Does sedentary and physical activity behaviour change between exercise session days vs non exercise session days in patients attending a phase 3 cardiac rehabilitation program?
Authors: Cicio Rodrigues De Sa G , Borges M , Lemos Pires M , Ribeiro M , Pinto F , Pinto R , Abreu A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Physical activity (PA) is one of the main components of phase III cardiac rehabilitation (CR) programs. In people with coronary artery disease (CAD), higher levels of moderate to vigorous physical activity (MVPA) are associated with lower cardiovascular risk as well as lower levels of mortality. On the other hand, spending more time in sedentary behaviour is associated with lower levels of physical fitness and higher body mass index (BMI). According to the World Health Organization (WHO) recommendations, at least 150 minutes of MVPA should be performed per week (21.4 min/day) and sedentary behaviour should be reduced. CR programs tend to focus more on MVPA recommendations than sedentary behaviour, therefore more studies are needed to assess this behaviour.

Purpose
To analyse the levels of sedentary behaviour, light PA and MVPA of cardiovascular disease (CVD) patients attending a phase III CR program and compare those levels on exercise session days and non-exercise session days.

Methods
A total sample of 207 CVD patients were assessed when entering the CR phase III program. Physical activity was evaluated through accelerometery during seven consecutive days (including days of CR program exercise sessions and non-exercise sessions days). Demographic and clinical outcomes were retrieved, and BMI was calculated through weight in kilograms divided by the square of the height in meters. Independent-samples Mann-Whitney U test was used.

Results
One hundred and sixty-seven patients completed all the assessments (mean age 61 ± 10 years, 81.4% male, 87.4% CAD, BMI 28.17 ± 4.26 kg/m2). Results of PA were as follows: light PA (171 ± 49 minutes/day); MVPA (49 ± 32 minutes/day); percentage of time spent in sedentary behaviour (75.1 ± 7.2 %) and time in sedentary behaviour (11.0 ± 1.4 hours/day). Comparing CR exercise session days and non-session days, the analysis showed that light PA is significantly superior on exercise session days (177 ± 50 minutes/day vs 165 ± 48 minutes/day, p=0.027), as well as MVPA (60 ± 32 minutes/day vs 39 ± 29 minutes/day, p&lt;0.001). Regarding the percentage of time spent in sedentary behaviour, it was found to be significantly higher on non-exercise session days (76.5 ± 7.0 % vs 73.7 ± 7.2 %, p&lt;0.001).

Conclusion
These findings demonstrate that CVD patients attending a phase III CR program achieve the WHO recommendations for MVPA, especially on CR exercise session days, but sedentary behaviour is high in both exercise and non-exercise session days. This suggests that CVD patients should be instructed to adopt strategies that promote an increase in PA levels and a reduction in sedentary behaviour, especially on days when CR exercise sessions are not performed. An individualized PA counselling consult in CR programs, by specialized exercise professionals, might be a good strategy to improve PA and sedentary behaviour in CVD patients.