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Kroesen SH, van Bakel BMA, de Bruin M, Günal A, Scheepmaker A, Aengevaeren WRM, Willems FF, Wondergem R, Pisters MF, Ortega FB, Hopman MTE, Thijssen DHJ, Bakker EA, Eijsvogels TMH. A cardiac-rehab behaviour intervention to reduce sedentary time in coronary artery disease patients: the SIT LESS randomized controlled trial. Int J Behav Nutr Phys Act 2024; 21:90. [PMID: 39160570 PMCID: PMC11331608 DOI: 10.1186/s12966-024-01642-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 08/12/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND High sedentary times (ST) is highly prevalent in patients with coronary artery disease (CAD), highlighting the need for behavioural change interventions that effectively reduce ST. We examined the immediate and medium-term effect of the SIT LESS intervention on changes in ST among CAD patients enrolled in cardiac rehabilitation (CR). METHODS CAD patients participating in CR at 2 regional hospitals were included in this randomized controlled trial (1:1, stratified for gender and hospital). The control group received CR, whereas SIT LESS participants additionally received a 12-week hybrid behaviour change intervention. The primary outcome was the change in accelerometer-derived ST from pre-CR to post-CR and 3 months post-CR. Secondary outcomes included changes in ST and physical activity characteristics, subjective outcomes, and cardiovascular risk factors. A baseline constrained linear mixed-model was used. RESULTS Participants (23% female; SIT LESS: n = 108, control: n = 104) were 63 ± 10 years. Greater ST reductions were found for SIT LESS compared to control post-CR (-1.7 (95% confidence interval (CI): -2.0; -1.4) versus - 1.1 (95% CI: -1.4; -0.8) h/day, pinteraction=0.009), but not at 3 months post-CR (pinteraction=0.61). Besides, larger light-intensity physical activity (LIPA) increases were found for SIT LESS compared to control post-CR (+ 1.4 (95% CI: +1.2; +1.6) versus + 1.0 (95% CI: +0.8; +1.3) h/day, pinteraction=0.020). Changes in other secondary outcomes did not differ among groups. CONCLUSION SIT LESS transiently reduced ST and increased LIPA, but group differences were no longer significant 3 months post-CR. These findings highlight the challenge to induce sustainable behaviour changes in CAD patients without any continued support. TRIAL REGISTRATION Netherlands Trial Register: NL9263. Registration Date: 24 February 2021.
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Affiliation(s)
- Sophie H Kroesen
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands
| | - Bram M A van Bakel
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands
| | - Marijn de Bruin
- Department of IQ healthcare, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, The Netherlands
| | - Arzu Günal
- Department of Cardiology, Bernhoven Hospital, Nistelrodeseweg 10, Uden, 5406 PT, The Netherlands
| | - Arko Scheepmaker
- Department of Cardiology, Bernhoven Hospital, Nistelrodeseweg 10, Uden, 5406 PT, The Netherlands
| | - Wim R M Aengevaeren
- Department of Cardiology, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815 AD, The Netherlands
| | - Frank F Willems
- Department of Cardiology, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815 AD, The Netherlands
| | - Roderick Wondergem
- Department of Rehabilitation, Physical Therapy Science and Sport, University Medical Centre Utrecht Brain Centre, Utrecht University, Universiteitsweg 100, Utrecht, 3584 CG, The Netherlands
- Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, Rachelsmolen 1, Eindhoven, 5612 MA, The Netherlands
- Centre for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centres, Universiteitsweg 100, Utrecht, 3584 CG, the Netherlands
| | - Martijn F Pisters
- Department of Rehabilitation, Physical Therapy Science and Sport, University Medical Centre Utrecht Brain Centre, Utrecht University, Universiteitsweg 100, Utrecht, 3584 CG, The Netherlands
- Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, Rachelsmolen 1, Eindhoven, 5612 MA, The Netherlands
- Centre for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centres, Universiteitsweg 100, Utrecht, 3584 CG, the Netherlands
| | - Francisco B Ortega
- Department of Physical Education and Sports, Sport and Health University Research Institute (iMUDS), University of Granada, Parque Tecnologico de la Salud, Av. del Conocimiento, s/n, Granada, 18007, Spain
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, Madrid, 28029, Spain
- Faculty of Sport and Health Sciences, University of Jyväskylä, Keskussairaalantie 4, Jyväskylä, 40600, Finland
| | - Maria T E Hopman
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands
| | - Dick H J Thijssen
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Esmée A Bakker
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands
- Department of Physical Education and Sports, Sport and Health University Research Institute (iMUDS), University of Granada, Parque Tecnologico de la Salud, Av. del Conocimiento, s/n, Granada, 18007, Spain
- Department of Primary and Community Care, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, The Netherlands
| | - Thijs M H Eijsvogels
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands.
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2
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Park C, Larsen B, Mogos M, Muchira J, Dietrich M, LaNoue M, Jean J, Norfleet J, Doyle A, Ahn S, Mulvaney S. A multiple technology-based and individually-tailored Sit Less program for people with cardiovascular disease: A randomized controlled trial study protocol. PLoS One 2024; 19:e0302582. [PMID: 38722831 PMCID: PMC11081313 DOI: 10.1371/journal.pone.0302582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/04/2024] [Indexed: 05/13/2024] Open
Abstract
Sedentary behavior, a key modifiable risk factor for cardiovascular disease, is prevalent among cardiovascular disease patients. However, few interventions target sedentary behavior in this group. This paper describes the protocol of a parallel two-group randomized controlled trial for a novel multi-technology sedentary behavior reduction intervention for cardiovascular disease patients (registered at Clinicaltrial.gov, NCT05534256). The pilot trial (n = 70) will test a 12-week "Sit Less" program, based on Habit Formation theory. The 35 participants in the intervention group will receive an instructional goal-setting session, a Fitbit for movement prompts, a smart water bottle (HidrateSpark) to promote hydration and encourage restroom breaks, and weekly personalized text messages. A control group of 35 will receive the American Heart Association's "Answers by Heart" fact sheets. This trial will assess the feasibility and acceptability of implementing the "Sit Less" program with cardiovascular disease patients and the program's primary efficacy in changing sedentary behavior, measured by the activPAL activity tracker. Secondary outcomes include physical activity levels, cardiometabolic biomarkers, and patient-centered outcomes (i.e. sedentary behavior self-efficacy, habit strength, and fear of movement). This study leverages commonly used mobile and wearable technologies to address sedentary behavior in cardiovascular disease patients, a high-risk group. Its findings on the feasibility, acceptability and primary efficacy of the intervention hold promise for broad dissemination.
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Affiliation(s)
- Chorong Park
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Britta Larsen
- Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, La Jolla, California, United States of America
| | - Mulubrhan Mogos
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
| | - James Muchira
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Mary Dietrich
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Marianna LaNoue
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Jason Jean
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
| | - John Norfleet
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Abigail Doyle
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Soojung Ahn
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Shelagh Mulvaney
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
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3
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Gonçalves C, Bravo J, Pais J, Abreu A, Raimundo A. Improving Health Outcomes in Coronary Artery Disease Patients with Short-Term Protocols of High-Intensity Interval Training and Moderate-Intensity Continuous Training: A Community-Based Randomized Controlled Trial. Cardiovasc Ther 2023; 2023:6297302. [PMID: 38146531 PMCID: PMC10749735 DOI: 10.1155/2023/6297302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/26/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023] Open
Abstract
Studies have shown that the higher the aerobic capacity, the lower the risk of cardiovascular mortality and morbidity. In the case of cardiac patients, high-intensity interval training (HIIT) seems to be more effective than moderate-intensity continuous training (MICT) in improving aerobic capacity. The aim of this study was to investigate the effects of two community-based exercise programs using two short-term protocols (HIIT and MICT) on physical fitness and physical activity (PA) levels in coronary artery disease (CAD) patients. Methods. In this randomized controlled trial, body composition, aerobic capacity, muscle strength, and daily PA levels were assessed before and after 6 weeks of intervention in 69 patients diagnosed with CAD. All patients were randomly (1 : 1 : 1) assigned to two exercise groups (HIIT or MICT) or a control group (no exercise). Both training programs consisted of 6 weeks of supervised treadmill exercise, three sessions per week. MICT targeted ≈70-75% of peak heart rate (HR), while HIIT aimed for ≈85-95% of peak HR. The control group only followed the medical recommendations. Results. Community-based exercise programs showed more positive effects on physical fitness variables and physical activity levels compared to control. HIIT could significantly improve waist circumference, body fat mass, VO2peak, sedentary behavior, and moderate-to-vigorous PA compared to MICT. Moreover, the control group showed poorer results. Conclusion. HIIT can improve health outcomes more positively than MICT and control. These findings indicate that HIIT may be an alternative and effective training method in community-based exercise programs for CAD patients. This trial is registered with NCT03538119.
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Affiliation(s)
- Catarina Gonçalves
- Department of Sports and Health, School of Science and Technology, University of Évora, 7000-727 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Portugal
| | - Jorge Bravo
- Department of Sports and Health, School of Science and Technology, University of Évora, 7000-727 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Portugal
| | - João Pais
- Department of Cardiology, Espírito Santo Hospital of Évora, 7000-811 Évora, Portugal
| | - Ana Abreu
- Department of Cardiology, Santa Maria Hospital, 1649-028 Lisbon, Portugal
| | - Armando Raimundo
- Department of Sports and Health, School of Science and Technology, University of Évora, 7000-727 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Portugal
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Won MH, Shim J. Combined effect of left ventricular ejection fraction and obesity on sedentary behavior in patients with coronary artery disease. Medicine (Baltimore) 2023; 102:e35839. [PMID: 37960741 PMCID: PMC10637509 DOI: 10.1097/md.0000000000035839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/06/2023] [Indexed: 11/15/2023] Open
Abstract
Sedentary behavior has been associated with poor adherence to treatment in patients with coronary artery disease. Low left ventricular ejection fraction and obesity have been separately linked to increased sedentary behavior in patients with coronary artery disease. However, the combined effect of low left ventricular ejection fraction and obesity on sedentary behavior in patients with coronary artery disease has not been thoroughly investigated. Therefore, this study aimed to examine the combined influence of left ventricular ejection fraction and obesity on sedentary behavior in patients with coronary artery disease. This descriptive cross-sectional study enrolled 200 inpatients aged ≥ 20 years who were diagnosed with coronary artery disease at a tertiary hospital in Korea between March and August 2022. Data were collected using structured questionnaires, and multivariate logistic regression analysis was performed to determine the combined effect of left ventricular ejection fraction and obesity on sedentary behavior in patients with coronary artery disease. Among the 111 patients with sedentary behavior, 38 (34.2%) had both low left ventricular ejection fraction and obesity, whereas only 11 (12.4%) of the 89 patients without sedentary behavior had both low left ventricular ejection fraction and obesity. In multivariate logistic regression analysis, patients with coronary artery disease who had both low left ventricular ejection fraction and obesity had the highest risk of sedentary behavior compared to those without either low left ventricular ejection fraction or obesity (odds ratio = 13.98, 95% confidence interval = 5.19-37.69, P < .001). The co-existence of low left ventricular ejection fraction and obesity in patients with coronary artery disease may be associated with sedentary behavior. Therefore, evaluating both left ventricular ejection fraction and obesity when assessing sedentary behavior in patients with coronary artery disease may be valuable in implementing patient-centered approaches for the secondary prevention and management of sedentary behavior in patients with coronary artery disease. However, further prospective cohort studies with larger sample sizes are required to establish causal relationships and explore interventions to mitigate sedentary behavior in this population.
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Affiliation(s)
- Mi Hwa Won
- Department of Nursing, Wonkwang University, Iksan, South Korea
| | - JaeLan Shim
- College of Nursing, Dongguk University, Gyeongju, South Korea
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Patterson K, Davey R, Keegan R, Niyonsenga T, Mohanty I, Bowen S, Regan E, Lander M, van Berlo S, Freene N. Testing the Effect of a Smartphone App on Hospital Admissions and Sedentary Behavior in Cardiac Rehabilitation Participants: ToDo-CR Randomized Controlled Trial. JMIR Mhealth Uhealth 2023; 11:e48229. [PMID: 37788043 PMCID: PMC10582808 DOI: 10.2196/48229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/04/2023] [Accepted: 08/16/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND People with coronary heart disease are at an increased risk of morbidity and mortality even if they attend cardiac rehabilitation. High sedentary behavior levels potentially contribute to this morbidity. Smartphone apps may be feasible to facilitate sedentary behavior reductions and lead to reduced health care use. OBJECTIVE We aimed to test the effect of a sedentary behavior change smartphone app (Vire app and ToDo-CR program) as an adjunct to cardiac rehabilitation on hospital admissions and emergency department (ED) presentations over 12 months. METHODS A multicenter, randomized controlled trial was conducted with 120 participants recruited from 3 cardiac rehabilitation programs. Participants were randomized 1:1 to cardiac rehabilitation plus the fully automated 6-month Vire app and ToDo-CR program (intervention) or usual care (control). The primary outcome was nonelective hospital admissions and ED presentations over 12 months. Secondary outcomes including accelerometer-measured sedentary behavior, BMI, waist circumference, and quality of life were recorded at baseline and 6 and 12 months. Logistic regression models were used to analyze the primary outcome, and linear mixed-effects models were used to analyze secondary outcomes. Data on intervention and hospital admission costs were collected, and the incremental cost-effectiveness ratios (ICERs) were calculated. RESULTS Participants were, on average, aged 62 (SD 10) years, and the majority were male (93/120, 77.5%). The intervention group were more likely to experience all-cause (odds ratio [OR] 1.54, 95% CI 0.58-4.10; P=.39) and cardiac-related (OR 3.26, 95% CI 0.84-12.55; P=.09) hospital admissions and ED presentations (OR 2.07, 95% CI 0.89-4.77; P=.09) than the control group. Despite this, cardiac-related hospital admission costs were lower in the intervention group over 12 months (Aus $252.40 vs Aus $859.38; P=.24; a currency exchange rate of Aus $1=US $0.69 is applicable). There were no significant between-group differences in sedentary behavior minutes per day over 12 months, although the intervention group completed 22 minutes less than the control group (95% CI -22.80 to 66.69; P=.33; Cohen d=0.21). The intervention group had a lower BMI (β=1.62; P=.05), waist circumference (β=5.81; P=.01), waist-to-hip ratio (β=.03, P=.03), and quality of life (β=3.30; P=.05) than the control group. The intervention was more effective but more costly in reducing sedentary behavior (ICER Aus $351.77) and anxiety (ICER Aus $10,987.71) at 12 months. The intervention was also more effective yet costly in increasing quality of life (ICER Aus $93,395.50) at 12 months. CONCLUSIONS The Vire app and ToDo-CR program was not an outcome-effective or cost-effective solution to reduce all-cause hospital admissions or ED presentations in cardiac rehabilitation compared with usual care. Smartphone apps that target sedentary behavior alone may not be an effective solution for cardiac rehabilitation participants to reduce hospital admissions and sedentary behavior. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001223123; https://australianclinicaltrials.gov.au/anzctr/trial/ACTRN12619001223123. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2020-040479.
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Affiliation(s)
- Kacie Patterson
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Rachel Davey
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Richard Keegan
- Research Institute for Sports and Exercise (UCRISE), Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Theo Niyonsenga
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Itismita Mohanty
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Sarah Bowen
- National Capital Private Hospital, Garran, ACT, Australia
| | | | | | | | - Nicole Freene
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
- Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT, Australia
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6
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Bargholtz M, Brosved M, Heimburg K, Hellmark M, Leosdottir M, Hagströmer M, Bäck M. Test-Retest Reliability, Agreement and Criterion Validity of Three Questionnaires for the Assessment of Physical Activity and Sedentary Time in Patients with Myocardial Infarction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6579. [PMID: 37623164 PMCID: PMC10454842 DOI: 10.3390/ijerph20166579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
Regular physical activity (PA) and limited sedentary time (SED) are highly recommended in international guidelines for patients after a myocardial infarction (MI). Data on PA and SED are often self-reported in clinical practice and, hence, reliable and valid questionnaires are crucial. This study aimed to assess the test-retest reliability, criterion validity and agreement of two PA and one SED questionnaire commonly used in clinical practice, developed by the Swedish National Board of Health and Welfare (BHW) and the Swedish national quality register SWEDEHEART. Data from 57 patients (mean age 66 ± 9.2 years, 42 males) was included in this multi-centre study. The patients answered three questionnaires on PA and SED at seven-day intervals and wore an accelerometer for seven days. Test-retest reliability, criterion validity and agreement were assessed using Spearman's rho and linearly weighted kappa. Test-retest reliability was moderate for three of the six-sub questions (k = 0.43-0.54) within the PA questionnaires. For criterion validity, the correlation was fair within three of the six sub-questions (r = 0.41-0.50) within the PA questionnaires. The SED questionnaire had low agreement (k = 0.12) and criterion validity (r = 0.30). The studied questionnaires for PA could be used in clinical practice as a screening tool and/or to evaluate the level of PA in patients with an MI. Future research is recommended to develop and/or evaluate SED questionnaires in patients with an MI.
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Affiliation(s)
- Marcus Bargholtz
- Department of Medicine, Lindesberg Hospital, 711 82 Lindesberg, Sweden
| | - Madeleine Brosved
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden (M.B.)
| | - Katarina Heimburg
- Department of Clinical Sciences Lund, Neurology, Skane University Hospital, Lund University, 222 42 Lund, Sweden
| | - Marie Hellmark
- Department of Physiotherapy, Orebro University Hospital, 701 85 Orebro, Sweden
| | - Margret Leosdottir
- Department of Cardiology, Skane University Hospital, 214 28 Malmo, Sweden
- Department of Clinical Sciences Malmo, Lund University, 214 28 Malmo, Sweden
| | - Maria Hagströmer
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 171 77 Stockholm, Sweden
- Academic Primary Health Care Centre, Region Stockholm, 113 65 Stockholm, Sweden
| | - Maria Bäck
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden (M.B.)
- Department of Medical and Health Sciences, Division of Physiotherapy, Linkoping University, 581 83 Linkoping, Sweden
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7
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van Bakel BMA, Kroesen SH, Bakker EA, van Miltenburg RV, Günal A, Scheepmaker A, Aengevaeren WRM, Willems FF, Wondergem R, Pisters MF, de Bruin M, Hopman MTE, Thijssen DHJ, Eijsvogels TMH. Effectiveness of an intervention to reduce sedentary behaviour as a personalised secondary prevention strategy for patients with coronary artery disease: main outcomes of the SIT LESS randomised clinical trial. Int J Behav Nutr Phys Act 2023; 20:17. [PMID: 36788615 PMCID: PMC9927064 DOI: 10.1186/s12966-023-01419-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/26/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND A high sedentary time is associated with increased mortality risk. Previous studies indicate that replacement of sedentary time with light- and moderate-to-vigorous physical activity attenuates the risk for adverse outcomes and improves cardiovascular risk factors. Patients with cardiovascular disease are more sedentary compared to the general population, while daily time spent sedentary remains high following contemporary cardiac rehabilitation programmes. This clinical trial investigated the effectiveness of a sedentary behaviour intervention as a personalised secondary prevention strategy (SIT LESS) on changes in sedentary time among patients with coronary artery disease participating in cardiac rehabilitation. METHODS Patients were randomised to usual care (n = 104) or SIT LESS (n = 108). Both groups received a comprehensive 12-week centre-based cardiac rehabilitation programme with face-to-face consultations and supervised exercise sessions, whereas SIT LESS participants additionally received a 12-week, nurse-delivered, hybrid behaviour change intervention in combination with a pocket-worn activity tracker connected to a smartphone application to continuously monitor sedentary time. Primary outcome was the change in device-based sedentary time between pre- to post-rehabilitation. Changes in sedentary time characteristics (prevalence of prolonged sedentary bouts and proportion of patients with sedentary time ≥ 9.5 h/day); time spent in light-intensity and moderate-to-vigorous physical activity; step count; quality of life; competencies for self-management; and cardiovascular risk score were assessed as secondary outcomes. RESULTS Patients (77% male) were 63 ± 10 years and primarily diagnosed with myocardial infarction (78%). Sedentary time decreased in SIT LESS (- 1.6 [- 2.1 to - 1.1] hours/day) and controls (- 1.2 [ ─1.7 to - 0.8]), but between group differences did not reach statistical significance (─0.4 [─1.0 to 0.3]) hours/day). The post-rehabilitation proportion of patients with a sedentary time above the upper limit of normal (≥ 9.5 h/day) was significantly lower in SIT LESS versus controls (48% versus 72%, baseline-adjusted odds-ratio 0.4 (0.2-0.8)). No differences were observed in the other predefined secondary outcomes. CONCLUSIONS Among patients with coronary artery disease participating in cardiac rehabilitation, SIT LESS did not induce significantly greater reductions in sedentary time compared to controls, but delivery was feasible and a reduced odds of a sedentary time ≥ 9.5 h/day was observed. TRIAL REGISTRATION Netherlands Trial Register: NL9263. Outcomes of the SIT LESS trial: changes in device-based sedentary time from pre-to post-cardiac rehabilitation (control group) and cardiac rehabilitation + SIT LESS (intervention group). SIT LESS reduced the odds of patients having a sedentary time >9.5 hours/day (upper limit of normal), although the absolute decrease in sedentary time did not significantly differ from controls. SIT LESS appears to be feasible, acceptable and potentially beneficial, but a larger cluster randomised trial is warranted to provide a more accurate estimate of its effects on sedentary time and clinical outcomes. CR: cardiac rehabilitation.
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Affiliation(s)
- B. M. A. van Bakel
- grid.10417.330000 0004 0444 9382Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - S. H. Kroesen
- grid.10417.330000 0004 0444 9382Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - E. A. Bakker
- grid.10417.330000 0004 0444 9382Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - R. V. van Miltenburg
- grid.10417.330000 0004 0444 9382Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - A. Günal
- grid.470077.30000 0004 0568 6582Department of Cardiology, Bernhoven Hospital, Uden, The Netherlands
| | - A. Scheepmaker
- grid.470077.30000 0004 0568 6582Department of Cardiology, Bernhoven Hospital, Uden, The Netherlands
| | - W. R. M. Aengevaeren
- grid.415930.aDepartment of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - F. F. Willems
- grid.415930.aDepartment of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - R. Wondergem
- grid.5477.10000000120346234Department of Rehabilitation, Physical Therapy Science and Sport, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands ,grid.448801.10000 0001 0669 4689Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands ,Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands
| | - M. F. Pisters
- grid.5477.10000000120346234Department of Rehabilitation, Physical Therapy Science and Sport, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands ,grid.448801.10000 0001 0669 4689Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands ,Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands
| | - M. de Bruin
- grid.10417.330000 0004 0444 9382Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M. T. E. Hopman
- grid.10417.330000 0004 0444 9382Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - D. H. J. Thijssen
- grid.10417.330000 0004 0444 9382Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands ,grid.4425.70000 0004 0368 0654Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - T. M. H. Eijsvogels
- grid.10417.330000 0004 0444 9382Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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8
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Physical activity and sedentary behaviour following combined aerobic and resistance training in coronary artery disease patients: A randomised controlled trial. Int J Cardiol 2023; 370:75-79. [PMID: 36367488 DOI: 10.1016/j.ijcard.2022.10.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Effective training modalities and potential determinants to induce favourable changes in physical activity (PA) and sedentary behaviour (SB) remains elusive in patients with coronary artery disease. AIMS This study aimed to investigate the effects of high-load resistance training and low-load RT combined with aerobic training in comparison to aerobic training alone on PA and SB, and whether baseline level of SB modifies PA outcomes in coronary artery disease patients. METHODS We randomised 79 patients to aerobic training, low-load resistance training and aerobic training or high-load resistance training and aerobic training. PA and SB were measured using triaxial accelerometer at baseline and post-training for 8 days. RESULTS There was no difference between training modalities in post-training PA and SB. When stratified by baseline SB, the very sedentary patients improved SB (-52 min/day, p = 0.001) and light intensity PA (+27 min/day, p = 0.009) following intervention. The improvement in PA was greater in the very sedentary patients (SB: +27%, p = 0.002; light intensity PA: +24%, p = 0.004) and in sedentary patients (SB: +24%, p = 0.009) compared to the very active patients. CONCLUSIONS Post-training improvement in PA and SB was determined by baseline SB, while the addition of low-load or high-load resistance training provided no further benefits in coronary artery disease patients. CLINICAL TRIALS REGISTRATION NUMBER NCT04638764.
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9
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Lönn A, Kallings LV, Börjesson M, Ekblom Ö, Ekström M. Convergent validity of commonly used questions assessing physical activity and sedentary time in Swedish patients after myocardial infarction. BMC Sports Sci Med Rehabil 2022; 14:117. [PMID: 35751097 PMCID: PMC9229098 DOI: 10.1186/s13102-022-00509-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/17/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Guidelines recommend regular physical activity (PA) and decreased sedentary time (SED) for patients after myocardial infarction (MI). Therefore, valid self-assessment of PA is vital in clinical practice. The purpose of this study was to assess the convergent validity of commonly used PA and SED questions recommended by the National Board of Health and welfare (NBHW) and national SWEDEHEART-registry using accelerometers as the reference method in patients after MI. METHODS Data were obtained 2017-2021 among Swedish men and women (180 assessments). Participants answered five commonly used PA and SED-questions (by NBHW and SWEDEHEART) and wore an accelerometer (Actigraph GT3X) for seven days. Convergent validity was assessed gradually by; Kruskall Wallis-, Sperman rho, Weighted Kappa- and ROC-analyses. Misclassification was explored by Chi-square analyses with Benjamini-Hochberg adjustment. RESULTS The strongest correlation (r = 0.37) was found for the SED-GIH question (NBHW). For PA, no specific question stood out, with correlations of r = 0.31 (NBWH), and r = 0.24-0.30 (SWEDEHEART). For all questions (NBHW and SWEDEHEART), there was a high degree of misclassification (congruency 12-30%) affecting the agreement (0.09-0.32) between self-report and accelerometer assessed time. The SED-GIH, PA-index and SWEDEHEART-VPA had the strongest sensitivity for identifying individuals with high SED (0.72) or low PA (0.77 and 0.75). CONCLUSION The studied PA and SED questions may provide an indication of PA and SED level among patients with MI in clinical practice and could be used to form a basis for further dialogue and assessment. Further development is needed, since practical assessment tools of PA and SED are desirable.
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Affiliation(s)
- Amanda Lönn
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Gymnastik- Och Idrottshögskolan (GIH), Lidingövägen 1, 114 33, Stockholm, Sweden. .,Women's Health and Allied Health Professionals Theme Medical Unit Occupational Therapy and Physiotherapy, 171 76, Stockholm, Sweden.
| | - Lena Viktoria Kallings
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Gymnastik- Och Idrottshögskolan (GIH), Lidingövägen 1, 114 33, Stockholm, Sweden.,Unit of Family Medicine, Department of Public Health and Caring Sciences, Uppsala University, 751 05, Uppsala, Sweden
| | - Mats Börjesson
- Center for Health and Performance, Department of Food, Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden.,Department of Neuroscience and Physiology, Sahlgrenska Academy & Sahlgrenska University Hospital, 411 24, Gothenburg, Sweden
| | - Örjan Ekblom
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Gymnastik- Och Idrottshögskolan (GIH), Lidingövägen 1, 114 33, Stockholm, Sweden
| | - Mattias Ekström
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, 182 88, Stockholm, Sweden
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10
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van Bakel BMA, Kroesen SH, Günal A, Scheepmaker A, Aengevaeren WRM, Willems FF, Wondergem R, Pisters MF, Dam J, Janssen AM, de Bruin M, Hopman MTE, Thijssen DHJ, Eijsvogels TMH. Sedentary Behaviour Intervention as a Personalised Secondary Prevention Strategy (SIT LESS) for patients with coronary artery disease participating in cardiac rehabilitation: rationale and design of the SIT LESS randomised clinical trial. BMJ Open Sport Exerc Med 2022; 8:e001364. [PMID: 35692440 PMCID: PMC9134157 DOI: 10.1136/bmjsem-2022-001364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/11/2022] Open
Abstract
Patients with coronary artery disease (CAD) are more sedentary compared with the general population, but contemporary cardiac rehabilitation (CR) programmes do not specifically target sedentary behaviour (SB). We developed a 12-week, hybrid (centre-based+home-based) Sedentary behaviour IntervenTion as a personaLisEd Secondary prevention Strategy (SIT LESS). The SIT LESS programme is tailored to the needs of patients with CAD, using evidence-based behavioural change methods and an activity tracker connected to an online dashboard to enable self-monitoring and remote coaching. Following the intervention mapping principles, we first identified determinants of SB from literature to adapt theory-based methods and practical applications to target SB and then evaluated the intervention in advisory board meetings with patients and nurse specialists. This resulted in four core components of SIT LESS: (1) patient education, (2) goal setting, (3) motivational interviewing with coping planning, and (4) (tele)monitoring using a pocket-worn activity tracker connected to a smartphone application and providing vibrotactile feedback after prolonged sedentary bouts. We hypothesise that adding SIT LESS to contemporary CR will reduce SB in patients with CAD to a greater extent compared with usual care. Therefore, 212 patients with CAD will be recruited from two Dutch hospitals and randomised to CR (control) or CR+SIT LESS (intervention). Patients will be assessed prior to, immediately after and 3 months after CR. The primary comparison relates to the pre-CR versus post-CR difference in SB (objectively assessed in min/day) between the control and intervention groups. Secondary outcomes include between-group differences in SB characteristics (eg, number of sedentary bouts); change in SB 3 months after CR; changes in light-intensity and moderate-to-vigorous-intensity physical activity; quality of life; and patients' competencies for self-management. Outcomes of the SIT LESS randomised clinical trial will provide novel insight into the effectiveness of a structured, hybrid and personalised behaviour change intervention to attenuate SB in patients with CAD participating in CR. Trial registration number NL9263.
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Affiliation(s)
- B M A van Bakel
- Department of Physiology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - S H Kroesen
- Department of Physiology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - A Günal
- Department of Cardiology, Bernhoven Hospital, Uden, The Netherlands
| | - A Scheepmaker
- Department of Cardiology, Bernhoven Hospital, Uden, The Netherlands
| | - W R M Aengevaeren
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - F F Willems
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - R Wondergem
- Department of Rehabilitation, Physical Therapy Science and Sport, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
- Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands
| | - M F Pisters
- Department of Rehabilitation, Physical Therapy Science and Sport, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
- Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands
| | - J Dam
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - A M Janssen
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - M de Bruin
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - M T E Hopman
- Department of Physiology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - D H J Thijssen
- Department of Physiology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - T M H Eijsvogels
- Department of Physiology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
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11
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How Much Time in Sedentary Behavior Should Be Reduced to Decrease Fear of Falling and Falls in Community-Dwelling Older Adults? J Aging Phys Act 2021; 30:806-812. [PMID: 34911037 DOI: 10.1123/japa.2021-0175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 09/30/2021] [Accepted: 11/17/2021] [Indexed: 11/18/2022]
Abstract
Fear of falling and history of falls are frequent situations in older adults, which can be aggravated by sedentary behavior (SB). The objective was to establish SB cutoff values which discriminate falls and fear of falling in older adults and verify the association between these conditions. This was a cross-sectional study including 308 community-dwelling older adults. The SB was assessed by International Physical Activity Questionnaire. The outcomes were history of falling in the last 12 months and fear of falling (higher or equal than 23 points in Falls Efficacy Scale International-Brazil). The cutoff points found were >4.14 (area under curve = 0.60, 95% confidence intervals [CIs] [0.54, 0.65]) and >3.90 hr per day (area under curve = 0.59, 95% CI [0.53, 0.64]) for fear of falling and history of falls, respectively. Older adults with SB had 1.71 (95% CI [1.03, 2.84]) and 1.75 (95% CI [1.06, 2.89]) greater odds of having greater fear of falling and suffering falls, respectively.
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12
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Kambic T, Šarabon N, Hadžić V, Lainscak M. Objectively Measured Physical Activity in Patients with Coronary Artery Disease: A Cross-Validation Study. BIOSENSORS-BASEL 2021; 11:bios11090318. [PMID: 34562908 PMCID: PMC8464699 DOI: 10.3390/bios11090318] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 01/15/2023]
Abstract
Physical activity (PA) and sedentary behavior (SB) levels in healthy adults are predominately based on self-reporting measures, which generally overestimate PA but underestimate SB. Patients with coronary artery disease (CAD) eligible for cardiac rehabilitation (CR) follow an individualized program; thus, objective assessment of physical performance and regular daily activity is required. This study aimed to compare self-reported and objectively measured PA and SB in patients with CAD prior to out-patient CR. We included 91 patients with CAD and assessed their PA with an accelerometer for 8 days prior to CR, along with the short form of the international physical activity questionnaire. We found that most patients were sedentary (61%, ~8 h/day), and on average performed 63 min/day of moderate-to-vigorous-intensity physical activity (MVPA). Males performed less daily light-intensity physical activity (−5%, p = 0.011) and performed more MVPA (+2%, p = 0.002) compared to females. Maximal aerobic capacity was significantly associated with MVPA (Spearman rho = 0.483, p < 0.001) and MVPA > 10 min bouts (Spearman rho = 0.391, p < 0.001). Self-reported measures overestimated MVPA (total MVPA, +108 min/day, p < 0.001; MVPA > 10 min bouts, +152 min, p < 0.001) and underestimated SB (−174 min/day, p < 0.001) compared to objective measures. There was no significant correlation between methods in MVPA (Spearman rho = 0.147, p = 0.165)), MVPA > 10 min bouts (Spearman rho = −0.059, p = 576), and SB (Spearman rho = 0.139, p = 0.187). Quantitative analysis demonstrated the huge proportional bias for MVPA, MVPA > 10 min bouts, and SB. Our findings demonstrate that self-reported physical activity provides inaccurate estimates of MVPA and SB in patients with CAD entering the ambulatory CR. This strongly supports the more objective assessments of daily PA, preferably using an accelerometer.
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Affiliation(s)
- Tim Kambic
- Cardiac Rehabilitation Unit, Department of Research and Education, General Hospital Murska Sobota, 9000 Murska Sobota, Slovenia
- Correspondence: (T.K.); (M.L.); Tel.: +386-(02)-5123-709 (T.K.); +386-(02)-512-3733 (M.L.)
| | - Nejc Šarabon
- Faculty of Health Sciences, University of Primorska, Polje 42, 6310 Izola, Slovenia;
- InnoRenew CoE, Human Health Department, Livade 6, 6310 Izola, Slovenia
- Laboratory for Motor Control and Motor Behavior, S2P, Science to Practice, Ltd., Tehnološki Park 19, 1000 Ljubljana, Slovenia
| | - Vedran Hadžić
- Faculty of Sport, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, 9000 Murska Sobota, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Natural Sciences and Mathematics, University of Maribor, 2000 Maribor, Slovenia
- Correspondence: (T.K.); (M.L.); Tel.: +386-(02)-5123-709 (T.K.); +386-(02)-512-3733 (M.L.)
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13
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Trecarten N, Kirkland S, Rainham D, Giacomantonio N, McGowan E, Murnaghan D, Reid R, King-Shier K, Spence JC, Warburton D, Rhodes RE, Blanchard CM. Location-Based Sedentary Time and Physical Activity in People Living With Coronary Artery Disease. J Cardiopulm Rehabil Prev 2021; 41:337-342. [PMID: 32947325 DOI: 10.1097/hcr.0000000000000533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Sedentary time (ST) and lack of physical activity increase the risk of adverse outcomes for those living with coronary artery disease (CAD). Little is known about how much ST, light physical activity (LPA), and moderate to vigorous physical activity (MVPA) that CAD participants not attending cardiac rehabilitation engage in, the locations where they engage in these behaviors, and how far from home the locations are. METHODS Participants completed a survey and wore an accelerometer and global positioning system receiver for 7 d at baseline and 6 mo later. RESULTS Accelerometer analyses (n = 318) showed that participants averaged 468.4 ± 102.7 of ST, 316.1 ± 86.5 of LPA, and 32.9 ± 28.9 of MVPA min/d at baseline. ST and LPA remained stable at 6 mo, whereas MVPA significantly declined. The global positioning system (GPS) analyses (n = 315) showed that most of participant ST, LPA, and MVPA time was spent at home followed by other residential, retail/hospitality, and work locations at baseline and 6 mo. When not at home, the average distance to a given location ranged from approximately 9 to 18 km. CONCLUSIONS Participants with CAD spent the majority of their time being sedentary. Home was the location used the most to engage in ST, LPA, and MVPA. When not home, ST, LPA, and MVPA were distributed across a variety of locations. The average distance from home to a given location suggests that proximity to home may not be a barrier from an intervention perspective.
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Affiliation(s)
- Neil Trecarten
- Departments of Medicine (Mr Trecarten and Drs Blanchard and Giacomantonio), Community Health and Epidemiology (Dr Kirkland), and Environmental Science (Dr Rainham), Dalhousie University, Halifax, Nova Scotia, Canada; School of Human Kinetics and Recreation, Memorial University of Newfoundland, St John's, Canada (Dr McGowan); School of Nursing, Thompson River University, Kamloops, British Columbia, Canada (Dr Murnaghan); Prevention and Rehabilitation Centre, Ottawa Heart Institute, Ottawa, Ontario, Canada (Dr Reid); Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada (Dr King-Shier); Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada (Dr Spence); School of Kinesiology, University of British Columbia, Vancouver, Canada (Dr Warburton); and School of Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada (Dr Rhodes)
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14
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Hammond-Haley M, Allen C, Han J, Patterson T, Marber M, Redwood S. Utility of wearable physical activity monitors in cardiovascular disease: a systematic review of 11 464 patients and recommendations for optimal use. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:231-243. [PMID: 36712392 PMCID: PMC9707885 DOI: 10.1093/ehjdh/ztab035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/22/2021] [Indexed: 02/01/2023]
Abstract
Aims Physical activity (PA) plays an important role in primary and secondary prevention of cardiovascular disease (CVD), functioning as a marker of disease progression and response to therapy. Real-world measurement of habitual PA is now possible through wearable activity monitors, however, their use in cardiovascular patients is not well described. Methods and results We performed a systematic review to summarize how wearable activity monitors have been used to measure PA in patients with CVD, with 11 464 patients included across 108 studies. Activity monitors were primarily used in the setting of cardiac rehabilitation (46, 43%). Most often, triaxial accelerometers (70, 65%) were instructed to be worn at the hip (58, 54%) for 7 days (n = 54, 50%). Thirty-nine different activity monitors were used, with a range of accelerometer specific settings for collection and reporting of activity data. Activity was reported most commonly as time spent in metabolic equivalent-defined activity levels (49, 45%), while non-wear time was defined in just 16 (15%) studies. Conclusion The collecting, processing, and reporting of accelerometer-related outcomes were highly heterogeneous. Most validation studies are limited to healthy young adults, while the paucity of methodological information disclosed renders interpretation of results and cross-study comparison challenging. While accelerometers are promising tools to measure real-world PA, we highlight current challenges facing their use in elderly multimorbid cardiology patients. We suggest recommendations to guide investigators using these devices in cardiovascular research. Future work is required to determine optimal methodology and consensus-based development of meaningful outcomes using raw acceleration data.
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Affiliation(s)
- Matthew Hammond-Haley
- British Heart Foundation Centre of Research Excellence, King's College London, Rayne Institute, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EP, UK,Department of Cardiology, Guys’ and St Thomas NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Christopher Allen
- British Heart Foundation Centre of Research Excellence, King's College London, Rayne Institute, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EP, UK,Department of Cardiology, Guys’ and St Thomas NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Jennie Han
- Royal Lancaster Infirmary, Ashton Road Lancaster, LA1 4RP, UK
| | - Tiffany Patterson
- British Heart Foundation Centre of Research Excellence, King's College London, Rayne Institute, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EP, UK,Department of Cardiology, Guys’ and St Thomas NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Michael Marber
- British Heart Foundation Centre of Research Excellence, King's College London, Rayne Institute, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EP, UK,Department of Cardiology, Guys’ and St Thomas NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Simon Redwood
- British Heart Foundation Centre of Research Excellence, King's College London, Rayne Institute, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EP, UK,Department of Cardiology, Guys’ and St Thomas NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, UK,Corresponding author. Tel: +44 207188 9359,
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15
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Pedometer Feedback Interventions Increase Daily Physical Activity in Phase III Cardiac Rehabilitation Participants. J Cardiopulm Rehabil Prev 2020; 40:183-188. [PMID: 31714397 DOI: 10.1097/hcr.0000000000000472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the effects of individually tailored interventions designed to increase physical activity (PA) in cardiac patients. METHODS A total of 99 (77 men and 22 women, 61.5 ± 10.7 yr) patients entering a phase III cardiac rehabilitation program completed a 12-wk PA intervention. Patients were randomized to usual care (UC, time-based recommendation), pedometer feedback (PF), newsletter-based motivational messaging (MM), or PF + MM. Both PF groups were given a goal of increasing steps/d by 10% of individual baseline value each week. If the goal for the week was not reached, the same goal was used for the next week. Physical activity was assessed for 7 d before beginning and after completing the program. The change in steps/d, moderate to vigorous intensity PA minutes, and sedentary time were compared among intervention groups. RESULTS Average change in steps/d was found to be significantly greater (P < .01) in the PF (2957 ± 3185) and the PF + MM (3150 ± 3007) compared with UC (264 ± 2065) and MM (718 ± 2415) groups. No group experienced changes in moderate to vigorous intensity PA time and only the PF intervention group decreased sedentary time (baseline 470.2 ± 77.1 to postintervention 447.8 ± 74.9 min/d, P = .01). CONCLUSION The findings from this study demonstrate that using PF was superior to the usual time-based PA recommendations and to newsletter-based MM in patients starting a phase III CR program. Cardiac rehabilitation programs are encouraged to implement PA feedback with individualized PA goals in order to support the increase in PA.
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16
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Prince SA, Cardilli L, Reed JL, Saunders TJ, Kite C, Douillette K, Fournier K, Buckley JP. A comparison of self-reported and device measured sedentary behaviour in adults: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2020; 17:31. [PMID: 32131845 PMCID: PMC7055033 DOI: 10.1186/s12966-020-00938-3] [Citation(s) in RCA: 203] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/19/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sedentary behaviour (SB) is a risk factor for chronic disease and premature mortality. While many individual studies have examined the reliability and validity of various self-report measures for assessing SB, it is not clear, in general, how self-reported SB (e.g., questionnaires, logs, ecological momentary assessments (EMAs)) compares to device measures (e.g., accelerometers, inclinometers). OBJECTIVE The primary objective of this systematic review was to compare self-report versus device measures of SB in adults. METHODS Six bibliographic databases were searched to identify all studies which included a comparable self-report and device measure of SB in adults. Risk of bias within and across studies was assessed. Results were synthesized using meta-analyses. RESULTS The review included 185 unique studies. A total of 123 studies comprising 173 comparisons and data from 55,199 participants were used to examine general criterion validity. The average mean difference was -105.19 minutes/day (95% CI: -127.21, -83.17); self-report underestimated sedentary time by ~1.74 hours/day compared to device measures. Self-reported time spent sedentary at work was ~40 minutes higher than when assessed by devices. Single item measures performed more poorly than multi-item questionnaires, EMAs and logs/diaries. On average, when compared to inclinometers, multi-item questionnaires, EMAs and logs/diaries were not significantly different, but had substantial amount of variability (up to 6 hours/day within individual studies) with approximately half over-reporting and half under-reporting. A total of 54 studies provided an assessment of reliability of a self-report measure, on average the reliability was good (ICC = 0.66). CONCLUSIONS Evidence from this review suggests that single-item self-report measures generally underestimate sedentary time when compared to device measures. For accuracy, multi-item questionnaires, EMAs and logs/diaries with a shorter recall period should be encouraged above single item questions and longer recall periods if sedentary time is a primary outcome of study. Users should also be aware of the high degree of variability between and within tools. Studies should exert caution when comparing associations between different self-report and device measures with health outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019118755.
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Affiliation(s)
- Stephanie A Prince
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, K1A 0K9, Canada.
| | - Luca Cardilli
- Birmingham Community Healthcare NHS Foundation Trust, Community Cardiac Services, Birmingham, United Kingdom
- Centre for Active Living, University Centre Shrewsbury, University of Chester, Guildhall, Frankwell Quay, Shrewsbury, United Kingdom
| | - Jennifer L Reed
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Travis J Saunders
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, Canada
| | - Chris Kite
- Centre for Active Living, University Centre Shrewsbury, University of Chester, Guildhall, Frankwell Quay, Shrewsbury, United Kingdom
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Kevin Douillette
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, Canada
| | - Karine Fournier
- Health Sciences Library, University of Ottawa, Ottawa, Canada
| | - John P Buckley
- Centre for Active Living, University Centre Shrewsbury, University of Chester, Guildhall, Frankwell Quay, Shrewsbury, United Kingdom
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17
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Validity of the Past-day Adults' Sedentary Time Questionnaire in a Cardiac Rehabilitation Population. J Cardiopulm Rehabil Prev 2020; 40:325-329. [PMID: 31972632 DOI: 10.1097/hcr.0000000000000488] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE Self-report measures of sedentary behavior are easier to use in a clinical setting; yet, no self-report measures of sedentary behavior appear to be validated in cardiac rehabilitation over time. The aim of this study was to assess the validity of the Past-day Adults' Sedentary Time (PAST) questionnaire in a cardiac rehabilitation population over 12 mo. METHODS Seventy-two cardiac rehabilitation participants were recruited to a prospective cohort study. Participants wore an ActiGraph ActiSleep accelerometer (sedentary time <100 counts/min) for 7 consecutive days and completed the self-administered PAST questionnaire at baseline, 6 wk, and 6 and 12 mo. Total daily sedentary time from both methods were compared using Bland-Altman plots and Spearman rank-order correlations. RESULTS Agreement between the 2 measures of sedentary time improved over 12 mo. At 6 and 12 mo, there was a good level of agreement between measures (mean difference between accelerometer and PAST 57 and -0.7 min, respectively), although the dispersion of the differences was wide (95% limits of agreement -428 to 541 and -500 to 498 min, respectively). There were weak correlations between the PAST questionnaire and average accelerometer measured sedentary time at all time points (α = -0.249 to 0.188). CONCLUSIONS Following repeated assessments, the PAST questionnaire may be useful to determine sedentary time in cardiac rehabilitation participants at a group level, with participants appearing to more accurately recall their time spent in sedentary behavior. Further research is indicated to assess the validity of sedentary behavior questionnaires in cardiac rehabilitation, with a combination of objective and self-reported measures currently recommended.
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Freene N, McManus M, Mair T, Tan R, Davey R. High sedentary behaviour and low physical activity levels at 12 months after cardiac rehabilitation: A prospective cohort study. Ann Phys Rehabil Med 2019; 63:53-58. [PMID: 31465863 DOI: 10.1016/j.rehab.2019.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/21/2019] [Accepted: 07/11/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND International cardiac rehabilitation guidelines recommend that participants meet public health physical activity guidelines. Few studies have objectively measured how much time cardiac rehabilitation participants spend in physical activity and sedentary behaviour, particularly over the long term. OBJECTIVE The aim of this study was to objectively assess physical activity and sedentary behaviour of cardiac rehabilitation participants over 12 months and determine whether they met the public health physical activity and sedentary behaviour guidelines. METHODS Cardiac rehabilitation participants with coronary heart disease were recruited in a prospective cohort study (n=72). Participants wore an ActiGraph ActiSleep accelerometer for 7 consecutive days at baseline, 6 weeks, and 6 and 12 months to assess daily minutes of moderate-to-vigorous physical activity and sedentary behaviour (<100 counts/min). Other outcomes collected were self-reported physical activity and sedentary behaviour, body mass index, waist-to-hip ratio, lipid profile, blood glucose level, quality of life, exercise capacity, anxiety and depression. RESULTS By intent-to-treat analysis, during the 6-week cardiac rehabilitation program, participants increased their light physical activity (P<0.01), which was maintained up to 12 months. Moderate-to-vigorous physical activity and sedentary behaviour did not change during the 6-week cardiac rehabilitation program but did improve over 6 months (sedentary behaviour decreased [P<0.001], moderate-to-vigorous physical activity increased [P<0.05]), which was maintained up to 1 year. Completion of moderate-to-vigorous physical activity in 10-min bouts did not change over 12 months, nor did the proportion of participants meeting physical activity guidelines (15-21%). Sedentary behaviour remained high throughout (11 hr/day). CONCLUSION Most cardiac rehabilitation participants did not meet the physical activity guidelines during and after a 6-week program up to 12 months. Reducing sedentary behaviour may be a more achievable first-line strategy for cardiac patients, moving participants along the energy expenditure continuum, aiming to increase their physical activity levels over the medium to long term. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12615000995572, http://www.ANZCTR.org.au/ACTRN12615000995572.aspx.
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Affiliation(s)
- Nicole Freene
- Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT, Australia; Health Research Institute, University of Canberra, Bruce, ACT, Australia.
| | | | - Tarryn Mair
- Exercise Physiology, Canberra Health Services, Garran, ACT, Australia.
| | - Ren Tan
- Cardiology, Canberra Health Services, Garran, ACT, Australia.
| | - Rachel Davey
- Health Research Institute, University of Canberra, Bruce, ACT, Australia; Centre for Research & Action in Public Health, Health Research Institute, University of Canberra, Bruce, ACT, Australia.
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Duran AT, Ewing Garber C, Cornelius T, Schwartz JE, Diaz KM. Patterns of Sedentary Behavior in the First Month After Acute Coronary Syndrome. J Am Heart Assoc 2019; 8:e011585. [PMID: 31364434 PMCID: PMC6761643 DOI: 10.1161/jaha.118.011585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 06/27/2019] [Indexed: 02/06/2023]
Abstract
Background Sedentary behavior is a key contributor to cardiovascular disease. Few data exist on the sedentary behavior patterns of patients with acute coronary syndrome. Methods and Results We characterized patterns of sedentary time and their correlates in 149 patients with acute coronary syndrome over the first month postdischarge, a critical period when lifestyle behaviors are formed. Sedentary time was measured by accelerometry for 28 days postdischarge. Group-based modeling at the day level was used to characterize sedentary patterns. Participants spent a mean of 9.7±2.0 hours per day sedentary during the 28 days postdischarge, with significant decreases in sedentary time observed in each consecutive week (P<0.01 for all). Three distinct sedentary patterns were identified: high (20.6% of participants), moderate (47.9%), and low (31.5%). The high and moderate sedentary groups spent a mean of 12.6±0.8 and 10.0±0.7 hours per day sedentary, respectively, and had only minimal decreases in their sedentary time (<3 minutes per day) over the 28 days. The low sedentary group spent a mean of 7.3±0.8 hours per day sedentary, with a rapid decrease in sedentary time (14 minutes per day) observed during the first week postdischarge followed by a relatively smaller decrease (≈5 minutes per day) that persisted until day 21 postdischarge. Non-Hispanic ethnicity, left ventricular ejection fraction <40%, lower physical health-related quality of life, and not having a partner were associated with an increased likelihood of being in the high sedentary group. Conclusions Survivors of acute coronary syndrome accrued high volumes of sedentary time during the first month postdischarge, with most showing little change over time. Interventions targeting reductions in sedentary time among survivors of acute coronary syndrome may be warranted, particularly for those with poor physical health and greater disease severity.
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Affiliation(s)
- Andrea T. Duran
- Department of Biobehavioral SciencesTeachers CollegeColumbia UniversityNew YorkNY
- Center for Behavioral Cardiovascular HealthColumbia University Irving Medical CenterNew YorkNY
| | - Carol Ewing Garber
- Department of Biobehavioral SciencesTeachers CollegeColumbia UniversityNew YorkNY
| | - Talea Cornelius
- Center for Behavioral Cardiovascular HealthColumbia University Irving Medical CenterNew YorkNY
| | - Joseph E. Schwartz
- Center for Behavioral Cardiovascular HealthColumbia University Irving Medical CenterNew YorkNY
- Department of PsychiatryStony Brook UniversityStony BrookNY
| | - Keith M. Diaz
- Center for Behavioral Cardiovascular HealthColumbia University Irving Medical CenterNew YorkNY
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Prince SA, Reid RD, Reed JL. Comparison of self-reported and objectively measured levels of sitting and physical activity and associations with markers of health in cardiac rehabilitation patients. Eur J Prev Cardiol 2018; 26:653-656. [PMID: 30354744 DOI: 10.1177/2047487318806357] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Stephanie A Prince
- 1 Division of Cardiac Prevention and Rehabilitation, Faculty of Health Sciences, University of Ottawa Heart Institute, Canada
| | - Robert D Reid
- 1 Division of Cardiac Prevention and Rehabilitation, Faculty of Health Sciences, University of Ottawa Heart Institute, Canada.,2 Faculty of Medicine, University of Ottawa, Canada
| | - Jennifer L Reed
- 1 Division of Cardiac Prevention and Rehabilitation, Faculty of Health Sciences, University of Ottawa Heart Institute, Canada.,2 Faculty of Medicine, University of Ottawa, Canada.,3 School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Canada
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Results of the Sedentary Intervention Trial in Cardiac Rehabilitation (SIT-CR Study): A pilot randomized controlled trial. Int J Cardiol 2018; 269:317-324. [DOI: 10.1016/j.ijcard.2018.07.082] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 07/04/2018] [Accepted: 07/17/2018] [Indexed: 12/17/2022]
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