Anatomy of a failure: a retrospective evaluation of a cognitive bias modification intervention to promote physical activity in cardiac rehabilitation

Objectives Promoting regular physical activity (PA) is essential in cardiac rehabilitation; yet many patients exhibit low levels of PA. In January 2022, the Improving Physical Activity (IMPACT) trial, a randomised controlled trial at the University Hospital of Geneva, was launched to promote PA in cardiac patients by targeting automatic approach tendencies towards exercise-related stimuli through a cognitive bias modification (CBM) intervention.

This article examines the limited acceptance of this intervention, identifies potential barriers and proposes strategies to improve future implementations. Setting The intervention was conducted in a cardiac rehabilitation centre in Switzerland.

Participants 68 cardiac rehabilitation patients (M age = 57.76, SD = 10.76 years, 87% male). Intervention Patients received 12 CBM sessions over six weeks, designed to target approach-avoidance tendencies to exercise-related stimuli and improve PA levels.

Primary and secondary outcome measures Acceptance was assessed using behavioural (e.g., enrolment and engagement rates), cognitive (e.g., perceived effectiveness) and emotional (e.g., affective evaluation) indicators. The cognitive and emotional indicators were derived from verbal feedback documented by the research assistants based on patients’ reactions during the intervention period.