Do cardiovascular disease patients return to pre-lockdown sedentary levels? A prospective cohort study

Abstract

Background: The COVID-19 lockdown negatively impacted physical activity (PA) and sedentary behaviour (SB) levels of the Dutch patients with cardiovascular diseases (CVD), but little is known whether these levels returned to pre-pandemic levels. In this study, we evaluated changes in SB and moderate-to-vigorous PA (MVPA) in CVD patients before, during, and after the COVID-19 pandemic and investigated which factors contributed to not returning to pre-pandemic sedentary levels.

Methods: 1,028 Dutch CVD patients participated in this prospective cohort study, where we assessed SB and MVPA before (2018), during (2020), and after (2023) the COVID-19 pandemic using validated questionnaires. Linear mixed model analyses were used to investigate changes over time. Binary logistic regression analyses were performed to examine factors associated with not returning to pre-pandemic SB levels.

Results: SB levels significantly increased from 7.8 h/day at pre-pandemic assessment to 8.7 h/day during lockdown and then significantly decreased to 8.5 h/day at the post-pandemic assessment, but did not return to pre-pandemic levels (p = 0.006). MVPA did not significantly change over time. Lower pre-pandemic SB levels, a larger increase in SB during lockdown, self-reported residual complaints after COVID-19, and diagnosis of arrhythmias at baseline were associated with not returning to pre-pandemic SB levels.

Conclusion: Sedentary time in CVD patients did not return to pre-pandemic levels, 3 years following initial COVID-19 lockdown, while levels of MVPA did not change over time. These findings suggest that lifestyle interventions could be considered to reactivate CVD patients and lower their risk of disease progression and adverse health outcomes. SB bij CVD-patiënten keerde niet terug naar het niveau van voor de pandemie, drie jaar na de eerste COVID-19 lockdown, terwijl MVPA onveranderd bleef. Deze bevindingen suggereren dat leefstijlinterventies overwogen kunnen worden om CVD-patiënten opnieuw te activeren en hun risico op ziekteprogressie en nadelige gezondheidseffecten te verlagen.

Keywords: COVID-19; Cardiovascular Disease; Pandemics; Physical inactivity; Sedentary time.

Fig. 1

Infographic

Fig. 2

Sedentary time (a) and MVPA (b) in hours per day of the cohort participating in the current study (n = 1028). Data is shown of pre- (2018), peri- (2020), and post-lockdown (2023) timepoints. The boxplots visualise median values with IQR and total variation across the population. MVPA moderate-to-vigorous physical activity

Fig. 3

Sankey plot of the flow of participants over time. Numbers represent percentages of participants of complete cases with SB data (n = 859). No return to pre-pandemic TB levels was defined as an increase of > 0.5 h/day over the total study period (2018 versus 2023). Percentages in red indicate an increase of > 0.5 hr/day when compared to the assessment in 2018. Percentages in green indicate a decrease in SB or an increase < 0.5 hr/day when compared to assessment in 2018. SB Sedentary Behaviour