Phase three cardiac rehabilitation – is there a role for planetary health?

As a widespread service with high patient turnover incorporating a “teachable moment”, Phase Three CR could theoretically represent favorable conditions for the introduction of planetary health education or the adaptation of sustainable clinical practices. The aim of this study was to explore attitudes on the potential for CR to play a role in the promotion of planetary health and sustainable living.

Patients and service providers working in Phase Three CR at one hospital in Dublin Ireland were asked as part of a semi structured interview whether their service had a role to play in the planetary health and sustainability movement. Clarke and Braun’s 6-step framework guided the thematic analysis of data using an inductive approach that identified, examined and defined themes within the data. 

Thirteen patients and all eight service providers involved in Phase Three CR took part in this study. Data analysis revealed uncertainty and feelings of helplessness and fear. Views differed as to whether Phase Three CR should operate with consideration to planetary health concerns. Most participants questioned any relevance, and some were against the idea of sustainability driven changes. Fear was expressed that such changes may result in a "race to the bottom" and there was a perception that infection control measures are required but inherently waste-producing. Conversely, it was proposed that the CR team could play an advocacy role and small opportunities to operate in a more sustainable manner were suggested (such as replacing paper resources with digital versions and educational sessions being conducted online). The potential impact of such initiatives however was heavily doubted. Participants concluded that the greatest effect the service could have on planetary health was indirect through improving the health of individuals resulting in reduced hospital admissions and the promotion of active transport etc.

Participants did not clearly see a direct role for the service relevant to planetary health. Benefits to patient health resulting from the service were thought to have the greatest potential to support sustainable living. 

There is a need to dispel fears that potential changes to health services in order to benefit planetary health may have a negative effect on individual patient care, and to quantify the impact of small achievable changes in practice.