Application & Barrier Mitigation

Where respondents “agree” or “strongly agree” with a barrier, mitigation strategies should be provided; a study of such an approach is underway. CR programs should where possible consider ways to mitigate barriers where mean scores among participants from their program, or inpatients who would be referred to their program, are above 3.5-4/5, using evidence-based approaches (Chindhy et al., 2020; Supervía et al., 2017).

There are several potential approaches to overcoming barriers to enrollment and participation in CR, many of which can be discussed with patients at the time of referral. Interventions that could help patients overcome one of the most prominent barriers “already exercise at home or in my community” include conveying to patients that in addition to exercise, CR programs include other beneficial components such as education and counselling that could assist in their recovery process. They could also be informed about the benefits of CR participation with regard to morbidity, mortality, health behaviour change, and quality of life. Patients who report “distance,” “travel,” and “severe weather” as barriers, could be informed of and referred to structured and monitored home-based CR programs. Home-based CR programs have been implemented to overcome distance and transportation barriers, and these programs have been found to be as effective in reducing risk factors and recurrent cardiac events as hospital-based CR programs. For those patients who report “work responsibilities” as a barrier, they could be referred to CR programs offering evening and weekend sessions where available to accommodate their needs.

Please see this file for recommended responses / mitigation strategies for each CRBS item (citation: Aljehani et al. from

You can also find a patient self-report version of the CRBS with these mitigation strategies tailored to patient responses, in several languages here: There are also mitigation tools found in the dropdown on my website "Tools to increase CR use".

Other work in this area is underway. We would be happy to hear from you with ideas and/or to collaborate.