Some survivors of a heart attack or stroke struggle to get moving, manage stress and maintain a healthy weight, says a new Canadian report that stresses how important rehabilitation programs and family support can be.

About 165,000 Canadians survived a heart attack or stroke last year, but there are still 350,000 hospitalizations for the diseases each year, the Heart and Stroke Foundation said in its report released Monday.

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The main benefit of cardiac rehabilitation is that it keeps survivors surviving, but motivation can be a barrier to success. (Mark Duncan/Associated Press)

The report includes highlights of an online poll of 2,010 Canadians who’d survived a heart attack or stroke, or were the loved ones of survivors.  About seven in 10 survivors said they’d made healthy changes since the scare.

Survivors were most successful in eating a healthier diet, quitting smoking and reducing alcohol consumption.

But among people who needed to make those changes, more than half couldn’t maintain the change and others didn’t try.

"The biggest barrier was related to motivation, which was defined as a lack of interest in making the change, a feeling that the goals were unrealistic and that there was too much required all at once," the report’s authors said.

Fitness instructor Nadia Bender, 46, was the picture of health when she had a heart attack in Toronto seven months ago. Motivation wasn't a problem for Bender, who looked forward to cardiac rehab after surgery to put in stents for two clogged arteries.

"I wanted to start it right away," Bender said. "Go once a week and talk to the other people who've had a heart attack, find out what their stories are. Were they experiencing chest pains like I was?"

Heart and Stroke's 5 healthy behaviours

Up to 80 per cent of heart disease and stroke is preventable. The group suggests five behaviours for all Canadians.

  • Eat a healthy diet.
  • Be physically active; 30 minutes most days of the week is all it takes to start, and everything counts.
  • Be smoke-free.
  • Manage stress.
  • Identify the source of your stress, talk to friends and family, and take time for yourself.
  • Limit alcohol consumption. Women should limit themselves to no more than two drinks a day, to a weekly maximum of 10; and men to three drinks a day to a weekly maximum of 15.

Other barriers respondents gave included not understanding what changes were needed or how to make them, loss of physical or cognitive abilities since the event, and cost and time constraints.

The report’s authors also looked at how to support recovery, calling rehabilitation referral rates "unacceptably low." Evidence shows that about one-third of cardiac survivors who are eligible for rehabilitation are referred.

The main reason people gave for not starting or completing rehabilitation as recommended was, "I just didn’t want to do it," which can be an indicator of other factors such as anxiety, depression and lack of a clear endorsement from their doctor on the benefits.

Dr. Neville Suskin, medical director of cardiac rehabilitation and secondary prevention at St. Joseph's Health Care in London, Ont., said too few rehabilitation programs and inadequate government funding may also be barriers.

"I suspect that the lack of availability of timely access to rehab programming may be playing a role of not getting referred or people waiting too long," said Suskin.

Suskin pointed to other benefits of cardiac and stroke rehab: it makes people feel better, improves their quality of life, and reduces hospital readmissions as well as costs to the health-care system.

More than eight in 10 survivors said they feel that their family support helped them achieve a healthy lifestyle, such as assisting with chores during recovery and keeping stress levels in check.

The poll was conducted online by Environics Research Group between Nov. 25 and Dec. 3, 2013.

With files from CBC's Kas Roussy and The Canadian Press