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Randomized Controlled Trial
. 2024 Aug 19;21(1):90.
doi: 10.1186/s12966-024-01642-2.

A cardiac-rehab behaviour intervention to reduce sedentary time in coronary artery disease patients: the SIT LESS randomized controlled trial

Sophie H Kroesen  1 , Bram M A van Bakel  1 , Marijn de Bruin  2 , Arzu Günal  3 , Arko Scheepmaker  3 , Wim R M Aengevaeren  4 , Frank F Willems  4 , Roderick Wondergem  5   6   7 , Martijn F Pisters  5   6   7 , Francisco B Ortega  8   9   10 , Maria T E Hopman  1 , Dick H J Thijssen  1   11 , Esmée A Bakker  1   8   12 , Thijs M H Eijsvogels  13
Affiliations
Randomized Controlled Trial

A cardiac-rehab behaviour intervention to reduce sedentary time in coronary artery disease patients: the SIT LESS randomized controlled trial

Sophie H Kroesen et al. Int J Behav Nutr Phys Act. .

Abstract

Background: High sedentary times (ST) is highly prevalent in patients with coronary artery disease (CAD), highlighting the need for behavioural change interventions that effectively reduce ST. We examined the immediate and medium-term effect of the SIT LESS intervention on changes in ST among CAD patients enrolled in cardiac rehabilitation (CR).

Methods: CAD patients participating in CR at 2 regional hospitals were included in this randomized controlled trial (1:1, stratified for gender and hospital). The control group received CR, whereas SIT LESS participants additionally received a 12-week hybrid behaviour change intervention. The primary outcome was the change in accelerometer-derived ST from pre-CR to post-CR and 3 months post-CR. Secondary outcomes included changes in ST and physical activity characteristics, subjective outcomes, and cardiovascular risk factors. A baseline constrained linear mixed-model was used.

Results: Participants (23% female; SIT LESS: n = 108, control: n = 104) were 63 ± 10 years. Greater ST reductions were found for SIT LESS compared to control post-CR (-1.7 (95% confidence interval (CI): -2.0; -1.4) versus - 1.1 (95% CI: -1.4; -0.8) h/day, pinteraction=0.009), but not at 3 months post-CR (pinteraction=0.61). Besides, larger light-intensity physical activity (LIPA) increases were found for SIT LESS compared to control post-CR (+ 1.4 (95% CI: +1.2; +1.6) versus + 1.0 (95% CI: +0.8; +1.3) h/day, pinteraction=0.020). Changes in other secondary outcomes did not differ among groups.

Conclusion: SIT LESS transiently reduced ST and increased LIPA, but group differences were no longer significant 3 months post-CR. These findings highlight the challenge to induce sustainable behaviour changes in CAD patients without any continued support.

Trial registration: Netherlands Trial Register: NL9263. Registration Date: 24 February 2021.

Keywords: Cardiac rehabilitation; Cardiovascular disease; Physical activity; Prevention; Sedentary lifestyle; e-Health.

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Conflict of interest statement

All authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT flowchart of the SIT LESS randomized controlled trial. In total 237 patients were approached for participation, of which 220 were randomized to either the SIT LESS group or the control group. Eight patients dropped out prior to cardiac rehabilitation (CR) initiation, leaving 108 patients in the SIT LESS group and 104 in the control group. CABG: coronary artery bypass grafting; CR: cardiac rehabilitation; HGS: Handgrip strength; TUG: Timed Up and Go
Fig. 2
Fig. 2
Constrained linear (A, B) and logistic (C) mixed model sedentary behaviour outcomes. The total group (black) pre-cardiac rehabilitation (CR; SIT LESS n = 103; control: n = 100), and for the SIT LESS (blue) and control (red) group immediately post-CR (SIT LESS: n = 90; control: n = 93) and 3 months post-CR (SIT LESS: n = 83; control: n = 91) are depicted. (A) Sedentary time in hours per day with the dashed line representing the upper-limit of normal (9.5 h per day). (B) Daily number of prolonged sedentary time bouts (≥ 30 min) per day. Data are plotted as mean with 95% confidence intervals. (C) Odds ratio of a sedentary time above the upper-limit of normal (≥ 9.5 h/day) for the SIT LESS compared to the control group. P-values depict between group differences (interaction term), with the values post-CR and 3 months post-CR compared to pre-CR
Fig. 3
Fig. 3
Constrained mixed model physical activity outcomes. The total group (black) pre-cardiac rehabilitation (CR; SIT LESS n = 103; control: n = 100), and for the SIT LESS (blue) and control (red) group immediately post-CR (SIT LESS: n = 90; control: n = 93) and 3 months post-CR (SIT LESS: n = 83; control: n = 91) are depicted. (A) Time spent in light-intensity physical activity (LIPA). (B) Time spent in moderate-to-vigorous intensity physical activity (MVPA). (C) Daily number of steps. Values are given per day and as mean and 95% confidence interval
Fig. 4
Fig. 4
Kaplan-Meier curve of the time to events for the SIT LESS (blue) and control (red) group. Events were defined as all-cause mortality and major adverse cardiovascular events (MACE; cardiovascular-related hospitalization and recurrence of acute coronary events). Adverse events occurred in 21 out of 212 participants (10%) between the start of cardiac rehabilitation and 2 years of follow-up. Participants in the SIT LESS group did not have a different event free survival (Hazard ratio: 0.60, 95% CI: 0.25; 1.44, p = 0.25) compared to participants in the control group
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