{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:32:41Z","timestamp":1792114361134,"version":"4.4.0"},"reference-count":21,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T00:00:00Z","timestamp":1751587200000},"content-version":"unspecified","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Hart4Onderzoek"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,6,19]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Regular physical exercise has well-known health benefits and is generally considered safe for adults with congenital heart disease (ACHD). However, many individuals with ACHD remain insufficiently physically active. This study explored the barriers and needs related to physical exercise as experienced by people with ACHD to inform the development of tailored strategies that support and promote increased physical activity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Qualitative study using semistructured interviews conducted between March and May 2023. The interview guide was based on the Fear Avoidance Model, Tampa Scale for Kinesiophobia Heart and European Society of Cardiology guidelines on sports cardiology and exercise for cardiovascular diseases. Interviews were coded and thematically analysed to identify specific physical exercise barriers and needs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Data saturation was reached after interviewing 19 individuals living with ACHD (median age 46 years (range 24\u201375), 10\u2009women). Thematic analysis identified four main barriers: (1) physical symptoms and negative past experiences, (2) alienation from peers, (3) perceived decline in physical fitness over time and (4) lack of knowledge about personal physical boundaries. Two needs were identified: (1) personalised, disease-specific exercise information and advice and (2) structured support and guidance from healthcare professionals.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>People with ACHD face multiple barriers to engaging in physical exercise. There is a clear need for specific, personalised exercise advice from healthcare providers and the development of long-term programmes and interventions to overcome relevant barriers.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-102090","type":"journal-article","created":{"date-parts":[[2025,7,5]],"date-time":"2025-07-05T13:45:17Z","timestamp":1751723117000},"page":"e102090","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Physical exercise barriers and needs in adults with congenital heart disease: a qualitative study"],"prefix":"10.1136","volume":"15","author":[{"given":"Yara F","family":"Langeveld","sequence":"first","affiliation":[{"name":"Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nienke","family":"ter Hoeve","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands"},{"name":"Capri Cardiac Rehabilitation, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annemien","family":"van den Bosch","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Robbers-Visser","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands"},{"name":"Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M","family":"Kauling","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmijn C","family":"van Groen","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands"},{"name":"Capri Cardiac Rehabilitation, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madoka","family":"Sunamura","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Franciscus Gasthuis & Vlietland Hospital, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3617-3256","authenticated-orcid":false,"given":"Harald T.","family":"Jorstad","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands"},{"name":"Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4923-6845","authenticated-orcid":false,"given":"Marjolein","family":"Snaterse","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands"},{"name":"Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,7,5]]},"reference":[{"key":"2025070506451324000_15.7.e102090.1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa554"},{"key":"2025070506451324000_15.7.e102090.2","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.120.017704","article-title":"Survival in Children With Congenital Heart Disease: Have We Reached a Peak at 97%?","volume":"9","author":"Mandalenakis","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"2025070506451324000_15.7.e102090.3","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-079691","article-title":"What does good care look like to people living with congenital heart disease in the 21st century? Qualitative online, asynchronous discussion forums","volume":"14","author":"Wray","year":"2024","journal-title":"BMJ Open"},{"key":"2025070506451324000_15.7.e102090.4","doi-asserted-by":"publisher","DOI":"10.1097\/JCN.0b013e31820984c9"},{"key":"2025070506451324000_15.7.e102090.5","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa605"},{"key":"2025070506451324000_15.7.e102090.6","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht433"},{"key":"2025070506451324000_15.7.e102090.7","doi-asserted-by":"crossref","DOI":"10.2340\/16501977-2749","article-title":"Fear of movement in patients attending cardiac rehabilitation: A validation study","volume":"52","author":"Keessen","year":"2020","journal-title":"J Rehabil Med"},{"key":"2025070506451324000_15.7.e102090.8","doi-asserted-by":"crossref","first-page":"2110","DOI":"10.1093\/ptj\/pzaa159","article-title":"Perceptions of Kinesiophobia in Relation to Physical Activity and Exercise After Myocardial Infarction: A Qualitative Study","volume":"100","author":"B\u00e4ck","year":"2020","journal-title":"Phys Ther"},{"key":"2025070506451324000_15.7.e102090.9","doi-asserted-by":"publisher","DOI":"10.1111\/chd.12069"},{"key":"2025070506451324000_15.7.e102090.10","doi-asserted-by":"crossref","first-page":"4533","DOI":"10.1093\/eurheartj\/ehad570","article-title":"Acquired cardiovascular disease in adults with congenital heart disease","volume":"44","author":"Brida","year":"2023","journal-title":"Eur Heart J"},{"key":"2025070506451324000_15.7.e102090.11","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1177\/1474515120963314","article-title":"Enablers and barriers for being physically active: experiences from adults with congenital heart disease","volume":"20","author":"Bay","year":"2021","journal-title":"Eur J Cardiovasc Nurs"},{"key":"2025070506451324000_15.7.e102090.12","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000388"},{"key":"2025070506451324000_15.7.e102090.13","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(03)00220-8"},{"key":"2025070506451324000_15.7.e102090.14","doi-asserted-by":"publisher","DOI":"10.1016\/0005-7967(83)90009-8"},{"key":"2025070506451324000_15.7.e102090.15","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"2025070506451324000_15.7.e102090.16","unstructured":"Centraal Bureau voor de Statistiek . Standaard Onderwijsindeling 2021 Editie 2023\/\u201924. Den Haag\/Heerlen. 2021."},{"key":"2025070506451324000_15.7.e102090.17","doi-asserted-by":"crossref","DOI":"10.2196\/22601","article-title":"Effects of Smartphone-Based Interventions on Physical Activity in Children and Adolescents: Systematic Review and Meta-analysis","volume":"9","author":"He","year":"2021","journal-title":"JMIR Mhealth Uhealth"},{"key":"2025070506451324000_15.7.e102090.18","doi-asserted-by":"crossref","DOI":"10.2196\/41649","article-title":"Effectiveness of eHealth Interventions Promoting Physical Activity in Children and Adolescents: Systematic Review and Meta-Analysis","volume":"26","author":"Sequ\u00ed-Dom\u00ednguez","year":"2024","journal-title":"J Med Internet Res"},{"key":"2025070506451324000_15.7.e102090.19","doi-asserted-by":"publisher","DOI":"10.1007\/s11205-013-0359-y"},{"key":"2025070506451324000_15.7.e102090.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.09.004"},{"key":"2025070506451324000_15.7.e102090.21","unstructured":"American Heart Assocation . Classes of heart failure, 2023. Available: https:\/\/www.heart.org\/en\/health-topics\/heart-failure\/what-is-heart-failure\/classes-of-heart-failure"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-102090","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,5]],"date-time":"2025-07-05T13:45:20Z","timestamp":1751723120000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-102090"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":21,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7,5]]},"published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1136\/bmjopen-2025-102090"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-102090","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]}}}