Integrating the quantitative with the qualitative: findings from a mixed methods cardiac rehabilitation exercise trial

Abstract

BackgroundCardiac rehabilitation is a core component of cardiovascular disease management. Eastern Corridor Medical Engineering-Cardiac Rehabilitation (ECME-CR) is a digital health platform for online cardiac rehabilitation exercise. We conducted a mixed methods pilot trial to evaluate ECME-CR. ObjectiveTo examine the difference between objectively measured outcomes and participant perceptions of benefits and improvements gained from participation in a cardiac rehabilitation exercise program. MethodsSeventeen participants (14 male, 3 female; age: 69.5 ± 7.3 years) took part and were allocated to one of two groups; an online exercise group (n = 8), or an in-person exercise (n = 9) group. Due to the COVID-19 pandemic, a pragmatic approach to group allocation was adopted. Objective outcomes were assessed at baseline and repeated following the intervention period, with the primary outcome being six-minute walk test distance. In addition to clinical outcome measurements, we undertook qualitative interviews with participants. ResultsOnly five participants demonstrated a clinically meaningful improvement in six-minute walk test distance, following the 8-week exercise program. The main theme emerging from the qualitative interviews was the valued benefits of the cardiac rehabilitation exercise program. Despite the lack of measurable physical change, participants self-defined a range of benefits they valued and attributed directly to participation in the cardiac rehabilitation exercise program. ConclusionThe findings from this study may offer a useful starting point for further study of community-based cardiac rehabilitation exercise and also highlight the benefit of adopting a mixed methods approach which considers both the objective outcomes measured as well as the subjective reports obtained from participants.