Supporting Physical Activity and Quality of Life in Older Adults with Coronary Heart Disease: Development of a Web-Based Nursing Intervention

Student summary

Why This Research Matters

Coronary heart disease (CHD) is one of the leading causes of illness and death worldwide, and older adults make up a large share of the people living with it after a revascularization procedure like angioplasty or bypass surgery. Staying physically active after these procedures is one of the strongest predictors of a good quality of life, yet most older adults never make it into or stay in a traditional cardiac rehabilitation program. Barriers like transportation, mobility limits, and rigid clinic schedules keep participation low. This Canadian Journal of Nursing Research article describes how a team of researchers built a new option: a French-language, web-based nursing intervention called Changeons ensemble ("Let's Change Together"), designed specifically with older adults with CHD in mind.

The team followed Intervention Mapping, a structured, step-by-step framework that health-promotion researchers use to design interventions logically instead of guessing what might help. The first step was a needs assessment, built from a review of the existing literature and semi-structured interviews with ten older adults living with CHD. Listening directly to this population let the researchers hear, in their own words, what stood in the way of staying active: not knowing what exercise was actually safe after a cardiac event, struggling to stay motivated over the long term, and not feeling confident in their own ability to exercise safely (self-efficacy). Participants also stressed how much they valued having a real professional check in with them individually rather than following a generic pamphlet.

With those needs identified, the team moved to setting objectives and designing the intervention itself, guided by the Information-Motivation-Behavioral Skills (IMB) model. This model assumes that people change a health behaviour, like exercising regularly, when they have accurate information, feel motivated, and have the practical skills and confidence to act on it. Applying that model, the researchers built Changeons ensemble as a seven-session program delivered entirely online. Each session combines short educational content about CHD and physical activity, reflective exercises that ask participants to think about their own motivations and barriers, and case stories showing other older adults managing similar challenges. A nurse gives individualized written feedback to each participant, participants build a personal action plan for becoming or staying active, and they track their own activity through an electronic diary. A discussion forum lets participants connect with one another, which can help replace some of the peer support that a traditional in-person cardiac rehab class would normally provide.

A defining feature of the program is its flexibility. Rather than requiring participants to show up at a set time and place, Changeons ensemble lets people move through the content at their own pace, from home. The design is also intentionally sensitive to the physical and emotional realities older adults face after a cardiac event, such as fatigue, fear of overexertion, or lower confidence in their bodies. That sensitivity is built directly into the tone and pacing of the content, not added afterward.

The article is a development study, not an effectiveness trial. It does not tell us whether Changeons ensemble actually improves physical activity levels or quality of life; it only describes how the program was built and why it looks the way it does. Testing effectiveness is being carried out separately in an associated pilot study, registered as ClinicalTrials.gov NCT06197347.

For nursing students, this article is a useful case study in intervention development itself. It shows how a needs assessment grounded in real patient interviews, paired with an established behaviour-change model like IMB, can turn into a concrete, deliverable nursing intervention rather than a vague idea. It also highlights a real access gap in cardiac care: many older adults who most need secondary prevention support are the least likely to receive it through conventional programs. Web-based, nurse-led interventions like this one are one way the profession is trying to close that gap, but students should remember that a well-designed intervention still needs to be tested for effectiveness before its impact on outcomes like quality of life can be confirmed.

Faculty notes

Educational Relevance

This paper, published in the Canadian Journal of Nursing Research, reports the development phase of Changeons ensemble, a French-language, web-based nursing intervention intended to promote sustained physical activity and improve quality of life among older adults with coronary heart disease (CHD) following revascularization. The authors, Lavoie and Dubé, situate the work squarely in the well-documented gap between the evidence for secondary-prevention exercise in CHD and the persistently low uptake of traditional, in-person cardiac rehabilitation among older adults.

Methodologically, the intervention was constructed using the Intervention Mapping framework, a systematic, multi-step approach widely used in health promotion program design. The reported needs assessment combined a literature review with semi-structured interviews conducted with ten older adults living with CHD, generating a qualitative account of unmet needs: informational gaps about safe post-revascularization activity, difficulty sustaining motivation, low self-efficacy for exercise, and a stated preference for individualized professional support over generic educational material. These findings then informed objective-setting and program design, guided by the Information-Motivation-Behavioral Skills (IMB) model, a well-established behaviour-change framework positing that information, motivation, and behavioural skills jointly determine whether a health behaviour is adopted and sustained.

The resulting intervention, Changeons ensemble, is structured as seven web-based sessions integrating educational content, reflexive activities, individualized written nursing feedback, action planning, self-monitoring via an electronic diary, a peer discussion forum, and case stories. This multicomponent structure is a direct, traceable translation of the IMB determinants identified in the needs assessment: education addresses information gaps, reflexive activities and case stories target motivation, and action planning with nursing feedback targets behavioural skills and self-efficacy. The design explicitly foregrounds flexibility (asynchronous, home-based delivery) and sensitivity to the physical and emotional adjustment older adults face after a cardiac event.

For teaching purposes, this article works well as a worked example of theory-driven intervention development rather than as evidence of clinical effectiveness. Instructors can use it to walk students through each Intervention Mapping step and show how a qualitative needs assessment translates into concrete program components rather than being cited only as background. It also opens a useful discussion about the equity dimension of cardiac rehabilitation access for older adults, and about the role of nurses as intervention designers and feedback providers rather than only as deliverers of pre-built programs.

Instructors should be transparent that this is a development/design paper: it establishes the theoretical and empirical rationale for the intervention's content but does not report outcome data on physical activity or quality of life. Effectiveness, feasibility, and acceptability are being evaluated separately in a companion pilot study (registered as NCT06197347), described in an associated JMIR Research Protocols publication, which reports a single-group pre-post pilot with roughly 30 participants and a nested qualitative component. That companion protocol is useful supplementary context for discussing pilot feasibility design (recruitment/retention targets, mixed-methods evaluation) but should not be conflated with the findings of the paper being assigned here. Discussion should also address the limits of an n=10 qualitative needs assessment for generalizability, the French-language and single-jurisdiction context, and the standard caveat that intervention mapping produces a plausible, theory-consistent program, not a proven one.