Isabel Ritchie

Cardiac rehabilitation and the fitness sector: the potential of public–private partnerships

11 April 2024

Two older people lifting dumbbell weights at the gym

Cardiac rehabilitation is an important part of recovery for people living with cardiovascular conditions, yet participation remains low. Could the commercial fitness sector be a missing player in this space?

Cardiovascular disease (CVD) is a leading cause of illness and death around the world, significantly impacting healthcare expenditure, population wellbeing and workforce productivity.

Cardiac rehabilitation is widely recommended as a cost-effective method of secondary prevention (i.e. preventing a subsequent cardiac event – such as a heart attack – after a person has experienced a first event). It centres around physical activity, alongside wellbeing support and education about reducing cardiovascular risks. Often, however, people don’t engage in a rehabilitation programme, despite such interventions being associated with improved quality of life, lower healthcare costs and a 20% reduction in the number of deaths from CVD.

Despite cardiac rehabilitation supporting recovery, participation remains low

In Europe, cardiac rehabilitation is recommended for a minimum of 12 sessions, with programmes generally being delivered in hospital settings. Concerningly, fewer than 50% of people who are eligible for cardiac rehabilitation participate in a programme. It is offered in over 90% of European countries but access remains limited, with reported barriers including long waiting lists and difficulty accessing hospital-based centres. For example, there is only one cardiac rehabilitation place available for every seven people living with ischaemic heart disease in Europe.

Even among those people who do participate, few complete a full programme. This is concerning, as the benefits of cardiac rehabilitation are dose-dependent. The longer someone engages in rehabilitation, the greater the reward in terms of health improvement and cardiac risk reduction.

This means addressing both enrolment and adherence is vital. For maximum benefit, people should continue being physically active beyond the end of their structured programme.

Fewer than 50% of people who are eligible for cardiac rehabilitation participate in a programme.

New delivery methods could improve participation

New delivery methods are being explored to support engagement with cardiac rehabilitation. For example, app-based programmes have been a key development for delivering rehabilitation at home, rather than interventions being limited to hospital settings. However, there are some concerns around these technologies requiring a high level of digital literacy, which is often lower among marginalised groups and older populations. With low usability among these groups, digital delivery of cardiac rehabilitation could risk perpetuating health inequalities. At-home programmes also lack the social contact, accountability and training support of in-person cardiac rehabilitation classes.

So, could there be another way?

A person using a piece of equipment in a gym, with a personal trainer guiding them

Delivering cardiac rehabilitation in commercial gyms, supported by in-person coaching, could raise participants’ confidence in exercising.

Could partnering with the commercial fitness sector help boost engagement in cardiac rehabilitation?

The fitness sector is uniquely positioned to support health promotion. Given the ubiquity of gyms in residential neighbourhoods, these spaces could become convenient locations for people to access cardiac rehabilitation. Using commercial gyms could also help to resolve capacity issues, reduce waiting times and support personalised programming with a range of exercise equipment.

Importantly, using these spaces would ensure cardiac rehabilitation programmes retain a social aspect, helping to connect people who are living with similar conditions and to facilitate peer support. Delivering the programmes in commercial gyms, supported by in-person coaching, could also raise participants’ confidence in exercising, which is important for encouraging sustained engagement with physical activity.

Promising initiatives indicate the potential of this approach

The partnership between PureGym and the British Heart Foundation (BHF) in the UK is an exciting example of how such an approach can widen access to cardiac rehabilitation. Since 2022, the BHF has been leading a programme to train PureGym personal trainers in delivering cardiac rehabilitation.

Initiatives centred on public–private partnerships have also shown promise. For example, a recent programme launched between ukactive and St Guy’s and St Thomas’ NHS Trust in England is delivering musculoskeletal rehabilitation in gyms and leisure centres. This holds potential as a template for cardiac-specific programmes, bringing publicly funded treatment ‘closer to home’. The programme also includes an offer for discounted membership at the end of the formal rehabilitation period, which helps incentivise sustained physical activity and provides an attractive membership outreach opportunity for gym operators.

Low engagement in cardiac rehabilitation is a major missed opportunity for improving outcomes for people living with cardiovascular conditions, reducing cardiac risk and enhancing the sustainability of our health systems.

If we want to increase engagement and adherence, we need to pursue innovative solutions – and the commercial fitness sector could be a key player to engage.

Cardiac rehabilitation and the fitness sector: the potential of public–private partnerships

Cardiac rehabilitation is an important part of recovery for people living with cardiovascular conditions, yet participation remains low. Could the commercial fitness sector be a missing player in this space?

Despite cardiac rehabilitation supporting recovery, participation remains low

Recent blogs

New delivery methods could improve participation

Could partnering with the commercial fitness sector help boost engagement in cardiac rehabilitation?

Promising initiatives indicate the potential of this approach

The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.