Are cardiac rehabilitation patients meeting the physical activity guidelines 12-months after their event? a longitudinal study Dr Nicole Freene Ms Margaret.

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Are cardiac rehabilitation patients meeting the physical activity guidelines 12-months after their event? a longitudinal study Dr Nicole Freene Ms Margaret McManus Dr Ren Tan Ms Tarryn Mair Prof Rachel Davey 10 mins plus 5 mins Q (CRICOS) #00212K

Physical activity in CHD Savage et al (2008) – baseline phase II CR (USA), non-CR days 5315 steps (13% meet 10,000 steps), CR days 7387 steps (n=107). Ayabe et al (2004) – phase III (Japan) , MVPA 18 mins /day (MVPA 11 mins/day non-CR days) (n=77). Evenson et al (2014) – NHANES (USA) CHD Dx (1-10 yrs), MVPA 11 mins/day, sedentary behaviour 9 hrs/day (n=318). Prince et al (2016) – 10/7 post CR program (Canada), MVPA 25 mins/day, sedentary behaviour 8 hours/day (56%/day) (n=263). ter Hoeve et al (2017) – pre, post-CR program (13 wks), 12 months (Netherlands), MVPA 6.3-6.7%/day, sedentary behaviour 65-62%/day (9 hours) (n=135).

Active Couch Potato Phenomenon Total Healthy CVD or diabetes

Aim Objectively assess the physical activity levels and sedentary behaviour of cardiac rehab participants over 12-months. 12-months 6-months 6-weeks baseline

Methods Prospective cohort study Consecutive recruitment Phase II hospital-based CR – 6 weeks, twice a week, exercise & education ≥ 18 years old, stable CHD +/- revascularisation (CABG, PCI, MI), no unstable medical conditions & able to complete 6MWT, adequate language (English) and cognitive skills

Outcome measures Physical activity (AAS, accelerometry (Actigraph ActiSleep, Freedson cut-points)) Sedentary behaviour (PAST Q, accelerometry (<100 cpm)) Body mass index (BMI) Waist-to-hip ratio (WHR) Blood lipid & glucose levels Blood pressure Exercise capacity (6MWT) QoL (MacNew Q) Anxiety & depression (HADS Q) Socio-demographic & clinical information (Q)

Results Demographics Baseline (n=72) Age (yrs), mean (SD) 64.2 (9.6) Gender, n males (%) 57 (79) Heritage, n country born (Australia) (%) 38 (66) Body mass index (kg/m2), mean (SD) 30.7 (5.0) Education level, n tertiary (%) 41 (72) Relationship status, n partner (%) 40 (70) Type 2 diabetes, n yes (%) 14 (24) Employment category, n paid work (%) 30 (52) Diagnosis, n PCI (%) 58 (81) Blood pressure medication, n yes (%) 49 (86) Cholesterol medication, n yes (%) 51 (90) MacNew Global, mean (SD) 5.56 (0.77) HADS-total, mean (SD) 6.99 (5.52) BGL, mean (SD) 6.13 (1.66)

Results Outcome measure (n=72) Baseline 12 months DBP (mmHg), mean (SD) 71 (8) 74(7)*** HDL (mmol/L), mean (SD) 1.1 (0.2) 1.2 (0.2)*** HADS-D, mean (SD) 3.0 (2.7) 2.4 (2.5)** HADS-total, mean (SD) 7.0 (5.5) 6 (4.9)* MacNew-Physical 5.2 (0.9) 5.9 (1.1)*** MacNew-Emotional 5.8 (0.9) 6 (0.8)*** MacNew-Social 5.5 (1.0) 6.3 (1.1)*** MacNew-Global 5.6 (0.8) 6 (0.7)*** 6MWTD (m), mean (SD) 487 (86) 551 (110)*** *p≤0.05, **p≤0.01, *** p≤0.001

Results n=63 ActiGraph 1s ActiGraph 10 min bout baseline 12 months MVPA min/day (mean, SD) 39 (23) 45 (25)*** 10 (14) 10 (15) Sufficient PA (time) (n, %) - 10 (16) 14 (21) Sedentary min/day (mean, SD) 723 (58) 648 (79)*** 259 (93) 144 (103)*** LPA min/day (mean, SD) 73 (22) 84 (26)*** - - #VPA x 2; *p<0.01, ***p<0.001 Sufficient PA ≥ 150 mins/wk MVPA

Results n=63 ActiGraph Self-report baseline 12 months MVPA 10 min bout min/day (mean, SD) 10 (14) 10 (15) 43 (32)a 82 (70)a*** Sufficient PA 10 min bout (time) (n, %) 10 (16) 14 (21) 40 (73)#a 51 (81)#a* Sedentary min/day (mean, SD) 723 (58) 648 (79)*** 586 (190)b 623 (217)b #VPA x 2; *p<0.05, **p<0.01, ***p≤0.001 Sufficient PA ≥ 150 mins/wk MVPA aAAS bPAST

Duration SB bouts/day (mins) Results n=63 Actigraph 1s baseline 12 months Percentage wear day SB 87 (4) 83 (5)*** Duration SB bouts/day (mins) 259 (93) 144 (103)*** No SB bouts/day 13 (4) 8 (5)*** No SB breaks/day *p≤0.05, **p≤0.01, *** p<0.001

Results 12 hours 12 hours 11 hours 11 hours

Practical Implications Encourage ↓ sitting time (easier concept) & then↑ MVPA Ax PA (risk factor) & sedentary behaviour – subjective or objective ? different strategies for ↑ MVPA & ↓ sedentary behaviour (usually true!) http://www.sedentarybehaviour.org/what-is-sedentary-behaviour/

Conclusion Meeting the PA guidelines appears difficult to achieve in first 12/12 post event -↑ understanding & different strategies, ?change in CR guidelines (further investigation) Short time (<3/12) - ↑ focus on ↓ sitting time - may be an achievable & feasible first-line or additional strategy to improve health in those with CHD Med-longer term (6-12/12) - encourage an increase in MVPA, aiming for > 10 Minute bouts (but anything is better than nothing!)

Acknowledgements Prof Rachel Davey (UC-HRI) The Canberra Hospital Marg McManus & team (nurses) Tarryn Mair & team (EPs) Dr Ren Tan Participants Funding (UC, ACT Health) Nicole.Freene@canberra.edu.au @NicoleFreene