Trajectories of physical activity and sedentary behaviour during and after cardiac rehabilitation in patients with acute coronary syndrome
Authors: Limpens M , Van Den Berg - Emons HJG , Den Uijl I , Sunamura M , Voortman T , Boersma E , Ter Hoeve N 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Big Medilytics - Horizon 2020

Background
Physical behaviour is a multidimensional construct comprising physical activity (PA) and sedentary behaviour. PA adherence, during and after cardiac rehabilitation (CR), is problematic with less than 55% of the patients meeting recommended levels. Furthermore, CR only results in limited improvements in sedentary behaviour. To optimize CR programs, more information is needed on which patients could benefit from additional physical behaviour counselling.

Purpose
To explore trajectories (improvement, stabilization, or worsening) of moderate-to-vigorous PA (MVPA) and sedentary behaviour during and after CR, and to identify predictors for trajectory membership in patients with acute coronary syndrome (ACS).

Methods
The study was performed among 533 patients (mean age 57.9 ± 8.9years; 18.2% women) who participated in a 12-week multi-dimensional CR program that started (median) 35 days after hospitalization for ACS. Physical behaviour was measured using accelerometry at CR start, CR completion and 12 and 18 months follow-up. Latent class trajectory modelling was applied to explore trajectories for MVPA and sedentary behaviour. Separate trajectories were determined for the CR period and post-CR period. Using multinomial logistic regression, potential demographic, psychological, and cardiovascular predictors for each of the trajectories were explored.

Results
Using trajectory analyses, three classes of patients were identified for MVPA and sedentary behaviour both during and after CR: an increasing group, a declining group, and a steady group with only minor changes (see figure 1). Baseline physical behaviour level was the main predictor for declining trajectories, where, interestingly, patients with a higher starting level of the specific physical behaviour were more likely to be in the declining group as compared to the steady group (odds ratio (OR) for MVPA and sedentary behaviour during and post-CR ranging from 1.06-1.45, all p &lt; 0.05). During CR, smokers were less likely to be in the declining group for sedentary behaviour (OR 0.29 (0.09-0.96)) as compared to the steady group. Post-CR, participants with a higher age were less likely to be in the increasing group for MVPA and more likely to be in the increasing group for sedentary behaviour (OR respectively 0.96 (0.93-1.00), 1.04 (1.01-1.07)). Furthermore, participants with a higher BMI were also less likely to be in the increasing group for MVPA post-CR (0.91 (0.84-1.00)). Conclusion: Distinct trajectories for MVPA and sedentary behaviour exist for CR patients, which are mainly distinguished by baseline physical behaviour level, where patients with a higher starting level of the specific physical behaviour were more likely to be in the declining class. We did not see this for the increasing group, suggesting that this phenomenon was not only explained by regression to the mean.
Abstract Figure.