Functional Capacity, Participation in Cardiac Rehabilitation, and Perceived Barriers among Patients with Coronary Artery Disease

Authors

• Sidra Ashraf, PhD Scholar (Physical Therapy), Assistant Professor, University Institute of Physical Therapy, University of Lahore, PakistanFollow
• Maryam Shabbir, PhD (Rehabilitation Sciences), Associate Professor, University Institute of Physical Therapy, University of Lahore, PakistanFollow
• Ashfaq Ahmad, PhD (Physical Therapy), Professor, Dean Faculty of Allied Health Sciences, University Institute of Physical Therapy, University of Lahore, PakistanFollow
• Naveed Arshad, PhD Scholar (Physical Therapy), Student, University Institute of Physical Therapy, University of Lahore, PakistanFollow
• Aqsa Majeed, PhD Scholar (Physical Therapy), Lecturer, University Institute of Physical Therapy, University of Lahore, PakistanFollow

Abstract

Background: Reduced functional capacity and limited participation in cardiac rehabilitation (CR) adversely affect recovery among patients with coronary artery disease (CAD). This study evaluated functional capacity, CR participation, perceived barriers, and factors associated with reduced functional capacity and CR non-participation among patients with CAD.
Methods: A hospital-based cross-sectional study was conducted among 178 clinically stable adults with CAD attending the University of Lahore Teaching Hospital and the University Institute of Physical Therapy clinics, Pakistan, from March to June 2026. Functional capacity was assessed using the Duke Activity Status Index (DASI), and perceived barriers were evaluated using the Cardiac Rehabilitation Barriers Scale (CRBS). Multivariable linear and logistic regression analyses were performed to identify predictors of reduced functional capacity and CR non-participation.
Results: The mean DASI score was 20.4 ± 11.3, corresponding to a mean estimated VO₂ peak of 18.4 ± 4.9 mL/kg/min, and 34.3% of participants had poor functional capacity. Overall, 41% received CR referral, 23% enrolled in CR programs, 12.4% completed the prescribed program, and 81.5% met the criteria for CR non-participation. The mean CRBS score was 3.24 ± 0.68, with socioeconomic/logistical barriers showing the highest domain score (3.68 ± 0.74). Older age, higher body mass index, lower left ventricular ejection fraction, and previous coronary artery bypass graft surgery independently predicted reduced functional capacity, whereas the absence of CR referral was the strongest predictor of CR non-participation (aOR = 8.42, 95% CI: 3.14–22.58). Functional capacity was inversely correlated with perceived barriers (ρ =-0.442, p < 0.001).
Conclusion: Patients with CAD demonstrated reduced functional capacity, low CR referral, enrollment, participation, and completion rates, together with substantial perceived barriers to rehabilitation. Strategies to strengthen referral pathways, improve patient education, and expand access to CR services may improve rehabilitation participation and functional recovery.

Recommended Citation

Sidra Ashraf, Maryam Shabbir, Ashfaq Ahmad, Naveed Arshad, Aqsa Majeed, Functional Capacity, Participation in Cardiac Rehabilitation, and Perceived Barriers among Patients with Coronary Artery Disease Journal of the Hong Kong College of Cardiology 2026;33(3):112-121 https://doi.org/10.55503/2790-6744.1590

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