Background and Aims: Cardiac patients who engage in regular physical activity (PA) can increase their cardio-respiratory fitness, thereby significantly reducing morbidity and mortality. Despite these benefits, the majority of cardiac patients are not engaging in enough PA or reaching the fitness levels needed to reap these benefits, even when they are enrolled in or have completed a structured PA program such as cardiac rehabilitation (CR). As such, behavioural interventions are needed to help these individuals improve and maintain their PA behaviours. The purpose of this systematic literature review was to examine the behavioural techniques and strategies that have been used in PA interventions for coronary heart disease (CHD) and congestive heart failure (CHF) patients, and to determine their effectiveness in increasing PA based on the cardiac rehabilitation (CR) context (i.e., during CR and following CR completion (Post CR), and for those not attending CR (Non CR)).

Methods: The search strategy included PubMed, PsychINFO, SPORTdiscus, Web of Science, Prowler and the Cochrane Library databases. Studies were eligible if they described a published experimental or non-experimental intervention study delivered to adults with diagnosed CHD or CHF that focused solely on promoting PA.

Results: Twenty-three studies, examining 18 different behavioural interventions, with a total of 2,446 CHD or CHF patients were included in this review. Fourteen interventions were delivered in the Post CR context and nine were delivered in the Non CR context. Overall, findings suggest that behavioural interventions can increase PA regardless of context; however, there were notable differences across CR contexts in the purpose of the interventions, the demographics of the participants, and some of the behavioural strategies employed. Behavioural strategies shown to be most effective in the Post CR context were self-regulatory processes, self-monitoring and provision of feedback and reinforcement from the researcher. In the Non CR context, unsupervised home-based PA interventions were shown to be effective at increasing PA, particularly when accompanied by PA counselling and/or self-monitoring. More frequent contacts at the start of the intervention appeared to be more important than the overall length of the intervention.

Conclusion: Post CR and Non CR interventions can result in improved PA outcomes; however, the research in this area is quite limited. More interventions are needed that target PA only rather than multiple health behaviours simultaneously. Since most cardiac patients do not attend CR programs, interventions with this population should be a priority.