{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T15:02:19Z","timestamp":1785855739890,"version":"3.56.0"},"reference-count":58,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,1,28]],"date-time":"2022-01-28T00:00:00Z","timestamp":1643328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background. Adherence to cardiac rehabilitation remains a challenge despite established evidence that engaging in regular exercise is a strong preventive measure to experiencing a second cardiac event. A recent study found a six-month cardiac rehabilitation program to be effective for facilitating regular exercise behavior among patients diagnosed with acute coronary syndrome. The purpose of this study was to conduct a phenomenological investigation using Colaizzi\u2019s descriptive technique to understand mechanisms responsible for behavior change. Methods. Data were collected and analyzed among patients with acute coronary syndrome at a cardiac rehabilitation using semi-structured interviews that were conducted over the phone across three months. Conclusion. Thematic analysis of 15 semi-structured interviews resulted in 124 statements that were analyzed. The data yielded seven themes that included \u201cmotivation to follow prescribed exercise program\u201d, \u201cvolitional decision\u201d, \u201ccapability of performing exercise\u201d, \u201cconnectedness to peers\u201d, \u201cplanning\u201d, \u201chabit formation\u201d, and \u201cadopting healthy behaviors beyond exercise\u201d. The emerged themes align with construct definitions of the self-determination theory, which include the three psychological needs (autonomy, competence, and relatedness), in addition to autonomous motivation, which represents internally driven reasons to participate in exercise. Planning and habit formation themes support contemporary research that identifies these constructs responsible for behavioral maintenance. While these themes help explain exercise participation, the final theme, adopting healthy behaviors beyond exercise, reflects the impact of the program on having a change towards a healthier lifestyle. The findings highlight the complexity of exercise behavior, and that long-term participation is likely explained by amalgamating the self-determination theory.<\/jats:p>","DOI":"10.3390\/ijerph19031482","type":"journal-article","created":{"date-parts":[[2022,1,29]],"date-time":"2022-01-29T05:26:17Z","timestamp":1643433977000},"page":"1482","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["How and Why Patients Adhere to a Prescribed Cardiac Rehabilitation Program: A Longitudinal Phenomenological Study of Patients with Acute Coronary Syndrome"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4511-7902","authenticated-orcid":false,"given":"Navin","family":"Kaushal","sequence":"first","affiliation":[{"name":"Department of Health Sciences, School of Health & Human Sciences, Indiana University, Indianapolis, IN 47405, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5844-5764","authenticated-orcid":false,"given":"Donya","family":"Nemati","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, School of Health & Human Sciences, Indiana University, Indianapolis, IN 47405, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rapha\u00eblle","family":"Gauthier-Bisaillon","sequence":"additional","affiliation":[{"name":"Montreal Heart Institute, Montreal, QC H1T 1C8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2433-6591","authenticated-orcid":false,"given":"Marie","family":"Payer","sequence":"additional","affiliation":[{"name":"Montreal Heart Institute, Montreal, QC H1T 1C8, Canada"},{"name":"Department of Psychology, Universite du Quebec a Montreal, Montreal, QC H3C 5J9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00e9atrice","family":"B\u00e9rub\u00e9","sequence":"additional","affiliation":[{"name":"Montreal Heart Institute, Montreal, QC H1T 1C8, Canada"},{"name":"Department of Psychology, Universite du Quebec a Montreal, Montreal, QC H3C 5J9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Juneau","sequence":"additional","affiliation":[{"name":"Montreal Heart Institute, Montreal, QC H1T 1C8, Canada"},{"name":"Department of Medicine, Universite de Montreal, Montreal, QC H3T 1J4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2258-8194","authenticated-orcid":false,"given":"Louis","family":"Bherer","sequence":"additional","affiliation":[{"name":"Montreal Heart Institute, Montreal, QC H1T 1C8, Canada"},{"name":"Department of Medicine, Universite de Montreal, Montreal, QC H3T 1J4, Canada"},{"name":"Centre de Recherche de l\u2019Institut Universitaire de Geriatrie de Montreal, Montreal, QC H3W 1W5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.pmedr.2017.03.001","article-title":"Risk of mortality and recurrent cardiovascular events in patients with acute coronary syndromes on high intensity statin treatment","volume":"6","author":"Rockberg","year":"2017","journal-title":"Prev. Med. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2022","DOI":"10.1001\/jama.2008.553","article-title":"Sudden death after myocardial infarction","volume":"300","author":"Adabag","year":"2008","journal-title":"JAMA"},{"key":"ref_3","unstructured":"American Heart Association (2021, November 01). Available online: https:\/\/www.heart.org\/en\/health-topics\/heart-attack\/life-after-a-heart-attack."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2344","DOI":"10.1161\/CIRCULATIONAHA.110.983536","article-title":"Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community","volume":"123","author":"Goel","year":"2011","journal-title":"Circulation"},{"key":"ref_5","first-page":"38","article-title":"Cardiac rehabilitation past, present and future: An overview","volume":"2","author":"Mampuya","year":"2012","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1097\/HCR.0000000000000404","article-title":"The Effectiveness of Interventions to Maintain Exercise and Physical Activity in Post-Cardiac Rehabilitation Populations: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"39","author":"Martinello","year":"2019","journal-title":"J. Cardiopulm. Rehabil. Prev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1097\/JCN.0b013e3182049f00","article-title":"Systematic review of physical activity intervention studies after cardiac rehabilitation","volume":"26","author":"Chase","year":"2011","journal-title":"J. Cardiovasc. Nurs."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e010108","DOI":"10.1161\/JAHA.118.010108","article-title":"Increased physical activity post-myocardial infarction is related to reduced mortality: Results from the SWEDEHEART registry","volume":"7","author":"Ekblom","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3286","DOI":"10.1093\/eurheartj\/eht258","article-title":"Physical activity in patients with stable coronary heart disease: An international perspective","volume":"34","author":"Stewart","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Kaushal, N., Payer, M., B\u00e9rub\u00e9, B., Juneau, M., and Bherer, L. (2021). Facilitating Exercise Habit Formation among Cardiac Rehabilitation Patients: A Randomized Controlled Pilot Trial. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18126440"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1111\/bjhp.12237","article-title":"The role of habit in different phases of exercise","volume":"22","author":"Kaushal","year":"2017","journal-title":"Br. J. Health Psychol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1007\/s10865-015-9640-7","article-title":"Exercise habit formation in new gym members: A longitudinal study","volume":"38","author":"Kaushal","year":"2015","journal-title":"J. Behav. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1007\/s12160-017-9881-5","article-title":"Increasing Physical Activity Through Principles of Habit Formation in New Gym Members: A Randomized Controlled Trial","volume":"51","author":"Kaushal","year":"2017","journal-title":"Ann. Behav. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s12160-013-9486-6","article-title":"The Behavior Change Technique Taxonomy (v1) of 93 Hierarchically Clustered Techniques: Building an International Consensus for the Reporting of Behavior Change Interventions","volume":"46","author":"Michie","year":"2013","journal-title":"Ann. Behav. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1177\/089801010001800107","article-title":"Cardiac Therapy for Men with Coronary Artery Disease: The Lived Experience","volume":"18","author":"Keaton","year":"2000","journal-title":"J. Holist. Nurs."},{"key":"ref_16","unstructured":"Magana, A. (2002). Variety in qualitative inquiry: Theoretical orientations. Patton, MQ Qualitative Research and Evaluation Methods, Sage Publications."},{"key":"ref_17","unstructured":"Marshall, C., and Rossman, G.B. (2014). Designing Qualitative Research, Sage publications."},{"key":"ref_18","unstructured":"Patton, M.Q. (2014). Qualitative Research and Evaluation Methods, Sage publications. [4th ed.]."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/S0140-6736(01)05548-9","article-title":"The art and science of clinical knowledge: Evidence beyond measures and numbers","volume":"358","author":"Malterud","year":"2001","journal-title":"Lancet"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"22","DOI":"10.7748\/nr.22.6.22.e1344","article-title":"Differentiating between descriptive and interpretive phenomenological research approaches","volume":"22","author":"Matua","year":"2015","journal-title":"Nurse. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4172\/2167-1168.1000119","article-title":"Understanding the differences between Husserl\u2019s (descriptive) and Heidegger\u2019s (interpretive) phenomenological research","volume":"1","author":"Reiners","year":"2012","journal-title":"J. Nurs. Care"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Birtwistle, S., Jones, I., Murphy, R., Gee, I., and Watson, P. (2021). \u201cDo what you can with a happy heart\u201d: A longitudinal study of patient and family members\u2019 lived experiences of physical activity post-myocardial infarction. Disabil. Rehabil., 1\u201310.","DOI":"10.1080\/09638288.2021.1878560"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1177\/1474515116651977","article-title":"The lived experience of individuals in cardiac rehabilitation who have a positive outlook on their cardiac recovery: A phenomenological inquiry","volume":"16","author":"Nadarajah","year":"2017","journal-title":"Eur. J. Cardiovasc. Nurs."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1177\/1474515119882549","article-title":"A systematic review and thematic synthesis exploring how a previous experience of physical activity influences engagement with cardiac rehabilitation","volume":"19","author":"McHale","year":"2019","journal-title":"Eur. J. Cardiovasc. Nurs."},{"key":"ref_25","unstructured":"Creswell, J.W., and Poth, C.N. (2018). Qualitative Inquiry and Research Design: Choosing Among Five Approaches, SAGE Publications."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1177\/1741826711409326","article-title":"Participating in cardiac rehabilitation: A systematic review and meta-synthesis of qualitative data","volume":"19","author":"Neubeck","year":"2011","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Resurrecci\u00f3n, D.M., Motrico, E., Rubio-Valera, M., Mora-Pardo, J.A., and Moreno-Peral, P. (2018). Reasons for dropout from cardiac rehabilitation programs in women: A qualitative study. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0200636"},{"key":"ref_28","first-page":"1838706","article-title":"Saturation controversy in qualitative research: Complexities and underlying assumptions. A literature review","volume":"6","year":"2020","journal-title":"Cogent Soc. Sci."},{"key":"ref_29","first-page":"24","article-title":"Women\u2019s Experiences with Cardiac Rehabilitation\u2014Participation and Non-Participation","volume":"28","author":"Schou","year":"2008","journal-title":"V\u00e5rd Nord."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1177\/1525822X05279903","article-title":"How Many Interviews Are Enough?: An Experiment with Data Saturation and Variability","volume":"18","author":"Guest","year":"2006","journal-title":"Field Methods"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Morgan, M.G., Fischhoff, B., Bostrom, A., and Atman, C.J. (2002). Risk Communication: A Mental Models Approach, Cambridge University Press.","DOI":"10.1017\/CBO9780511814679"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1007\/s11136-011-9943-2","article-title":"Individual interviews and focus groups in patients with rheumatoid arthritis: A comparison of two qualitative methods","volume":"21","author":"Coenen","year":"2012","journal-title":"Qual. Life Res."},{"key":"ref_33","unstructured":"Braun, V.C.V. (2013). Successful Qualitative Research: A Practical Guide for Beginners, SAGE Publication."},{"key":"ref_34","first-page":"643","article-title":"Colaizzi\u2019s descriptive phenomenological method","volume":"28","author":"Morrow","year":"2015","journal-title":"Psychologist"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1097\/00012272-198701000-00010","article-title":"Components of courage in chronically ill adolescents: A phenomenological study","volume":"9","author":"Haase","year":"1987","journal-title":"ANS Adv. Nurs. Sci."},{"key":"ref_36","unstructured":"(NVivo Qualitative Data Analysis Software, 2018). NVivo Qualitative Data Analysis Software, Version 12."},{"key":"ref_37","first-page":"365","article-title":"The lived experience of family caregivers caring for patients dependent on life-sustaining technologies","volume":"5","author":"Kongsuwan","year":"2018","journal-title":"Int. J. Nurs. Sci."},{"key":"ref_38","first-page":"435","article-title":"Trustworthiness in Qualitative Research","volume":"25","author":"Connelly","year":"2016","journal-title":"Medsurg. Nurs."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1080\/1612197X.2019.1655779","article-title":"Qualitative research in six sport and exercise psychology journals between 2010 and 2017: An updated and expanded review of trends and interpretations","volume":"19","author":"McGannon","year":"2019","journal-title":"Int. J. Sport Exerc. Psychol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"50","DOI":"10.7748\/nr2003.01.10.2.50.c5888","article-title":"An approach to the phenomenological analysis of data","volume":"10","author":"Priest","year":"2002","journal-title":"Nurse Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1037\/0003-066X.55.1.68","article-title":"Self-Determination Theory and the Facilitation of Intrinsic Motivation, Social Development, and Well-Being","volume":"55","author":"Ryan","year":"2000","journal-title":"Am. Psychol."},{"key":"ref_43","unstructured":"Deci, E., and Ryan, R. (2002). Handbook of Self-Determination Research, University of Rochester Press."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Ryan, R., and Deci, E. (2017). Self-Determination Theory: Basic Psychological Needs in Motivation, Development, and Wellness, Guilford Press.","DOI":"10.1521\/978.14625\/28806"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"101548","DOI":"10.1016\/j.psychsport.2019.101548","article-title":"Self-determination in recreational exercise: Associations with lapse and post-lapse emotions","volume":"45","author":"Murphy","year":"2019","journal-title":"Psychol. Sport Exerc."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"284","DOI":"10.4278\/ajhp.110211-QUAL-62","article-title":"Maintaining physical activity over time: The importance of basic psychological need satisfaction in developing the physically active self","volume":"27","author":"Springer","year":"2013","journal-title":"Am. J. Health Promot."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1177\/1403494808090633","article-title":"How important are individual counselling, expectancy beliefs and autonomy for the maintenance of exercise after cardiac rehabilitation?","volume":"36","author":"Mildestvedt","year":"2008","journal-title":"Scand. J. Public Health"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1249\/JES.0000000000000008","article-title":"An integrated behavior change model for physical activity","volume":"42","author":"Hagger","year":"2014","journal-title":"Exerc. Sport Sci. Rev."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/bs.adms.2016.11.001","article-title":"The evolving understanding of physical activity behavior: A multi-process action control approach","volume":"4","author":"Rhodes","year":"2017","journal-title":"Adv. Motiv. Sci."},{"key":"ref_50","first-page":"1","article-title":"Modeling health behavior change: How to predict and modify the adoption and maintenance of health behaviors","volume":"57","author":"Schwarzer","year":"2008","journal-title":"Appl. Psychol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1123\/jsep.2017-0307","article-title":"Mediating Mechanisms in a Physical Activity Intervention: A Test of Habit Formation","volume":"40","author":"Kaushal","year":"2018","journal-title":"J. Sport Exerc. Psychol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/aphw.12017","article-title":"Implementation intention and action planning interventions in health contexts: State of the research and proposals for the way forward","volume":"6","author":"Hagger","year":"2014","journal-title":"Appl. Psychol. Health Well-Being"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1080\/17461391.2017.1417486","article-title":"Fluctuation\u2013a common but neglected pattern of physical activity behaviour: An exploratory review of studies in recent 20 years","volume":"18","author":"Shang","year":"2018","journal-title":"Eur. J. Sport Sci."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e001687","DOI":"10.1136\/openhrt-2021-001687","article-title":"Efficacy of interventions to increase physical activity for people with heart failure: A meta-analysis","volume":"8","author":"Amirova","year":"2021","journal-title":"Open Heart"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1123\/jpah.2014-0605","article-title":"Association of longitudinal changes of physical activity on smoking cessation among young daily smokers","volume":"13","author":"Loprinzi","year":"2016","journal-title":"J. Phys. Act. Health"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1007\/s12160-015-9761-9","article-title":"Exercise to Enhance Smoking Cessation: The Getting Physical on Cigarette Randomized Control Trial","volume":"50","author":"Prapavessis","year":"2016","journal-title":"Ann. Behav. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1177\/1049732304263638","article-title":"Descriptive Versus Interpretive Phenomenology: Their Contributions to Nursing Knowledge","volume":"14","author":"Lopez","year":"2004","journal-title":"Qual. Health Res."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"2581","DOI":"10.1111\/jocn.12867","article-title":"Dealing with existential anxiety in exercise-based cardiac rehabilitation: A phenomenological-hermeneutic study of patients\u2019 lived experiences","volume":"24","author":"Pedersen","year":"2015","journal-title":"J. Clin. Nurs."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/3\/1482\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:09:40Z","timestamp":1760134180000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/3\/1482"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,28]]},"references-count":58,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["ijerph19031482"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19031482","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,28]]}}}