Summary of themes and subthemes derived from thematic analyses of focus group discussion transcripts
| Theme | Subtheme | Quotes |
| 1. Fear of undertaking physical activity. | “I’m not confident when I go out on my own. I’m frightened I’m going to collapse.” (FG 1, male, aged 57) “It’s frightening when you’ve gone too far. Something’s always holding me back from going that little bit further, you know.” (FG 1, male, aged 56) | |
| 2. Family members influence physical activity efforts. | 2.1. Fear in family members prevents engaging with physical activity. | “I've got a wife who’s not happy if I say I’m going out for a walk for an hour…, because she thinks that’s too much.” (FG 2, male, aged 67) “…Sometimes, your family don’t want you to do it, not because they’re being horrible, it’s because they’re concerned about you.” (FG 1, male, aged 78) |
| 2.2. Support from family members facilitates physical activity. | “I needed motivation which I got from the family, which is great…I don’t know how I would have fared without family.” (FG 2, female, aged 62) “I think it does help if you’ve got a supportive partner. My husband has come out with me for all my walks right from the start. I think it’s good if your partners can be involved and then they realise, don’t they, how they can help.” (FG 2, female, aged 62) | |
| 3. Physical activity programmes require endorsement by clinicians. | “I think my biggest breakthrough was…I was doing more and more but, again, family was saying, ‘Take it easy.’ Fortunately, my wife was with me on one occasion when I saw Dr ‘XX’ and he asked what I’d been doing, and he said, ‘Well, do more.’ I said, ‘How do you mean by that?’ He said, ‘Just do more and more until you feel you can’t and then back off a bit.’ So, fortunately, my wife was there and she heard him say it. So, I’ve had no peace since then.” (FG 1, male, aged 78) “My nurse certainly was interested [in my physical activity habits] and when I went last time, was aware of what I was doing and obviously encouraging.” (FG 2, female, aged 62) | |
| 4. Completion of a cardiac rehabilitation programme provides confidence to complete a physical activity programme at home. | “I think the most important thing when you’ve had a heart attack is to have the confidence to do it at all. I think the cardiac rehabilitation that I had gave me the confidence and then you can move on to do other things. I think if you had just had a heart attack and someone says, ‘Right, you’ve got to go for a walk every day,’ it would be difficult to do. I think it would. So it’s like a step in the process.” (FG 2, male, aged 71) “I was really upset when it [cardiac rehabilitation] finished. I had somewhere to go. I’m sat at home by myself all day, so coming here on the Wednesday [for the study visit] and receiving feedback, it was like Christmas all over again, you know. It was great.” (FG 1, male, aged 56) | |
| 5. Coach support increases motivation long term. | “[having your coach call you] encourages you to keep up with it, definitely, because I think if you didn’t get the phone calls, I think you might just go, ‘It’s not very nice out today, I’ll not bother going.” (FG 2, female, aged 62) “When somebody is monitoring you, it makes you get up and go out, doesn’t it? I mean if you go to the gym yourself, some mornings you might say, ‘I’m not going to go today,’ but it’s helping you, isn’t it?” (FG 3, male, aged 62) | |
| 6. Weekly agreed targets increased confidence and motivation. | “It’s a target as everyone’s saying and you want to do it and you feel very enthusiastic about doing it and I will certainly continue after the 12 weeks because it would be pointless stopping all together wouldn’t it? It would waste the benefit sort of thing.” (FG 2, male, aged 70) “I think if you were told increase to 12 000 and I come back in 12 weeks’ time and we talk about it, you would go…but what’s good is on Tuesday [my coach] rings me and goes through all the information, we get an average and then he’ll ask me how I'm feeling, etc., etc., and say, ‘Right, let’s try and take that 12 000 up to 12 500.’ That’s on a weekly basis. You know for a fact that someone’s interested in what’s been happening for the past week and we can take that from where we are now to try and improve things.” (FG 2, male, aged 69) | |
| 7. A credible team increased the likelihood of participation. | “I think the fact that people like yourselves who are specialists in this sort of area take such an interest in us people. I think that gives you the boost again. I think it does boost people when you’ve got people who are really even higher than your GP and what not in that specific area of cardiac problems.” (FG 2, male, aged 78) “Well I think this is a speciality subject, what you’re doing and all the stuff here that we’ve been doing. I think it’s better in that situation to get the right advice.” (FG 2, male, aged 67) | |
| 8. The surrounding environment creates barriers to increased physical activity/exercise. | “I think another…difficulty…trying to get people motivated is the area that they live in. Now if you’ve got a bit of countryside, open fields and that, it opens you to more space unlike just got solid concrete, trying to get people motivated to walk down the same street or go a particular…way, that’s going to be difficult I think. If you’re going to motivate people you’re going to have to think where they actually live because people need different types of motivation. For people who live near the coast and the countryside, people living smack bang in the middle of a built-up area etc.” (FG 2, male, aged 67) “To me, I’m okay most of the time on the flat, but it’s any incline. The littlest incline in the world kills me.” (FG 2, male, aged 78) “I think some of the benefit was the climate as well, it’s a struggle in wind and rain.” (FG 3, female, aged 63) | |
| 9. Participation prompts an increase in everyday activity levels. | “What I do now is I have to drive to the supermarket but I park in the furthest corner of the car park and I walk round the car park. Then on rainy days, what I have been doing is going into the supermarket and going round it twice before I start my shopping. The people must think you’re mad if they look at you on the CCTV.” (FG 2, male, aged 71) “I think it’s got to work doing exercise. I mean they brought me in here; they’re going on about putting a defibrillator in. Now when he saw me, how my heart had changed just through doing things, he decided he wouldn’t put one in.” (FG 3, male, aged 62) “I haven’t been back to see my specialist at the Freeman [hospital], because he doesn’t want to see me for 12 months because I’m too fit for him. I said, ‘Are you sick of me?’ he said, ‘No.’ It was 6 months before and then I went for the last check sometime last year, he said, ‘Right, I don’t want to see you for 12 months. I said, have you gone off me?” (FG 2, male, aged 71) “Well since I’ve completed the course (Active-at-Home-HF), I‘ve been diabetic for 30 years, my blood sugar levels have never been as normal as an ordinary person’s in my life.” (FG 2, male, aged 79) | |
| 10. Support to maintain long-term activity levels would be beneficial. | 10.1. Support from a healthcare professional following completion of the programme would help maintain increased physical activity. | “I think a follow-up is a good idea. You need some sort of follow-up after you’ve finished. How they do it, whether it’s a phone call or a meeting with your doctor or whatever, your GP or anybody like that, I don’t know how they would do it. But I think that’s quite important that. Then you wouldn’t feel as if you’ve been chucked on the scrap heap type of thing, you’ve finished, it’s done.” (FG 3, male, aged 73) “Do you know, that’s the worst thing, when you’ve finished your course and the following Wednesday there’s no phone call. It’s horrendous isn’t it?” (FG 2, male, aged 67) |
| 10.2. Group peer support would promote long-term physical activity. | “I know it’s just the start of this programme…, As far as feedback on it is concerned, maybe something about halfway through, maybe six weeks you could have a little meeting with some of the people just for half an hour, just have a little chat and see who’s there, what’s what, talk to people, something like that anyway. A little informal meeting or a social evening or whatever you want to call it. It lets everybody else know that it’s not just you or another two or three people, it might be 20 people.” (FG 3, male, aged 73) |
FG, focus group; GP, general practitioner.