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Six databases were searched from inception through March 2021: APA PsycInfo, CINAHL, Embase, Emcare, Medline and PubMed. Only those studies referring to barriers and facilitators reported by CR participants were considered. Pilot and case report studies, non-peer-reviewed literature and studies published in a language other than English, Portuguese or Spanish were excluded.<\/jats:p><\/jats:sec><jats:sec id=\"S1368980021002962_as3\"><jats:title>Results:<\/jats:title><jats:p>Data were extracted and analysed on the basis of individual-, provider- and system\/environmental-level factors. Of 2083 initial citations, sixteen studies were included, with nine being qualitative and seven observational in design. From these, ten multi-level barriers and seven multi-level facilitators were identified. Dietary recommendations included developing healthy eating habits, transitioning to vegetarian-rich diets and increasing fish oil and <jats:italic>n<\/jats:italic>-3 intake. Only one study reported on all of the nutrition education programme factors recommended by the Workgroup for Intervention Development and Evaluation Research.<\/jats:p><\/jats:sec><jats:sec id=\"S1368980021002962_as4\"><jats:title>Conclusion:<\/jats:title><jats:p>To the best of our knowledge, this review is the first to summarise specific barriers and facilitators to recommendation adherence among CR participants. Few of the studies offered any conclusions regarding programme design that could facilitate improved dietary adherence practices. Future studies should aim to explore patient perspectives on the nutritional patterns and recommendations outlined in the Mediterranean Diet, the Dietary Approaches to Stop Hypertension Diet, Vegetarian or Vegan diets and the Portfolio Diet.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s1368980021002962","type":"journal-article","created":{"date-parts":[[2021,8,4]],"date-time":"2021-08-04T07:17:29Z","timestamp":1628061449000},"page":"4823-4839","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":24,"title":["Barriers and facilitators to participant adherence of dietary recommendations within comprehensive cardiac rehabilitation programmes: a systematic review"],"prefix":"10.1017","volume":"24","author":[{"given":"Lais Manata","family":"Vanzella","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Rouse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatim","family":"Ajwani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niloufar","family":"Deilami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"Pokosh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Oh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7946-3718","authenticated-orcid":false,"given":"Gabriela Lima de Melo","family":"Ghisi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2021,8,4]]},"reference":[{"key":"S1368980021002962_ref47","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1136\/jech.52.6.377","article-title":"The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions","volume":"52","author":"Downs","year":"1998","journal-title":"J Epidemiol Community Health"},{"key":"S1368980021002962_ref33","doi-asserted-by":"publisher","DOI":"10.1080\/13557858.2011.610440"},{"key":"S1368980021002962_ref52","doi-asserted-by":"publisher","DOI":"10.4278\/0890-1171-10.4.318"},{"key":"S1368980021002962_ref79","doi-asserted-by":"publisher","DOI":"10.1016\/0020-7489(93)90060-8"},{"key":"S1368980021002962_ref26","doi-asserted-by":"publisher","DOI":"10.1097\/JCN.0b013e3181a6a1e5"},{"key":"S1368980021002962_ref32","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2702.2010.03430.x"},{"key":"S1368980021002962_ref75","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2003.02980.x"},{"key":"S1368980021002962_ref27","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2005.067611"},{"key":"S1368980021002962_ref86","doi-asserted-by":"publisher","DOI":"10.1016\/j.jada.2008.07.007"},{"key":"S1368980021002962_ref14","first-page":"9","article-title":"Health benefits and risk associated with adopting a vegetarian diet","volume":"65","author":"Pilis","year":"2014","journal-title":"Rocz Panstw Zakl Hig"},{"key":"S1368980021002962_ref22","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8223(98)00204-1"},{"key":"S1368980021002962_ref61","unstructured":"61. 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