Exploring the Interplay of Socioecological Factors Shaping Physical Activity and Exercise in Heart Failure Patients After Hospital Discharge in a Context of Phase II Cardiac Rehabilitation Availability

Physical activity (PA) and exercise are cornerstones of heart failure (HF) management, yet adherence remains low, particularly following hospital discharge. This qualitative study explored how socioecological factors and their interplay influence PA behaviours in individuals with HF, providing novel insights within the context of a Spanish healthcare setting where only Phase II cardiac rehabilitation (CR) is implemented. Semistructured interviews were conducted with 22 patients diagnosed with reduced or mildly reduced ejection fraction HF (NYHA I–II) and 8 family members, during the postdischarge period. Interviews were thematically analysed using an approach informed by the socioecological model. Findings highlight the dynamic interplay of socioecological factors acting as facilitators or barriers to PA in HF patients. At the intrapersonal level, fear of symptom exacerbation, fatigue and emotional distress emerged as major barriers. These were reinforced or mitigated by interpersonal influences. Overprotective relatives could inhibit autonomy, while supportive family members enhanced confidence and routine PA. At the organisational level, CR programs, provided structure, routine and supervision for exercise. However, lack of personalisation or the abrupt end of the program led to frustration and disengagement. The absence of post‐CR follow‐up at the community level further disrupted continuity and weakened motivation. Environmental factors such as unsafe or inaccessible public spaces also limited PA, especially when interacted with intrapersonal limitations, which led to reduced social interaction and more emotional distress. This study underscores the need for strategies that address the interconnection of intrapersonal, interpersonal, organisational, community and environmental factors. Tailored interventions aligning professional guidance, family support, continuity of care and accessible environments are essential to foster sustainable PA and exercise engagement in HF patients after discharge.