilevel barriers to CR enrollment and participation.
- The study examined three distinct Brazilian cohorts: non-attending cardiac outpatients (public/private), paying cardiac outpatients, and high-risk residents not utilizing free exercise programs.
Main Methods:
- A survey using the Cardiac Rehabilitation Barriers Scale was administered to Brazilian residents in urban (Florianopolis) and rural (Luzerna) settings.
- Mann-Whitney U tests were employed for cross-sectional comparisons of barriers between the defined cohorts.
Main Results:
- A total of 628 participants were analyzed, with 237 from Florianopolis and 391 from Luzerna.
- CR nonattendees in Florianopolis reported higher barriers related to distance and awareness, while Luzerna participants faced more work and family-related obstacles.
- Significant differences in total CR barriers were observed across the cohorts (P < 0.001).
Conclusions:
- Individuals not participating in CR reported substantially greater barriers than those who attended.
- Future CR program development should focus on mitigating identified barriers to improve access and uptake.
Unlabelled:
Cardiovascular diseases (CVD) are the leading cause of mortality in middle-income countries, such as Brazil. However, given the diversity in health care systems in Brazil, access to proven services, such as cardiac rehabilitation (CR), varies widely.
Purpose:
To describe and compare multilevel barriers to CR enrollment and participation in three Brazilian cohorts: (1) cardiac outpatients not attending CR (public or private system); (2) cardiac outpatients paying for CR; and (3) residents at high-risk of CVD with access to a free comprehensive exercise program but not making use of the program.
Methods:
Brazilian residents from two cities were invited to participate - Florianopolis, an urban center; and Luzerna, a rural center. Respondents completed a survey including the Cardiac Rehabilitation Barriers Scale. Mann-Whitney U tests were used to compare barriers between cohorts cross-sectionally.
Results:
Six hundred twenty-eight Brazilians consented to participate: 237 (37.7%) from Florianopolis, of which 139 (22.1%) participated in CR; and 391 (62.3%) from Luzerna. The mean total CR barriers for the sample were 1.66 ± 0.6 and differed significantly by cohort (P < 0.001). CR nonattendees from Florianopolis (eg, distance and not knowing about CR) and participants from Luzerna (eg, work and family responsibilities) reported significantly higher barriers than CR attendees from Florianopolis.
Conclusion:
CR nonattendees reported significantly greater barriers than CR attendees. It is hoped that the provision of CR will increase, and that the development of the programs will be in a manner which mitigates the chief barriers identified herein.
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