Joanna Blackwell

Exercise-based rehabilitation forms a key part of the UK National Health Service patient-care pathway for cardiac rehabilitation (CR). Only around half of all eligible patients attend core CR, however, with social inequalities affecting participation. Few qualitative studies have explored in-depth the key factors influencing engagement with CR, specifically from a sociological theoretical, and ethnographic perspective. Utilising an ethnographic approach allowed us to get a sense of the embodied experiences of 10 participants attending or declining core CR, together with a further seven family members/significant others. This provided in-depth appreciation of participants’ lifeworld contexts as key influences on CR participation. The article draws on these qualitative data and focuses on 1) participants’ initial thoughts about CR; and 2) navigating the field of CR, analysed via thematic analysis. We utilise a Bourdieusian theoretical perspective to theorise the findings, including salient socio-cultural factors influencing attendance/non-attendance and (non)adherence. The article findings highlight how perceptions of CR and the ability to navigate the field are strongly influenced by habitus and capital, and how personal biographies and socio-material conditions affect adherence to CR programmes. The study provides original insights into embodied experiences of exercise-based CR, and novel understandings of the reasons for drop-out/poor adherence, theorised from a Bourdieusian perspective.

Adam B. Evans, Natalie Barker-Ruchti, Joanna Blackwell, Georgia Clay, Fiona Dowling, Stine Frydendal, Maria Gliemann Hybholt, Solveig E. Hausken-Sutter, Verena Lenneis, Dominic Malcolm, Cassandra Phoenix, Brett Smith, Charlotte Svendler Nielsen, Laura Wilcock, Oli Williams and Helle Winther Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark; School of Health Sciences, € Orebro University, € Orebro, Sweden; School of Sport and Exercise Science, University of Lincoln, Lincoln, UK; Department of Sport and Social Sciences, Norwegian School of Sport Sciences, Oslo, Norway; Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden; Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK; Department of Sport and Exercise Sciences, Durham University, Durham, UK; Carnegie School of Sport, Leeds Beckett University, Leeds, UK; The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK; Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK

The National Health Service (NHS) cardiac rehabilitation patient care pathway has remained largely unchanged for many years despite, on average, half of all eligible patients declining to engage. To investigate reasons for non-engagement, we explored the experiences of ten cardiac patients who participated in cardiac rehabilitation, dropped out, or declined, as well as experiences of seven people deemed significant others by participants. Our ethnographic study involved participant observations, repeat in-depth semi-structured interviews, and reflexive journaling. Reflexive thematic analysis was conducted, focusing on participants' lived experiences. Utilising Bourdieusian concepts of habitus, capital, and field, this article highlights how personal biography, material conditions, and dispositional inclinations combine to make cardiac health care decision-making individual and complex. Despite this, health professionals were not always attuned to specific circumstances arising from differences in patients' experiences and lifeworlds. By considering service improvement recommendations that acknowledge socio-cultural influences, cardiac rehabilitation can work towards providing patients and their significant others with more appropriate, personalised, and person-centred support.