Sedentary behaviour and physical activity following multimodal exercise-based cardiac rehabilitation in patients with coronary artery disease

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Slovenian Research Agency Background Despite high levels of sedentary behaviour (SB) in patients with coronary artery disease (CAD), there is still limited evidence on the efficacy of multimodal exercise interventions combined with physical activity (PA) counselling on SB and PA in cardiac rehabilitation (CR). Such combined modalities in CR may provide additional benefits for PA and SB, although this remains to be investigated. Purpose The aim of our study was to investigate the effects of multimodal exercise training combined with brief PA counselling on PA and SB according to sedentary status of patients with CAD. Methods We randomised 79 patients with CAD to low-load (LL) resistance training (RT) + aerobic training (AT) (30%-40% of one repetition maximum [1-RM]), high load RT+AT (70%-80% of 1-RM) and AT alone. The study was completed by 57 patients, with [mean (SD)] age = 61 (8) years, height = 171.8 (8.5) cm, weight = 85.12 (15.59) kg and left ventricular ejection fraction = 53 % (45,60) [median (first, third quartile)]. During the study, each patient received an hour of PA counselling and written PA brochure. Step count, daily SB, light intensity PA (LIPA) and moderate-to-vigorous PA (MVPA) were measured at baseline and post-training using triaxial accelerometer. Following baseline measurement, we stratified patients to quartiles based on their levels of SB: most sedentary, sedentary, less sedentary, least sedentary. Results Upon enrolment to CR patients have surpassed daily PA recommendation (+21 min, p < 0.001). All measures of PA and SB remained unchanged following training intervention (all p > 0.388). Patients classified as the most sedentary have decreased SB (-52 min/day, p = 0.001) and increased LIPA (+27 min/day, p = 0.009), while the least sedentary patients increased SB (+69 min/day, p = 0.006) and decreased LIPA (-25 min/day, p = 0.038) following the intervention. The improvement in PA was greater in the most sedentary patients (SB: +27%, p = 0.002; LIPA: +24%, p = 0.004) and in sedentary patients (SB: +24%, p = 0.009) compared to the least sedentary patients. After the training intervention, LIPA was improved more in less sedentary patients compared to the least sedentary patients (+19 %, p = 0.031). Two-way analysis of variance has demonstrated non-significant effect of time x training modality interaction on all PA and SB variables (p = 0.285-0.819). Conclusions The addition of RT and brief PA counselling to standard CR showed limited effects on post-training improvement in SB and MVPA. Individually tailored PA behavioural counselling based on patients’ sedentary status along with regular PA monitoring during CR should be implemented to enhance the effects of combined RT and AT in patients with CAD.