Comparison of device-based physical activity and sedentary behaviour following percutaneous coronary intervention in a cohort from Sweden and Australia: a harmonised, exploratory study

Nicole Freene, Sabina Borg, Margaret McManus, Tarryn Mair, Ren Tan, Rachel Davey, Birgitta Öberg, Maria Bäck, Nicole Freene, Sabina Borg, Margaret McManus, Tarryn Mair, Ren Tan, Rachel Davey, Birgitta Öberg, Maria Bäck

Abstract

Background: Few studies have measured device-based physical activity and sedentary behaviour following a percutaneous coronary intervention (PCI), with no studies comparing these behaviours between countries using the same methods. The aim of the study was to compare device-based physical activity and sedentary behaviour, using a harmonised approach, following a PCI on-entry into centre-based cardiac rehabilitation in two countries.

Methods: A cross-sectional study was conducted at two outpatient cardiac rehabilitation centres in Australia and Sweden. Participants were adults following a PCI and commencing cardiac rehabilitation (Australia n = 50, Sweden n = 133). Prior to discharge from hospital, Australian participants received brief physical activity advice (< 5 mins), while Swedish participants received physical activity counselling for 30 min. A triaxial accelerometer (Actigraph GT3X/ActiSleep) was used to objectively assess physical activity (light (LPA), moderate-to-vigorous (MVPA)) and sedentary behaviour. Outcomes included daily minutes of physical activity and sedentary behaviour, and the proportion and distribution of time spent in each behaviour.

Results: There was no difference in age, gender or relationship status between countries. Swedish (S) participants commenced cardiac rehabilitation later than Australian (A) participants (days post-PCI A 16 vs S 22, p < 0.001). Proportionally, Swedish participants were significantly more physically active and less sedentary than Australian participants (LPA A 27% vs S 30%, p < 0.05; MVPA A 5% vs S 7%, p < 0.01; sedentary behaviour A 68% vs S 63%, p < 0.001). When adjusting for wear-time, Australian participants were doing less MVPA minutes (A 42 vs S 64, p < 0.001) and more sedentary behaviour minutes (A 573 vs S 571, p < 0.001) per day. Both Swedish and Australian participants spent a large part of the day sedentary, accumulating 9.5 h per day in sedentary behaviour.

Conclusion: Swedish PCI participants when commencing cardiac rehabilitation are more physically active than Australian participants. Potential explanatory factors are differences in post-PCI in-hospital physical activity education between countries and pre-existing physical activity levels. Despite this, sedentary behaviour is high in both countries. Internationally, interventions to address sedentary behaviour are indicated post-PCI, in both the acute setting and cardiac rehabilitation, in addition to traditional physical activity and cardiac rehabilitation recommendations.

Trial registrations: Australia: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12615000995572. Registered 22 September 2015, Sweden: World Health Organization Trial Registration Data Set: NCT02895451.

Keywords: Acute coronary syndrome; Secondary prevention.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

© The Author(s) 2020.

Figures

Fig. 1
Fig. 1
Percentage of waking hours spent in sedentary behaviour, light (LPA) and moderate-to-vigorous physical activity (MVPA) at baseline

References

    1. Byrne RA, Stone GW, Ormiston J, Kastrati A. Coronary balloon angioplasty, stents, and scaffolds. Lancet. 2017;390(10096):781–792. doi: 10.1016/S0140-6736(17)31927-X.
    1. AIHW. Davies J. Coronary revascularisation in Australia 2000. Bulletin no.7. AIHW Cat. No. AUS 35. Canberra: AIHW; 2003.
    1. Chew DP, Scott IA, Cullen L, French JK, Briffa TG, Tideman PA, et al. National Heart Foundation of Australia & Cardiac Society of Australia and new Zealand: Australian clinical guidelines for the Management of Acute Coronary Syndromes 2016. Heart Lung Circ. 2016;25(9):895–951. doi: 10.1016/j.hlc.2016.06.789.
    1. Australian Commission on Safety and Quality in Health Care . Acute Coronary Syndromes Clinical Care Standard. Sydney: ACSQHC; 2014.
    1. Woodruffe S, Neubeck L, Clark RA, Gray K, Ferry C, Finan J, et al. Australian cardiovascular health and rehabilitation association (ACRA) core components of cardiovascular disease secondary prevention and cardiac rehabilitation 2014. Heart Lung Circ. 2015;24(5):430–441. doi: 10.1016/j.hlc.2014.12.008.
    1. Piepoli MF, Corra U, Adamopoulos S, Benzer W, Bjarnason-Wehrens B, Cupples M, et al. Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery: a policy statement from the cardiac rehabilitation section of the European Association for Cardiovascular Prevention & Rehabilitation. Endorsed by the Committee for Practice Guidelines of the European Society of Cardiology. Eur J Prev Cardiol. 2014;21(6e):664–681. doi: 10.1177/2047487312449597.
    1. Anderson L, Thompson DR, Oldridge N, Zwisler AD, Rees K, Martin N, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2016;1:CD001800. doi: 10.1002/14651858.CD001800.pub3.
    1. Gerber Y, Myers V, Goldbourt U, Benyamini Y, Scheinowitz M, Drory Y. Long-term trajectory of leisure time physical activity and survival after first myocardial infarction: a population-based cohort study. Eur J Epidemiol. 2011;26(2):109–116. doi: 10.1007/s10654-010-9523-8.
    1. Apullan FJ, Bourassa MG, Tardif JC, Fortier A, Gayda M, Nigam A. Usefulness of self-reported leisure-time physical activity to predict long-term survival in patients with coronary heart disease. Am J Cardiol. 2008;102(4):375–379. doi: 10.1016/j.amjcard.2008.03.072.
    1. Ekblom O, Ek A, Cider A, Hambraeus K, Borjesson M. Increased Physical Activity Post-Myocardial Infarction Is Related to Reduced Mortality: Results From the SWEDEHEART Registry. J Am Heart Assoc. 2018;7(24):e010108. doi: 10.1161/JAHA.118.010108.
    1. Prince SA, Adamo KB, Hamel ME, Hardt J, Gorber SC, Tremblay M. A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nutr Phys Act. 2008;5(1):56. doi: 10.1186/1479-5868-5-56.
    1. Dowd KP, Szeklicki R, Minetto MA, Murphy MH, Polito A, Ghigo E, et al. A systematic literature review of reviews on techniques for physical activity measurement in adults: a DEDIPAC study. Int J Behav Nutr Phys Act. 2018;15:15. doi: 10.1186/s12966-017-0636-2.
    1. van der Ploeg HP, Chey T, Korda RJ, Banks E, Bauman A. Sitting time and all-cause mortality risk in 222 497 Australian adults. Arch Intern Med. 2012;172(6):494–500. doi: 10.1001/archinternmed.2011.2174.
    1. Charman SJ, van Hees VT, Quinn L, Dunford JR, Bawamia B, Veerasamy M, et al. The effect of percutaneous coronary intervention on habitual physical activity in older patients. BMC Cardiovasc Disord. 2016;16(1):248. doi: 10.1186/s12872-016-0428-7.
    1. Goodwin AM, Duran AT, Kronish IM, Moise N, Sanchez GJ, Garber CE, et al. Factors associated with objectively measured exercise participation after hospitalization for acute coronary syndrome. Int J Cardiol. 2018. 10.1016/j.ijcard.2018.09.080.
    1. Ramadi A, Haennel RG. Sedentary behavior and physical activity in cardiac rehabilitation participants. Heart Lung. 2019;48(1):8–12. doi: 10.1016/j.hrtlng.2018.09.008.
    1. ter Hoeve N, Sunamura M, van Geffen ME, Fanchamps MH, Horemans HL, Bussmann JB, et al. Changes in physical activity and sedentary behavior during cardiac rehabilitation. Arch Phys Med Rehabil. 2017;98(12):2378–2384. doi: 10.1016/j.apmr.2017.05.008.
    1. Australian Institute of Health and Welfare . A working guide to international comparisons of health. Cat. no. PHE 159. Canberra: AIHW; 2012.
    1. United Nations Development Programme . Human development indices and indicators: 2018 statistical update. New York: United Nations Development Programme; 2018.
    1. . Accessed 29 Nov 2018.
    1. Australian Institute of Health and Welfare . Australia’s health 2018. Australia’s health series no. 16. AUS 221. Canberra: AIHW; 2018.
    1. The National Board of Health and Welfare (Sweden) Statistics on causes of death. 2019.
    1. Australian Institute of Health and Welfare . Cardiovascular disease snapshot. 2018.
    1. Australian Institute of Health and Welfare . Transition between hospital and community care for patients with coronary heart disease: New South Wales and Victoria, 2012–2015. Canberra: AIHW; 2018.
    1. Jernberg T. SWEDEHEART annual report 2018. Matador kommunikation AB. 2018.
    1. Ayabe M, Brubaker PH, Dobrosielski D, Miller HS, Ishi K, Yahiro T, et al. The physical activity patterns of cardiac rehabilitation program participants. J Cardpulm Rehabil. 2004;24(2):80–86. doi: 10.1097/00008483-200403000-00003.
    1. Prince SA, Blanchard CM, Grace SL, Reid RD. Objectively-measured sedentary time and its association with markers of cardiometabolic health and fitness among cardiac rehabilitation graduates. Eur J Prev Cardiol. 2016;23(8):818–825. doi: 10.1177/2047487315617101.
    1. Freene N, Del Pozo CB, Davey R. Assessing the ‘active couch potato’ phenomenon in cardiac rehabilitation: rationale and study protocol. BMC Health Serv Res. 2016;16:75. doi: 10.1186/s12913-016-1313-x.
    1. Borg S, Öberg B, Nilsson L, Söderlund A, Bäck M. The role of a behavioural medicine intervention in physiotherapy for the effects of rehabilitation outcomes in exercise-based cardiac rehabilitation (ECRA) - the study protocol of a randomised, controlled trial. BMC Cardiovasc Disord. 2017;17:1–8. doi: 10.1186/s12872-017-0557-7.
    1. Freene N, McManus M, Mair T, Tan R, Davey R. Objectively measured changes in physical activity and sedentary behavior in cardiac rehabilitation: a prosepctive cohort study. J Cardiopulm Rehabil Prev. 2018;38(6):E5–E8. doi: 10.1097/HCR.0000000000000334.
    1. Freene N, McManus M, Mair T, Tan R, Davey R. High sedentary behaviour and low physical activity levels at 12 months after cardiac rehabilitation: a prospective cohort study. Ann Phys Rehabil Med. 2019. 10.1016/j.rehab.2019.07.008.
    1. National Heart Foundation of Australia. My heart, my life. 2nd ed: National Heart Foundation of Australia; 2015. .
    1. Ögmundsdottir Michelsen H, Sjölin I, Schlyter M, Hagström E, Kiessling A, Henriksson P, et al. Cardiac rehabilitation after acute myocardial infarction in Sweden – evaluation of programme characteristics and adherence to European guidelines: The Perfect Cardiac Rehabilitation (Perfect-CR) study. Eur J Prev Cardiol. 2020;27(1):18–27. doi: 10.1177/2047487319865729.
    1. World Health Organisation . Global recommendations on physical activity for health. Geneva: WHO; 2010.
    1. Migueles JH, Cadenas-Sanchez C, Ekelund U, Delisle Nyström C, Mora-Gonzalez J, Löf M, et al. Accelerometer data collection and processing criteria to assess physical activity and other outcomes: a systematic review and practical considerations. Sports Med. 2017;47(9):1821–1845. doi: 10.1007/s40279-017-0716-0.
    1. Sasaki JE, John D, Freedson PS, Sasaki JE, John D, Freedson PS. Validation and comparison of ActiGraph activity monitors. J Sci Med Sport. 2011;14(5):411–416. doi: 10.1016/j.jsams.2011.04.003.
    1. Kozey-Keadle S, Libertine A, Lyden K, Staudenmayer J, Freedson PS. Validation of wearable monitors for assessing sedentary behavior. Med Sci Sports Exerc. 2011;43(8):1561–1567. doi: 10.1249/MSS.0b013e31820ce174.
    1. What are counts? . Accessed 29 Nov 2018.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Rogerson MC, Le Grande MR, Dunstan DW, Magliano DJ, Murphy BM, Salmon J, et al. Television viewing time and 13-year mortality in adults with cardiovascular disease: data from the Australian diabetes, obesity and lifestyle study (AusDiab) Heart Lung Circ. 2016;25(8):829–836. doi: 10.1016/j.hlc.2016.03.006.
    1. Ku P-W, Steptoe A, Liao Y, Hsueh M-C, Chen L-J. A cut-off of daily sedentary time and all-cause mortality in adults: a meta-regression analysis involving more than 1 million participants. BMC Med. 2018;16(1):74. doi: 10.1186/s12916-018-1062-2.
    1. Australia’s Physical Activity and Sedentary Behaviour Guidelines . Accessed 29 Nov 2018.
    1. U.S. Department of Health and Human Services . Physical Activity Guidelines for Americans. 2. Washington, D.C: U.S. Department of Health and Human Services; 2018.
    1. Paratz ED, Wilkinson LE, MacIsaac AI. Outcomes of obese and morbidly obese patients undergoing percutaneous coronary intervention. Heart Lung Circ. 2018;27(7):785–791. doi: 10.1016/j.hlc.2017.08.009.
    1. Redfern J, Hyun K, Chew DP, Astley C, Chow C, Aliprandi-Costa B, et al. Prescription of secondary prevention medications, lifestyle advice, and referral to rehabilitation among acute coronary syndrome inpatients: results from a large prospective audit in Australia and New Zealand. Heart. 2014;100(16):1281–1288. doi: 10.1136/heartjnl-2013-305296.
    1. World Health Organization . Health literacy: the solid facts. Denmark: World Health Organization Regional Office for Europe; 2013.
    1. World Health Organization Regional Office for Europe . Sweden Physical Activity Factsheet. 2018.
    1. Onerup A, Arvidsson D, Blomqvist Å, Daxberg E-L, Jivegård L, Jonsdottir IH, et al. Physical activity on prescription in accordance with the Swedish model increases physical activity: a systematic review. Br J Sports Med. 2018. 10.1136/bjsports-2018-099598.
    1. Healy GN, Winkler EAH, Owen N, Anuradha S, Dunstan DW. Replacing sitting time with standing or stepping: associations with cardio-metabolic risk biomarkers. Eur Heart J. 2015;36(39):2643–2649. doi: 10.1093/eurheartj/ehv308.
    1. Dohrn IM, Sjostrom M, Kwak L, Oja P, Hagstromer M. Accelerometer-measured sedentary time and physical activity-a 15 year follow-up of mortality in a Swedish population-based cohort. J Sci Med Sport. 2018;21(7):702–707. doi: 10.1016/j.jsams.2017.10.035.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit