{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T20:28:27Z","timestamp":1785616107958,"version":"3.56.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,2,15]],"date-time":"2022-02-15T00:00:00Z","timestamp":1644883200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100016168","name":"Ludwig Boltzmann Gesellschaft","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100016168","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess the impact of the closure of group-based cardiac rehabilitation (CR) training during the first COVID-19 lockdown in spring 2020 on patients\u2019 physical activity, cardiorespiratory fitness, and cardiovascular risk, and to describe the patient experience of lockdown and home-based exercise training during lockdown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Mixed methods study. Prospectively collected post-lockdown measurements were compared to pre-lockdown medical record data. Quantitative measurements were supplemented with qualitative interviews about the patient experience during lockdown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Outpatient CR centre in Salzburg, Austria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Twenty-seven patients [six female, mean (SD) age 69 (7.4) years] who attended weekly CR training sessions until the first COVID-19 lockdown in March 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcome Measure(s)<\/jats:title><jats:p>Quantitative: exercise capacity (maximal ergometer test, submaximal ergometer training), cardiovascular risk (Framingham risk score, blood pressure, body mass index, lipids). Qualitative: individual semi-structured interviews.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Exercise capacity had significantly reduced from pre- to post-lockdown: mean (SD) power (W) in maximal ergometry 165 (70) vs. 151 (70), <jats:italic>p<\/jats:italic> &amp;lt; 0.001; submaximal ergometer training 99 (40) vs. 97 (40), <jats:italic>p<\/jats:italic> = 0.038. There was no significant difference in Framingham risk score and other cardiovascular risk factors. Qualitative data showed that almost all patients had kept physically active during lockdown, but 17 (63%) said they had been unable to maintain their exercise levels, and 15 (56%) felt their cardiorespiratory fitness had deteriorated. Many patients missed the weekly CR training and the motivation and sense of community from training together with others. Several patients stated that without professional supervision they had felt less confident to carry out home-based exercise training at high intensity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study highlights the importance of group-based supervised exercise training for patients who engage well in such a setting, and the detrimental impact of disruption to this type of CR service on physical activity levels and exercise capacity. Additionally, learning from the COVID-19 pandemic may inform the development and implementation of remote CR modalities going forward.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyg.2022.817912","type":"journal-article","created":{"date-parts":[[2022,2,15]],"date-time":"2022-02-15T05:22:46Z","timestamp":1644902566000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Outpatient Cardiac Rehabilitation Closure and Home-Based Exercise Training During the First COVID-19 Lockdown in Austria: A Mixed-Methods Study"],"prefix":"10.3389","volume":"13","author":[{"given":"Stefan Tino","family":"Kulnik","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahdi","family":"Sareban","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"H\u00f6ppchen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silke","family":"Droese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Egger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Gutenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Mayr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Reich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Wurhofer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josef","family":"Niebauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,2,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3390\/nu12061583","article-title":"Effects of COVID-19 home confinement on eating behaviour and physical activity: results of the ECLB-COVID19 international online survey.","volume":"12","author":"Ammar","year":"2020","journal-title":"Nutrients"},{"key":"B2","article-title":"Home-based versus centre-based cardiac rehabilitation.","volume":"6","author":"Anderson","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"B3","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1161\/CIR.0b013e3181e52e69","article-title":"Clinician\u2019s Guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association.","volume":"122","author":"Balady","year":"2010","journal-title":"Circulation"},{"key":"B4","author":"Beiglb\u00f6ck","year":"2020","journal-title":"Stellungnahme zur COVID19 Krise, 30.03.2020. Executive Summary."},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17176265","article-title":"Practical recommendations for maintaining active lifestyle during the COVID-19 pandemic: a systematic literature review.","volume":"17","author":"Bentlage","year":"2020","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B6","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1136\/bmj.311.6999.251","article-title":"Qualitative interviews in medical research.","volume":"311","author":"Britten","year":"1995","journal-title":"BMJ"},{"key":"B7","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1177\/1468794106058877","article-title":"Integrating quantitative and qualitative research: how is it done?","volume":"6","author":"Bryman","year":"2006","journal-title":"Qual. Res."},{"key":"B8","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/j.jshs.2020.02.001","article-title":"Coronavirus disease (COVID-19): the need to maintain regular physical activity while taking precautions.","volume":"9","author":"Chen","year":"2020","journal-title":"J. Sport Health Sci."},{"key":"B9","author":"Cresswell","year":"2021","journal-title":"Designing and Conducting Mixed Methods Research"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e24","DOI":"10.1177\/2047487320927597","article-title":"Physical activity\/inactivity and COVID-19.","volume":"28","author":"Crisafulli","year":"2020","journal-title":"Eur. J. Prev. Cardiol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1067\/mhj.2000.96469","article-title":"Primary and subsequent coronary risk appraisal: new results from the Framingham study.","volume":"139","author":"D\u2019Agostino","year":"2000","journal-title":"Am. Heart J."},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18126342","article-title":"Physical activity, sedentary behavior and well-being of adults with physical disabilities and\/or chronic diseases during the first wave of the COVID-19 pandemic: a rapid review.","volume":"18","author":"de Boer","year":"2021","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B13","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1016\/j.hlpt.2020.09.003","article-title":"Europe\u2019s Covid-19 outliers: German, Austrian and Swiss policy responses during the early stages of the 2020 pandemic.","volume":"9","author":"Desson","year":"2020","journal-title":"Health Policy Technol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1183","DOI":"10.1136\/bjsports-2020-102575","article-title":"Is the COVID-19 lockdown nudging people to be more active: a big data analysis.","volume":"54","author":"Ding","year":"2020","journal-title":"Br. J. Sports Med."},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18137056","article-title":"Physical activity among adults residing in 11 countries during the COVID-19 pandemic lockdown.","volume":"18","author":"Ding","year":"2021","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1291","DOI":"10.1111\/sms.13710","article-title":"Physical activity: benefits and challenges during the COVID-19 pandemic.","volume":"30","author":"Dwyer","year":"2020","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"B17","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1002\/oby.23066","article-title":"The impact of COVID-19 stay-at-home orders on health behaviors in adults.","volume":"29","author":"Flanagan","year":"2021","journal-title":"Obesity"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-13-117","article-title":"Using the framework method for the analysis of qualitative data in multi-disciplinary health research.","volume":"13","author":"Gale","year":"2013","journal-title":"BMC Med. Res. Methodol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1007\/s00508-020-01762-2","article-title":"Recommendations on the utilization of telemedicine in cardiology.","volume":"132","author":"Gruska","year":"2020","journal-title":"Wien Klin Wochenschr"},{"key":"B20","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1016\/j.pcad.2020.04.005","article-title":"A tale of two pandemics: how will COVID-19 and global trends in physical inactivity and sedentary behavior affect one another?","volume":"64","author":"Hall","year":"2021","journal-title":"Prog. Cardiovasc. Dis."},{"key":"B21","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1177\/1474515117743978","article-title":"Test-retest reliability and responsiveness to change of clinical tests of physical fitness in patients with acute coronary syndrome included in the SWEDEHEART register.","volume":"17","author":"Hellmark","year":"2018","journal-title":"Eur. J. Cardiovasc. Nurs."},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17176268","article-title":"Health behavior changes during COVID-19 pandemic and subsequent \u201cstay-at-home\u201d orders.","volume":"17","author":"Knell","year":"2020","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwab116","article-title":"Cardiovascular rehabilitation in the COVID-19 era: \u201ca phoenix arising from the ashes?","author":"Laoutaris","year":"2021","journal-title":"Eur. J. Prev. Cardiol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"906","DOI":"10.1177\/2047487320916823","article-title":"Physical inactivity and cardiovascular disease at the time of coronavirus disease 2019 (COVID-19).","volume":"27","author":"Lippi","year":"2020","journal-title":"Eur. J. Prev. Cardiol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"898","DOI":"10.1016\/j.cardfail.2020.08.005","article-title":"Impact of the Coronavirus disease-19 outbreak on physical activity of patients with implantable cardioverter defibrillators.","volume":"26","author":"Malanchini","year":"2020","journal-title":"J. Card. Fail."},{"key":"B26","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1177\/1474515120924530","article-title":"Delivering healthcare remotely to cardiovascular patients during COVID-19?: a rapid review of the evidence.","volume":"19","author":"Neubeck","year":"2020","journal-title":"Eur. J. Cardiovasc. Nurs."},{"key":"B27","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1177\/2047487312446137","article-title":"Outpatient cardiac rehabilitation: the Austrian model.","volume":"20","author":"Niebauer","year":"2013","journal-title":"Eur. J. Prev. Cardiol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"2152","DOI":"10.1016\/j.jaip.2020.04.039","article-title":"Exercise and fitness in the age of social distancing during the COVID-19 pandemic.","volume":"8","author":"Nyenhuis","year":"2020","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c4587","article-title":"Three techniques for integrating data in mixed methods studies.","volume":"341","author":"O\u2019Cathain","year":"2010","journal-title":"BMJ"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.2196\/23389","article-title":"The use of digital platforms for adults\u2019 and adolescents\u2019 physical activity during the COVID-19 pandemic (Our Life at Home): survey study.","volume":"23","author":"Parker","year":"2021","journal-title":"J. Med. Internet Res."},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18094441","article-title":"Impact of the COVID-19 pandemic on physical activity and sedentary behaviour: a qualitative study in a Canadian city.","volume":"18","author":"Petersen","year":"2021","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B32","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1136\/bmj.311.6996.42","article-title":"Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research.","volume":"311","author":"Pope","year":"1995","journal-title":"BMJ"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1026","DOI":"10.1177\/2047487319898958","article-title":"Efficacy of extended, comprehensive outpatient cardiac rehabilitation on cardiovascular risk factors: a nationwide registry.","volume":"27","author":"Reich","year":"2020","journal-title":"Eur. J. Prev. Cardiol."},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17228444","article-title":"Behavioral changes during COVID-19 confinement in France: a web-Based Study.","volume":"17","author":"Rossinot","year":"2020","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18158218","article-title":"Concerns and support after one year of COVID-19 in Austria: a qualitative study using content analysis with 1505 participants.","volume":"18","author":"Schaffler","year":"2021","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1177\/2047487320939671","article-title":"The future is now: a call for action for cardiac telerehabilitation in the COVID-19 pandemic from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology.","author":"Scherrenberg","year":"2020","journal-title":"Eur. J. Prev. Cardiol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1007\/s11577-017-0454-1","article-title":"How to construct a mixed methods research design.","volume":"69","author":"Schoonenboom","year":"2017","journal-title":"Kolner Z Soz Sozpsychol"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10143071","article-title":"Cardiac rehabilitation in German speaking countries of Europe-evidence-based guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 2.","volume":"10","author":"Schwaab","year":"2021","journal-title":"J. Clin. Med."},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17197161","article-title":"Validity and reliability of international physical activity questionnaires for adults across EU countries: systematic review and meta analysis.","volume":"17","author":"Sember","year":"2020","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B40","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1111\/bjhp.12497","article-title":"Determinants of physical activity among adults in the United Kingdom during the COVID-19 pandemic: the DUK-COVID study.","volume":"26","author":"Spence","year":"2021","journal-title":"Br. J. Health Psychol."},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsem-2020-000960","article-title":"Changes in physical activity and sedentary behaviours from before to during the COVID-19 pandemic lockdown: a systematic review.","volume":"7","author":"Stockwell","year":"2021","journal-title":"BMJ Open Sport Exerc. Med."},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18115555","article-title":"Physical activity during the first lockdown of the COVID-19 pandemic: investigating the reliance on digital technologies, perceived benefits, barriers and the impact of affect.","volume":"18","author":"Symons","year":"2021","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1177\/2047487320922926","article-title":"Future-proofing cardiac rehabilitation: transitioning services to telehealth during COVID-19.","author":"Thomas","year":"2020","journal-title":"Eur. J. Prev. Cardiol."},{"key":"B44","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1177\/2047487314560100","article-title":"High-intensity interval training is not superior to other forms of endurance training during cardiac rehabilitation.","volume":"23","author":"Tschentscher","year":"2016","journal-title":"Eur. J. Prev. Cardiol."},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph182211929","article-title":"Changes in physical activity and sedentary behaviour in cardiovascular disease patients during the COVID-19 Lockdown.","volume":"18","author":"van Bakel","year":"2021","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B46","doi-asserted-by":"publisher","first-page":"2093","DOI":"10.1002\/ehf2.12916","article-title":"The detrimental effect of COVID-19 nationwide quarantine on accelerometer-assessed physical activity of heart failure patients.","volume":"7","author":"Vetrovsky","year":"2020","journal-title":"ESC Heart Failure"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1186\/s12966-021-01218-4","article-title":"The effectiveness of digital interventions for increasing physical activity in individuals of low socioeconomic status: a systematic review and meta-analysis.","volume":"18","author":"Western","year":"2021","journal-title":"Int. J. Behav. Nutr. Phys. Act"},{"key":"B48","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1038\/s41586-020-2521-4","article-title":"Factors associated with COVID-19-related death using OpenSAFELY.","volume":"584","author":"Williamson","year":"2020","journal-title":"Nature"},{"key":"B49","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1093\/tbm\/ibaa086","article-title":"Determinants of physical activity maintenance during the Covid-19 pandemic: a focus on fitness apps.","volume":"10","author":"Yang","year":"2020","journal-title":"Transl. Behav. Med."}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2022.817912\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,15]],"date-time":"2022-02-15T05:22:50Z","timestamp":1644902570000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2022.817912\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,15]]},"references-count":49,"alternative-id":["10.3389\/fpsyg.2022.817912"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2022.817912","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,15]]},"article-number":"817912"}}