1. 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

2. 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 %/day, sedentary behaviour 65-62%/day (9 hours) (n=135).

3. Active Couch Potato Phenomenon
Total
Healthy
CVD or diabetes

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

5. 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

6. 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)

7. 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)

8. 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

9. 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

10. 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

11. 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

12. Results
12 hours
12 hours
11 hours
11 hours

13. 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!)

14. 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!)

15. 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)
@NicoleFreene