São Paulo State University, School of Technology and Sciences, Presidente Prudente, São Paulo, Brazil.
Toronto Rehabilitation Institute, Cardiovascular Prevention and Rehabilitation Program, University Health Network, 347 Rumsey Road, Toronto, ONM4G 2R6, Canada.
Public Health Nutr. 2021 Oct;24(15):4823-4839. doi: 10.1017/S1368980021002962. Epub 2021 Aug 4.
To identify individual-, provider- and system/environmental-level barriers and facilitators affecting cardiac rehabilitation (CR) participants' adherence to dietary recommendations.
A systematic review of the medical literature was conducted. Six databases were searched from inception through March 2021: APA PsycInfo, CINAHL, Embase, Emcare, Medline and PubMed. Only those studies referring to barriers and facilitators reported by CR participants were considered. Pilot and case report studies, non-peer-reviewed literature and studies published in a language other than English, Portuguese or Spanish were excluded.
Data were extracted and analysed on the basis of individual-, provider- and system/environmental-level factors. Of 2083 initial citations, sixteen studies were included, with nine being qualitative and seven observational in design. From these, ten multi-level barriers and seven multi-level facilitators were identified. Dietary recommendations included developing healthy eating habits, transitioning to vegetarian-rich diets and increasing fish oil and n-3 intake. Only one study reported on all of the nutrition education programme factors recommended by the Workgroup for Intervention Development and Evaluation Research.
To the best of our knowledge, this review is the first to summarise specific barriers and facilitators to recommendation adherence among CR participants. Few of the studies offered any conclusions regarding programme design that could facilitate improved dietary adherence practices. Future studies should aim to explore patient perspectives on the nutritional patterns and recommendations outlined in the Mediterranean Diet, the Dietary Approaches to Stop Hypertension Diet, Vegetarian or Vegan diets and the Portfolio Diet.
确定影响心脏康复（CR）参与者遵循饮食建议的个体、提供者和系统/环境层面的障碍和促进因素。
对医学文献进行了系统综述。从 2021 年 3 月开始，在六个数据库中进行了搜索：APA PsycInfo、CINAHL、Embase、Emcare、Medline 和 PubMed。仅考虑参考 CR 参与者报告的障碍和促进因素的研究。排除试点和案例报告研究、非同行评审文献以及以英语、葡萄牙语或西班牙语以外的语言发表的研究。
根据个体、提供者和系统/环境层面的因素提取和分析数据。在 2083 条初始引用中，有 16 项研究被纳入，其中 9 项为定性研究，7 项为观察性设计。从中确定了十个多层次障碍和七个多层次促进因素。饮食建议包括养成健康的饮食习惯、过渡到富含素食的饮食以及增加鱼油和 n-3 的摄入量。只有一项研究报告了工作组制定的营养教育计划的所有因素。
据我们所知，这是首次对 CR 参与者的建议遵守情况进行障碍和促进因素的总结。很少有研究对方案设计提出任何结论，以促进更好的饮食遵守实践。未来的研究应旨在探讨患者对地中海饮食、高血压饮食的饮食方法、素食或纯素饮食和投资组合饮食中概述的营养模式和建议的看法。
