Facilitators and Barriers of Exercise Rehabilitation Programs Implementation in Coronary Heart Disease Patients: A Mixed Method Systematic Review

Background: Although researchers have developed various exercise rehabilitation programs for patients with coronary heart disease (CHD) with proven effectiveness, multilevel implementation challenges limit patient access and hinder optimal outcomes. Objective: In this systematic review, we aimed to identify facilitators and barriers affecting the implementation of exercise rehabilitation programs for patients with CHD to improve program quality and accessibility. Methods: We used a literature search guided by the Population-Exposure-Intervention framework across databases from inception to June 1, 2024. Two independent researchers conducted study selection. The Mixed Methods Appraisal Tool was used to evaluate methodological quality across study designs and systematically extracted and categorized data using the Consolidated Framework for Implementation Research (CFIR) into 5 dimensions: intervention characteristics, outer setting, inner setting, individual characteristics, and implementation process. Results: A total of 21 studies included in this systematic review demonstrated effectiveness. A total of 18 facilitators and 16 barriers were identified as affecting exercise rehabilitation programs implementation for patients with CHD. Among the facilitators, positive exercise attitude was most prevalent, whereas severe clinical conditions emerged as the predominant barrier, both categorized under the individual characteristics dimension, which comprised the highest proportion with 9 facilitators and 8 barriers. Conclusions: We synthesized evidence-based facilitators and barriers affecting the exercise rehabilitation programs implementation for patients with CHD and mapped them onto the 5 CFIR dimensions. These results offer practical guidance for developing multilevel exercise rehabilitation programs. Future implementations should prioritize mitigating modifiable barriers while capitalizing on key facilitators to optimize program quality and accessibility.