title: Dealing with existential anxiety in exercise-based cardiac rehabilitation: a phenomenological-hermeneutic study of patients' lived experiences.
abstract: OBJECTIVE
  To investigate patients' lived experiences of exercise-based cardiac rehabilitation.
  
  
  BACKGROUND
  Exercise-based cardiac rehabilitation is used to enable patients with cardiac problems to move forward to lead satisfying lives. However, knowledge of patients' concerns while they follow the current programmes is sparse.
  
  
  METHODS
  This study, which included nine men and two women with unstable angina pectoris and non-ST-elevation myocardial infarction, used a phenomenological-hermeneutic approach.
  
  
  METHODS
  The patients were followed by field observations during exercise-based cardiac rehabilitation. Focus group interviews were conducted at the programme end, and individual interviews were performed one to two months later. The interpretation comprised three methodological steps: naïve reading, structural analysis, and comprehensive interpretation and discussion.
  
  
  RESULTS
  Although both physically and psychologically challenged, the patients were encouraged to maintain an active lifestyle. Three themes were identified: anxiety regarding exercise, whereby the patients are initially insecure about how to behave with their diseased hearts; encouragement from training together, whereby the patients support each other in exercising; and growing confidence in the heart, whereby the patients enjoy being physically active.
  
  
  CONCLUSIONS
  In exercise-based cardiac rehabilitation, patients' insecurity with respect to their heart disease is revealed as an existential anxiety. Through peer support and a positive physical perception, the patients gain renewed self-efficacy, helping them to continue their lives in an active and satisfying way.
  
  
  CONCLUSIONS
  Knowing that patients are confronted with an existential anxiety during exercise-based cardiac rehabilitation is important because it requires specific care. Recognising this anxiety also highlights how participating in the programme can be very demanding, which can help us understand aspects of adherence problems. Of greatest importance is that exercise-based cardiac rehabilitation enables patients to find a new foothold, which comprises enjoying being physically active.
authors.affiliation: Institute of Health, Section of Nursing Science, Aarhus University, Aarhus, Denmark.|Region Zealand, Slagelse Hospital, Slagelse, Denmark.
authors.forename: Charlotte P
authors.initials: CP
authors.lastname: Simonÿ
authors.affiliation: Research Unit of Nursing, Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark.
authors.forename: Birthe D
authors.initials: BD
authors.lastname: Pedersen
authors.affiliation: Institute of Health, Section of Nursing Science, Aarhus University, Aarhus, Denmark.|Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Pia
authors.initials: P
authors.lastname: Dreyer
authors.affiliation: Section of Health Services Research Lillebaelt Hospital/University of Southern Denmark, Vejle, Denmark.
authors.forename: Regner
authors.initials: R
authors.lastname: Birkelund
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D001008:Anxiety Disorders; D003718:Denmark; D005081:Exercise Therapy; D005260:Female; D017144:Focus Groups; D066297:Hermeneutics; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000451:nursing / Q000523:psychology / Q000534:rehabilitation*
keywords: coronary heart disease; exercise-based cardiac rehabilitation; existential anxiety; patients' lived experiences; peer support