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. 2026 Apr 13;49(5):520–528. doi: 10.1002/nur.70072

Perceptions of Patients and Health Professionals Regarding the Experience of Patients With a Hybrid Cardiac Rehabilitation Program

Pamela Tanguay 1,2,✉, Nicole Marquis 1, Alexandra Ethier 1,3, Jennifer Hakim 1,2, Monique Dufour Doiron 4, Gaétan Thériault 5, Michel Leblanc 5, Marie‐Andrée Giroux 1,2, Mathieu Bélanger 1,2,4
PMCID: PMC13539701  PMID: 41972946

ABSTRACT

Hybrid cardiac rehabilitation (HCR), which combines supervised center‐based and monitored home‐based exercise programs, gained popularity during the COVID‐19 pandemic. While HCR appears to be as effective as standard cardiac rehabilitation, patients' experiences within these programs remain largely unexplored. This study aimed to explore program participants' (PP) perceptions and healthcare professionals' (HP) impressions of PP' experiences with HCR. A qualitative descriptive design was used. Audio‐recorded semi‐structured interviews were conducted with PP and HP, who had experience with HCR. Data were analyzed thematically. Interviews with PP (n = 16) and HP (n = 12) revealed four main themes: having fewer sessions at the center reduces accessibility barriers; going to the center provides a chance to connect with others; feeling safe in a supervised environment helps regain confidence; and going through the program supports progress through the stages of behavior change. The HCR program was perceived as convenient, primarily because it required fewer trips to the center. The program helped PP overcome feelings of social isolation, and the center was perceived as a safe environment where PP could test their physical limits. The HCR program raised awareness of their eating habits and physical activity through education. Overall, PP' experiences with HCR were positive and aligned with HP' impressions. Since PP primarily emphasized the benefits of the in‐center sessions, the benefits of this component should not be overlooked.

Keywords: cardiac rehabilitation, health behavior, qualitative research

1. Background

Cardiac rehabilitation (CR) has been shown to reduce cardiovascular mortality, recurrent cardiovascular events, and hospitalizations, as well as to improve quality of life and functional capacity in individuals with cardiovascular diseases (Brown et al. 2024). Traditional CR programs are typically delivered in outpatient centers or hospitals. They generally consist of 2−3 weekly sessions of prescribed cardiovascular and strengthening exercises, lasting for at least 8 weeks (Jones et al. 2020), combined with core components such as education on health behavior change, management of lifestyle risk factors, psychosocial health, medical risk management, long‐term strategies, and audit and evaluation processes (British Association for Cardiovascular Prevention and Rehabilitation 2023). CR programs are multidisciplinary, with nurses playing a pivotal role in optimizing patient outcomes through clinical assessments, personalized education, and support for psychological challenges (Izzo et al. 2025).

Patients usually report positive perceptions of CR programs (Yates et al. 2018), including increased disease‐related knowledge, perceived functional improvements, and enhanced psychosocial well‐being (Nascimento et al. 2021). These positive impressions may remain for up to 2 years after discharge from CR programs (Nascimento et al. 2021). However, some patients report feeling constrained by a perceived lack of choice in their exercise program and express a desire for more personalized information (Yates et al. 2018). In addition, CR programs are not widely accessible and often suffer from low recruitment and participation rates, meaning that relatively few eligible patients ultimately benefit from them (Chindhy et al. 2020).

The COVID‐19 pandemic prompted calls for alternative methods of delivering CR (Babu et al. 2020). As a result, hybrid CR (HCR) programs have gained popularity as an alternative to traditional center‐based CR. HCR is defined as a combination of center‐based and home‐based exercise sessions (Heindl et al. 2021). As in traditional CR programs, HCR includes the exercise component combined with at least another core component of CR (British Association for Cardiovascular Prevention and Rehabilitation 2023; Heindl et al. 2021). However, in HCR, home‐based sessions gradually replace some of the center‐based session that would have taken place in a traditional CR setting (Heindl et al. 2021). Home‐based CR sessions can be supervised in several ways: in‐person (healthcare professionals [HP] visit the patient's home), virtually (synchronous with real‐time audiovisual communication), or remotely (asynchronous) (Beatty et al. 2021). Remote CR can be monitored through phone calls (Seron et al. 2024), logbooks (Christle et al. 2020), or digital devices such as smartwatches (Fukuta et al. 2023).

HCR encourages patients to exercise in their home environment through home‐based sessions, in addition to the center‐based sessions. HCR programs also incorporate multiple behavioral change techniques aimed at increasing patient autonomy and supporting the long‐term maintenance of health gains (Tanguay et al. 2026). Research suggests better adherence and lower costs of HRC compared to center‐based CR programs, as well as greater satisfaction (Tanguay et al. 2026). This higher satisfaction may stem from the increased convenience, accessibility, and flexibility of HCR. Furthermore, reviews and recent studies on the effectiveness of HCR have demonstrated that they are comparable to traditional CR programs in their capacity to reduce cardiovascular disease events and improve both exercise capacity and health‐related quality of life (Amedro et al. 2024; Fukuta et al. 2023; Lahtio et al. 2023; Racodon et al. 2025; Tanguay et al. 2026).

Despite the growing number of comparative studies, the perceptions of patients and HP regarding patients' experiences with HCR remain relatively unexplored. Some qualitative studies have described hybrid models as acceptable and convenient (Damery et al. 2025; Vanzella et al. 2024). Gaining further insight into these perceptions could inform the design and delivery of HCR programs, ultimately promoting greater adherence and improved clinical outcomes. Therefore, the study aims to explore patients' perceptions and HP's impressions of the patients' experiences with an HCR program.

2. Methods

A qualitative descriptive design is well‐suited for exploratory inquiries aimed at clarifying relatively unexplored concepts (Gallagher and Marceau 2020). This design enables detailed descriptions of the phenomenon under study while remaining closely grounded in participants' accounts (Kim et al. 2017). As in other qualitative descriptive studies, the authors define their epistemological framework as postpositivist, acknowledging the existence of multiple participant perspectives and recognizing the probabilistic nature of cause‐and‐effect relationships (Creswell and Poth 2018). The study was reviewed and approved by the Research Ethics Committee Vitalité Health Network (#101,745). The study took place in New Brunswick, Canada, within the Vitalité Health Network, a publicly funded health authority.

2.1. HCR Program

Program participants (PP) took part in a 12‐week HCR program of the Vitalité Health Network. During the first 6 weeks of the program, PP attended a CR center twice a week. During Weeks 7−9, PP visited the center once a week and were instructed to complete at least one exercise session or more at home per week. To ensure the follow‐up of the home sessions, PP were asked to complete a logbook. In the logbook, PP were asked to record information regarding each cardiovascular (e.g., duration, perceived exertion, symptoms; number of steps taken per day or the distance covered during each walk) and strengthening exercise (e.g., number of repetitions and sets) performed. HP used the logbook to monitor the exercise done by PP at home. However, the logbooks were not used in this research because the research team did not have access to the medical records due to the nature of the ethical approval received. During Weeks 10–12, PP were expected to complete two or more home exercise sessions per week. Throughout these weeks, HP made weekly phone calls. Consistent with previous studies (Christle et al. 2020; Fournier et al. 2018), home‐based exercise sessions were monitored through phone calls and logbooks.

For each PP, the center‐based and home‐based sessions were guided by an individualized exercise program. In accordance with the Canadian recommendation for physical activity (Warburton et al. 2007), HP personalized the exercise program based on the PP' condition, preferences, and the equipment available at home. The exercise program included muscle strengthening, stretching, and cardiovascular exercises such as walking. Elastic bands were provided to PP to support the completion of muscle‐strengthening exercises at home.

The HCR program included 14 educational modules during the center‐based sessions. Twelve of these modules were presented as short educational videos covering various topics such as medication management and sleep (Supporting Information Material 1). The short videos were presented to PP at the end of center‐based sessions. The two other modules were related to nutrition and were in‐person sessions conducted by a dietician. All PP referred to the health network's CR program were offered 12 weeks of publicly funded HCR (no direct cost to PP).

2.2. Participants

PP were invited to take part in this study by a HP during their final evaluation (6 months after completion of the HCR program) as to ensure they understood the entire program and had time to reflect on the long‐term impacts of the HCR program for them. All PP who had completed the HCR program offered by the Vitalité Health Network in the Southeast region of New Brunswick could be invited to participate, with no exclusion criteria. Because women and men can have different experiences with CR (women are more likely to drop out due to family obligations or financial reasons [Colbert et al. 2015; Colella et al. 2015]), a purposive sampling strategy (Patton 2023) was used to achieve variation in the PP gender. Recruitment continued until data saturation was reached, defined as the point at which no new information emerged during interviews (Thorne 2020). Of the 19 PP invited, two women and one man declined to participate, citing time constraints due to other commitments. The 16 PP recruited included nine men and seven women, all Caucasian, with ages ranging from 54 to 86 years (median of 75 years).

HP delivering the HCR program were interviewed for a distinct research objective (to explore their perceptions of the program's acceptability). Since their interviews also provided data on their perceptions of the PP' experiences with the HCR program, this information was included in the current study for triangulation and to provide a more in‐depth understanding of the PP' experiences. HP (nurses or kinesiologists) were recruited via email. To be included, they needed to work for a CR program in the Vitalité Health Network, with no exclusion criteria. Of the 18 HP working in a CR center, 12 (three men and nine women; six kinesiologists and six nurses; all Caucasian) agreed to participate in the interviews. Their experience in a CR center ranged from 1 to 9 years. They represented all nine CR centers part of the Vitalité Health Network across New Brunswick, and every HP had experience with both center‐based CR and HCR.

2.3. Data Collection

Data was collected through individual open‐ended semi‐structured interviews, which were transcribed verbatim for both PP and health professionals. Those with PP were conducted by the first author at the participants' preferred location: their homes, over the phone, or in a public setting. They were conducted between June 2023 and January 2024, and lasted between 30 and 90 min. Those with the HP were conducted by MAG through an online teleconference software during the summer of 2023, and lasted between 45 and 75 min.

The patient interview guide was initially constructed based on Bandura's self‐efficacy framework (Bandura et al. 2019) to explore PP' perceptions of their self‐efficacy in maintaining healthy behaviors after participating in an HCR program. Bandura's self‐efficacy framework states that for a person to adopt a behavior, they have to feel capable of doing so (self‐efficacy) and this feeling can be influenced by performance outcomes, vicarious experiences, verbal persuasion, and physiological feedback (Bandura et al. 2019). The interview guide aimed to explore each of these four concepts. It was developed and pilot‐tested with the team's patient partners (G.T., M.L.). As data were collected and analyzed iteratively (Sandelowski 2010), the interview guide was iterated (Poupart 1997) based on what seemed most important to PP to better understand their experiences with an HCR program. The final interview guide (Supporting Information Material 2), therefore, shifted to focus on the PP' understanding of the program and its impact on their daily lives.

For HP, the interview guide was constructed based on Sekhon's acceptability framework (Sekhon et al. 2017). This framework explores the perspectives of HP involved in an intervention, both prospectively and retrospectively (Sekhon et al. 2017, 2022). This framework proposes that acceptability is a multifaceted construct consisting of seven components: affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self‐efficacy. The guide also asked professionals' impressions regarding similarities and differences of hybrid versus center‐based programs. The final interview guide (Supporting Information Material 3) was designed to explore the acceptability of the HCR program in comparison to a center‐based CR program, as well as to gather HP' impressions of PP' experience with HCR.

2.4. Data Analysis

Transcripts of all interviews were compared to the audio files, and any discrepancies were corrected. The anonymization of the transcripts was conducted by the first author. An inductive thematic analysis approach was employed, with the aim of identifying emergent themes rather than making theoretical inferences (Miles et al. 2018). Our analysis was inspired by Miles et al.'s framework, which includes four key steps: data collection, data condensation, data display, and conclusion drawing/verification (Miles et al. 2018). In our study, data display was conducted through narrative summaries of each participant's experience.

Three authors (P.T., G.T., and M.L.) independently reviewed a sample of patient interviews and met to identify preliminary codes and themes. Subsequently, four authors (P.T., A.E., J.H., and M.B.) conducted data condensation of the patient interviews by coding the transcripts line‐by‐line (Miles et al. 2018), focusing on PP' experiences with the HCR program. Specifically, at least two authors read each transcript, and the four authors frequently met to discuss their overall understanding of each patient's experience. They collectively defined the codes using the ATLAS.ti web software (version 24). At each meeting, they discussed their coding of up to two interviews and continued meeting until they identified no new codes. Twelve interviews were discussed through this process, and the remaining transcripts (n = 4) were reviewed by the first author. This collaboration helped the authors gain a mutual understanding of both the data and the PP' experiences (Weston et al. 2001). In these meetings, one author presented a narrative interpretation of each participant's experience. These narratives were then verified and critiqued by all four authors to develop an intersubjective consensus (Miles et al. 2018). Through this process, recurring patterns across participants' experiences were identified and grouped into overarching themes (conclusion drawing).

A similar data analysis process was conducted for HP interviews. Two authors (P.T., M.‐A.G.) read the transcripts of the HP and developed codes and themes with the goal of exploring professionals' impressions of the PP' experiences. For the triangulation, the first author then identified themes in the HP' transcript related to the themes in the PP' transcripts. Any contradictions in opinions between the PP and the HP were reported in the findings. Two other authors (N.M., M.B.) subsequently reviewed the triangulation process to develop an intersubjective consensus (Miles et al. 2018).

To enhance the credibility of the findings, peer examination was conducted throughout the study by three authors (M.D.D., G.T., and M.L.). When disagreements arose regarding the interpretation of the data, they were discussed collectively until a consensus was reached. Finally, data from French‐speaking participants (n = 14) were translated into English during manuscript preparation. Each translation was independently verified by at least two authors (fluent in both French and English).

3. Results

Four main themes were identified: having fewer sessions at the center reduces accessibility barriers, going to the center provides a chance to connect with others, feeling safe in a supervised environment helps regain confidence, and going through the program supports progress through the stages of behavior change (Table 1).

Table 1.

Program participants and healthcare professionals quotes for each theme.

Themes Description of the themes Program participants quotes Healthcare professional quotes
Having fewer sessions at the center reduces accessibility barriers The HCR program was perceived as practical by program participants due to less travel and fewer work interruptions. Healthcare professionals added that the program appeared more accommodating than the traditional model.

Leaving home to go [to the center], [the road is] not always easy. (PP13)

The price of gas is not that cheap and it's quite a drive. (PP16)

I took time off work to go to [the centre] (PP07)

It's too expensive to drive me to [the centre], and during the winter months, I'm not comfortable driving in storms or snow at my age. (PP04)

It is much easier for people, especially those who work, to complete the [hybrid] program. (HP04)

I find that fewer people drop out with the hybrid program than with the traditional program. Yes. I've had some dropouts […] but most of the time it was because they had to go back to work and couldn't come anymore. (HP06) I think people would choose hybrids more often because of the cost of petrol and living costs (HP12).

With the traditional program, there are more people who refuse because it seems like a lot, three months twice a week. […] Sometimes, we managed to recruit them by explaining that it was only six weeks twice a week and then it decreased, so they would say, ‘Oh, okay, I'll do it.’ (HP10)
Going to the center provides a chance to connect with others Center‐based sessions helped program participants break social isolation by enabling them to leave home and engage socially with others, a benefit also recognized by healthcare professionals.

Well besides the physical, the mental boost I got from going because the people there are all so upbeat and they give you confidence somehow or other, you know, you feel that ok, you're not a useless old thing yet. (PP16)

There was a kinesiologist who [was there] […]. I really appreciated that. (PP10)

For me, coming here was like a social activity. (PP12)

The patient develops a relationship of trust with you […]. This is the basis of a therapeutic patient‐nurse relationship. (HP05)

They come [to the centre] to get out of the house. (HP09) [The patients] feel better […] because we are there. (HP11)
Feeling safe in a supervised environment helps regain confidence The center helped program participants feel safer and more confident being active by learning to monitor their bodies and exercise under supervision.

[The healthcare professionals] made me feel safe by watching me do the exercises. (PP06)

I was following my heart rate, that's what was important to me. (PP03)

It reassured me, I was able to do everything, and I didn't have any more pain. […] When I did my exercises, I didn't have any pain at all. (PP11)

It gave me a lot of confidence knowing what I could do again (PP07)

[They] don't know their limits. They come here to find out how far they can go. (HP10)

[The patients] came here and it just gave [them] the confidence to go for walks without worrying, without thinking, ‘Is something going to happen?’ (HP11)

[They] did it because [they are] really anxious about [their] heart, [there are] anxious to push [themselves].[…] [There are] going to [the centre] for that reason. (HP05)
Going through the program supports progress through the stages of bevavior change The program contributed to raising program participants' awareness of healthy behaviors and supported program participants in progressing toward adopting healthier habits.

I felt better, I think I'm healthier, and I'm eating better too. (PP04)

Well, I learned that sugar is bad for everyone. I probably drank to much liquor, so I cut back on that. (PP06) I would say that it got me back in shape and also helped me see that exercise can make me stronger. (PP10)

I do a lot of education on […] what exercise is, what it means to be active, and what an active lifestyle is. (HP12)

I've really seen an improvement in their nutrition. (HP03)

Patients learn to listen to and understand themselves and their abilities. (HP06)
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Abbreviations: HCR, hybrid cardiac rehabilitation; HP, healthcare professional; PP, program participant.

3.1. Having Fewer Sessions at the Center Reduces Accessibility Barriers

This theme reflects how PP described the challenges associated with attending center‐based sessions. HP nuanced that, because the HCR program includes fewer in‐person sessions, it helps reduce these challenges. As a result, the program can appear more convenient and accessible than a traditional model.

In fact, several PP reported difficulties traveling to the center due to the distance from their homes and challenging weather conditions. PP also mentioned the indirect costs incurred by transportation: “Unfortunately, my car isn't small—it's a big car that's hard on gas. With current gas prices, it was costing me $20 a day every time I drove [to the centre]” (PP03). In addition to those costs, PP must take time off work at their own expense to attend center‐based CR sessions. Some indicated these combined factors limited their ability to participate fully in center‐based rehabilitation.

HP also added nuance by comparing the HCR to the traditional CR program: the HCR program appears more convenient than the traditional program. As one professional stated: “Maybe they didn't start the [centre‐based] program because of the [indirect] costs, as they couldn't afford to attend. However, a hybrid program could accommodate them. For example, attending twice a week for 6 weeks and then gradually reducing to once a week makes its less and less challenging” (HP09). HP explained that reduced travel time and time off work make it easier for PP to participate in the program. They further noted employers might be more accommodating in granting time off for a program lasting for a shorter period: “If employers know in advance that the program will last about a month and a half and that it will gradually decrease, they may be more accommodating with a hybrid format” (HP01). HP felt that because HCR was more convenient than the traditional CR program, it could recruit a greater proportion of patients.

However, one of the main observations from this study is that PP talked only about the center‐based program components. While questions about the home‐based exercise sessions were included in the interviews, PP associated HCR solely with the center‐based sessions. It is possible that the perceived greater convenience of HCR over traditional CR is related to PP not realizing home‐based sessions were meant to represent a formal part of CR, despite HP reporting having provided this information.

3.2. Going to the Center Provides a Chance to Connect With Others

This theme captures how center‐based sessions within the HCR program helped PP overcome feelings of social isolation by leaving the house and connecting with the HP.

Many PP reported their physical limitations had previously confined them to their homes, limiting social interactions and outings. Participation in the center‐based sessions provided an opportunity to leave the house: “So once you go to cardiac rehabilitation you say that you like it because […] it gives you a chance to like get out of the house” (PP09). HP also reported this, adding some PP even preferred attending sessions over staying at home, highlighting the social and psychological benefits of the program beyond its physical rehabilitation goals: “They come to [the centre], and it seems some of them prefer it to staying at home.” (HP08).

PP reported center‐based sessions provided an opportunity for social interaction, but primarily with HP: “We didn't really get the chance to talk to anyone else except [the HP]” (PP05). Many described the emotional impact of these encounters, noting that contact with professionals provided motivation and support: “Well besides the physical, I got a mental boost from going [to the centre] because of the [HP]” (PP16). This was echoed by a HP who noted, “I think they enjoy the social contact with us” (HP07). These findings suggest that while the center‐based component fostered meaningful connections with HP, it did not facilitate peer support or socialization among participants.

3.3. Feeling Safe in a Supervised Environment Helps Regain Confidence

Participants described the CR centers as a safe environment. This sense of safety was also perceived by their relatives, who felt reassured knowing that the PP were exercising under professional supervision. During the HCR program, PP perceived the center as a safe environment for engaging in physical activity. This sense of safety was shaped by two elements: the ability to monitor their vital signs and the supervision provided by HP.

PP stated that learning how to monitor their vital signs through the HCR program helped them regain confidence in their physical abilities. Monitoring vital signs allowed them to observe how their bodies responded to physical activity, which reassured them. Many PP expressed initial concerns about engaging in physical activity, as they were unsure of what they could do without harming their hearts or bodies: “I had no idea if my heart was responding [to the exercise] correctly, you know” (PP03).

PP mentioned kinesiologists and nurses' supervision during the early phases of the HCR program helped them regain confidence in their physical abilities: “You knew that while you were there you were in safe hands […] [the HP] gave me a lot more confidence” (PP16). They found it reassuring to know someone familiar with their condition could intervene if a problem arose. This supervision allowed PP to feel at ease when practicing exercise, which was essential in rebuilding their confidence.

The center‐based sessions gave the PP an opportunity to test the limits of their body in a safe environment. PP who were generally physically inactive prior to the program stated that center‐based sessions enabled them to understand more about their physical limits: “I wanted to come here for the exercises, I wanted to see what was too much” (PP14). However, this experience contrasted with the experience of PP who had been active prior to the program. These more active participants felt they could not push their limits as much as they hoped: “When they asked me to walk 15 min on the treadmill, well, I was able to do half an hour at home, so I could [walk] 15 min easily there” (PP03). They expressed that they would have liked to be pushed further by HP.

Challenging their physical limits helped PP strengthen their confidence and sense of self‐efficacy in engaging in physical activity. As one participant shared: “It showed me that I could do [physical activity] even with my heart problem and that I could push myself as hard as I wanted without any problems” (PP14). HP echoed this observation, noting that PP were often uncertain or hesitant about exercising on their own at the beginning of the program. They emphasized the center‐based sessions played a crucial role in building PP' self‐efficacy by providing a safe, supervised environment: “At first, people are very worried, they don't really know what to do […]. Afterwards, […] when they're reassured, they're able to start exercising by themselves at home when they see it's not dangerous” (HP01).

Additionally, PP shared that their relatives felt reassured knowing that their loved ones were under professional supervision and well cared for. Many reported that their loved ones were afraid of their condition worsening. They noted that participation in the CR program helped reduce this stress: “[My partner] wants me to be as healthy as possible. So [my condition] stresses him out a lot. It reassures him that I'm going [to the cardiac rehabilitation centre], that I'm doing the exercises and all that, and that I'm trying to be healthy” (PP01). This reduction was largely due to knowing that HP were monitoring and following up on their health.

3.4. Going Through the Program Supports Progress Through the Stages of Behavior Change

This theme highlights how PP and professionals felt the HCR program contributed to raising PP' awareness of healthy behaviors, including eating habits and physical activity through education. Beyond awareness, this theme also describes how participation in the program supported PP in progressing toward adopting healthier habits, which led to improvements in their daily lives.

The HCR program included two optional nutrition classes during center‐based sessions, which PP valued for their positive impact on daily life. When asked what they would remember most about the HCR program, many PP highlighted the impact of the nutrition sessions. They mentioned learning about various aspects of nutrition, including the appropriate amounts and proportions of nutrients to consume, as well as specific nutrients tailored to their condition: “[I learned] what to eat, what not to eat, and how much to eat” (PP09). Also, PP reported that the classes helped them realize they needed to change their eating habits to achieve health goals such as weight loss: “So that helped me understand […] why I was gaining weight like I was. They said maybe I was not eating enough protein” (PP01). As a result of these classes, PP felt more confident in making changes to their diets. For some, this translated into concrete actions, including this participant who explained having changed the types of food he consumes for snacks: “Cookies and chips and [stuff like that] are really good. But that's it, it's zero. So now, I eat grapes and oranges and whatever else is better” (PP02). Since they were not involved in delivering these classes, the kinesiologists and nurses interviewed had limited insights about those. HP hypothesized the classes helped PP realize their eating habits were not as healthy as they had initially thought: “People think they are eating well, but they are surprised to learn things” (HP01).

PP learned about factors affecting physical activity practices through education provided by HP within the HCR program. Before the program, some PP were unsure why they were not physically active and simply perceived themselves as lazy. The program helped them recognize barriers to physical activity and allowed them to understand the reasons impeding their intent to exercise. Additionally, several PP realized their insufficient level of physical activity. However, most PP in this study appeared not to be doing any exercise at the time of the interview. Many PP mentioned that they did not integrate exercise into their daily lives due to a lack of variety in the exercises offered. When we asked one participant who did not enjoy walking whether he had been offered alternative activities, he replied, “Not that I can remember” (PP15). HP mentioned that PP who are close to the idea of integrating physical activity in their lives are not receptive to suggestions regarding alternative activities. One expressed that regardless of the CR program they are in or the specific exercises prescribed, “Patients who really want to exercise are going to do so whether it's hybrid or not” (HP01).

To help PP maintain their physical activity level in the later parts of the HCR program, it was planned for professionals to use telephone follow‐ups. Through these follow‐ups, professionals were meant to encourage the completion of home‐based exercise sessions and address questions related to behavior changes. While some PP enjoyed the follow‐up calls, they fell short of attaining their objectives with others. Some even did not recall receiving telephone follow‐ups. Perceptions related to the telephone follow‐ups, either positive or negative, had more to do with its process rather than its intent. For example, those who appreciated the calls, mainly women, felt that it maintained their relationship with the HP they had connected with during the center‐based sessions. One patient said, “[The phone calls] allowed to verify I did fine and check if I had problems. I thought it was okay, but it would have been more fun to go [to the centre] more often” (PP10). PP who did not appreciate the calls expressed a preference for in‐person conversations, mentioned difficulties with phone communication, or did not find the calls relevant to their health follow‐up. For example, due to his level of education, this participant would have preferred other means of communication as phone conversations were difficult for him: “I don't like being on the phone. I graduated at grade 7. […] talking on the phone to have a conversation, no. No, it doesn't appeal to me” (PP02). From the HP' perspective, most of them found the telephone follow‐ups impersonal and ineffective for building relationships with PP, providing information, or promoting healthy behaviors. They also questioned the accuracy of the information provided by PP over the phone and found gathering the necessary details difficult: “I find over the phone it's much like during COVID. I mean when you lose the contact all the time it's impersonal, you don't always know what to say on the phone because it's a question, it's not a conversation” (HP02).

4. Discussion

This study provides an understanding of PP' experiences with an HCR program by incorporating both patient and healthcare professional perspectives. The findings suggest that the HCR program was perceived as convenient, while center‐based sessions provided a chance to connect with others and were perceived as a safe environment. In addition, the education and experience provided during the program help PP progress through the stages of behavior change.

One of the main observations from this study is that PP rarely considered the home‐based component of the program when describing their experiences. Given that PP mainly talked about the center‐based sessions, it appears important not to underestimate the advantages of center‐based sessions in a context where new CR models emerge. This would be consistent with the findings of another qualitative study which documented the experience of participants having participated in a home‐based telerehabilitation program. Participants would have liked to have center‐based sessions to learn how to perform exercises, to monitor their vital signs, and for safety concerns (Vanzella et al. 2024). This underscores the fact that a minimum number of center‐based sessions is possibly required to get PP familiar and comfortable with the idea of engaging in physical activity. At the same time, the convenience of the HCR program, particularly through the reduction in the number of center‐based sessions, was described by HP as an advantage, and has also been reported in other studies (Damery et al. 2025; Vanzella et al. 2024). This feature may contribute to improving patient recruitment by making participation more accessible.

Our findings align with those found in studies exploring the experiences of participants with traditional center‐based CR programs (Yates et al. 2018). The current study suggests that the safe environment provided by center‐based CR sessions can help PP both gain confidence in their physical abilities and break social isolation. Other studies have demonstrated that CR can positively influence psychosocial well‐being (Yates et al. 2018), for example, by reducing symptoms of anxiety and depression (Zheng et al. 2019). These beneficial effects have largely been attributed to the positive impact of physical activity on mental health (Maynou et al. 2021), but our studies showed that center‐based sessions can also have a positive impact.

Education is a core component of any CR program (Lara‐Breitinger et al. 2021), and it is noteworthy that among the 14 education sessions offered, only the nutritional education classes were highlighted as having been greatly appreciated by PP. The topic of nutrition may have been more appealing to PP than other educational aspects of the program. Alternatively, it is possible that the in‐person education sessions on nutrition catered better to PP than the short video vignettes approach used for the other topics. As previously documented, self‐guided educational material like booklets and videos can effectively enhance disease‐related knowledge in patients with coronary heart disease (Jaiswal et al. 2022), but in‐person education offers more in‐depth and detailed information (Thomas et al. 2021) which can be more beneficial for patients.

These findings offer several practical implications for the design and delivery of future HCR programs. We recommend that alternative models of CR should consider including some center‐based sessions, as this seems important to strengthen the confidence of the PP. To better promote home‐based sessions, improvements could include providing clearer exercise instructions and allowing participants to understand that this part of the program needs to be continued at home. Additionally, offering a greater variety of home‐based exercises appears important as individualization of exercises is crucial for promoting adherence to an exercise program (André et al. 2024). Although telephone follow‐ups had been shown to support adhere (Zhang et al. 2025) and were an integral to the hybrid model studied, most PP did not fully grasp their purpose or how they could support home exercise. Clarifying the objectives of these calls, such as reminding participants to continue exercising, may enhance their impact.

There is growing evidence that HCR is as effective as the traditional CR program (Imran et al. 2019). Future studies should nevertheless explore how to optimize the balance between face‐to‐face and remote components to improve engagement, adherence, and accessibility. Additionally, to promote long‐term adherence, alternative CR programs may need to incorporate strategies shown to be effective in community‐based interventions, such as using technology (e.g., phone apps or smartwatches) to support walking through self‐monitoring and goal setting (Oh et al. 2021).

This study has several limitations. First, PP had no knowledge of the structure of a traditional CR program and could therefore not contrast their experience with what it would have been under a traditional model. Second, only individuals who completed the HCR program were recruited, excluding the perspectives of PP who discontinued the program, which may have led to a selection bias favoring more positive experiences. Third, it is possible that remote monitoring of home‐based exercise sessions through phone calls and logbooks was not sufficient for PP to consider home‐based sessions as an integral part of the HCR program. PP may have been more likely to consider home‐based sessions if the monitoring methods were synchronous (in person or virtually). Logbook data could have provided valuable insight into the extent to which PP exercised at home. However, these data were not accessible, as participants had only consented to take part in interviews and not to giving access to data from their personal records. Fourth, it is possible that HP had preferences for one CR model over the other, which could have led to the expression of biased opinions. While the interview guide included questions focused on the experience associated with some of the individual components of CR, it was not developed with a specific aim to directly assess the impact of all components of HCR. Therefore, taking a deductive approach to examine the impact of each component was not possible in this study. However, it could enhance future research on PP' perception on specific components of a HCR program. Nevertheless, the use of an inductive approach helped identify elements that participants perceived as having been the most significant in shaping PP' experiences with the HCR (Miles et al. 2014).

5. Conclusion

Our findings enhance our understanding of HCR as a novel CR delivery model. This study highlights that PP who took part in an HCR program perceived it as convenient, accessible, and reduced barriers for attending the CR program. They also perceived the center‐based sessions provided a chance to connect with others and were perceived as a safe environment. This environment helps them gain confidence in themselves. In addition, the program helps PP progress through the stages of behavior change. Whereas HCR distinguishes itself from traditional CR by the inclusion of home‐based exercise sessions, there is a need to continue recognizing the merit of center‐based sessions as they contribute to PP's psychological well‐being. Additionally, studies should also explore how to optimize the balance between face‐to‐face and remote components to improve engagement, adherence, and accessibility.

Author Contributions

All authors contributed to the conception and design of the study. Pamela Tanguay performed the data collection. The analysis was performed by all the authors. Pamela Tanguay wrote the first draft of the manuscript, and all authors commented on previous versions. All authors read and approved the final manuscript.

Conflicts of Interest

The authors declare no conflicts of interest.

Patient Contribution

Two patient partners are members of the research team and have been fully engaged in all study phases, from project conception to knowledge translation. They contributed to the development of the research question, co‐constructed the interview guide, piloted the interview guide, and participated in the analysis and writing of the manuscript. They are co‐authors of this manuscript.

Supporting information

Supporting File

NUR-49-520-s001.docx (19.4KB, docx)

Acknowledgments

Pamela Tanguay has received grants to fund her PhD formation and the research project of which this article is a part. She has received funding from the following organizations: Ordre des professionnel de la physiothérapie du Québec, RechercheNB, Maritime SPOR SUPPORT UNIT, and the New Brunswick Health Research Foundation (NBHRF), Université de Sherbrooke. At the time of the study, Alexandra Ethier was a CIHR Research Graduate Scholarships–Doctoral Program recipient (#476590).

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supporting File

NUR-49-520-s001.docx (19.4KB, docx)

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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