title: Barriers to cardiac rehabilitation use in Canada versus Brazil.
abstract: OBJECTIVE
  Despite its well-established benefits, cardiac rehabilitation (CR) is greatly underutilized globally. Barriers to its utilization have been identified in high-income countries. Given the growing epidemic of noncommunicable diseases in low- to middle-income countries, the identification of barriers to use of these low-cost interventions is warranted. The aim of this study was to describe and compare barriers to CR use in Brazilian and Canadian cardiac outpatients.
  
  
  METHODS
  Two cardiac samples consisting of 237 Brazilian (recruited from 2 CR centers in southern Brazil) and 1434 Canadian (recruited from 11 community and academic hospitals in Ontario) outpatients were compared cross-sectionally. Barriers were assessed by using the Cardiac Rehabilitation Barriers Scale, psychometrically validated in English and Portuguese. Mann-Whitney U tests were used to compare barriers between samples.
  
  
  RESULTS
  Overall, 139 (58.6%) Brazilian and 779 (54.3%) Canadian respondents were enrolled in CR. The mean total barriers score for Brazilian respondents was 1.71 ± 0.63, and 2.37 ± 1.0 (P < .01) for the Canadians. For 17 of 21 barriers, Canadians reported significantly greater barriers than Brazilians (P < .02). As their greatest barriers, Canadians rated already exercising at home or in the community and personal travel, while Brazilians identified distance to and cost of the CR program.
  
  
  CONCLUSIONS
  Despite the significantly lower availability of CR in Brazil and the universal health care system in Canada, cardiac outpatients in Canada perceived significantly greater CR barriers. Arguably, however, these barriers were more modifiable.
authors: Exercise Sciences Department, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada. Gabriela.meloghisi@utoronto.ca
authors: Gabriela Lima
authors: GL
authors: de Melo Ghisi
authors: Paul
authors: P
authors: Oh
authors: Magnus
authors: M
authors: Benetti
authors: Sherry L
authors: SL
authors: Grace
mesh_terms: D000368:Aged; D001938:Brazil; D002170:Canada; D000072038:Cardiac Rehabilitation; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010465:Perception; D011594:Psychometrics; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires