Effectiveness of an intervention to reduce sedentary behaviour as a personalised secondary prevention strategy for patients with coronary artery disease: main outcomes of the SIT LESS randomised clinical trial

Abstract

Background A high sedentary time is associated with increased mortality risk. Previous studies indicate that replacement of sedentary time with light- and moderate-to-vigorous physical activity attenuates the risk for adverse outcomes and improves cardiovascular risk factors. Patients with cardiovascular disease are more sedentary compared to the general population, while daily time spent sedentary remains high following contemporary cardiac rehabilitation programmes. This clinical trial investigated the effectiveness of a sedentary behaviour intervention as a personalised secondary prevention strategy (SIT LESS) on changes in sedentary time among patients with coronary artery disease participating in cardiac rehabilitation. Methods Patients were randomised to usual care (n = 104) or SIT LESS (n = 108). Both groups received a comprehensive 12-week centre-based cardiac rehabilitation programme with face-to-face consultations and supervised exercise sessions, whereas SIT LESS participants additionally received a 12-week, nurse-delivered, hybrid behaviour change intervention in combination with a pocket-worn activity tracker connected to a smartphone application to continuously monitor sedentary time. Primary outcome was the change in device-based sedentary time between pre- to post-rehabilitation. Changes in sedentary time characteristics (prevalence of prolonged sedentary bouts and proportion of patients with sedentary time ≥ 9.5 h/day); time spent in light-intensity and moderate-to-vigorous physical activity; step count; quality of life; competencies for self-management; and cardiovascular risk score were assessed as secondary outcomes. Results Patients (77% male) were 63 ± 10 years and primarily diagnosed with myocardial infarction (78%). Sedentary time decreased in SIT LESS (− 1.6 [− 2.1 to − 1.1] hours/day) and controls (− 1.2 [ ─1.7 to − 0.8]), but between group differences did not reach statistical significance (─0.4 [─1.0 to 0.3]) hours/day). The post-rehabilitation proportion of patients with a sedentary time above the upper limit of normal (≥ 9.5 h/day) was significantly lower in SIT LESS versus controls (48% versus 72%, baseline-adjusted odds-ratio 0.4 (0.2–0.8)). No differences were observed in the other predefined secondary outcomes. Conclusions Among patients with coronary artery disease participating in cardiac rehabilitation, SIT LESS did not induce significantly greater reductions in sedentary time compared to controls, but delivery was feasible and a reduced odds of a sedentary time ≥ 9.5 h/day was observed. Trial registration Netherlands Trial Register: NL9263. Graphical Abstract Outcomes of the SIT LESS trial: changes in device-based sedentary time from pre-to post-cardiac rehabilitation (control group) and cardiac rehabilitation + SIT LESS (intervention group). SIT LESS reduced the odds of patients having a sedentary time >9.5 hours/day (upper limit of normal), although the absolute decrease in sedentary time did not significantly differ from controls. SIT LESS appears to be feasible, acceptable and potentially beneficial, but a larger cluster randomised trial is warranted to provide a more accurate estimate of its effects on sedentary time and clinical outcomes. CR: cardiac rehabilitation.

Comparison of time‐matched aerobic, resistance or combined exercise training in women living with obesity: The EXOFFIT study

“…While all three interventions improved PAL, only COM and RE demonstrated an improvement in sitting time which could translate into clinical significance with the reduction in COM greater than three times the minimally effective change (30‐min) which has been correlated with a decrease of 2%–4% in cardiovascular risk and 2% in mortality risk 72–74 . Pain severity, interference and prevalence reported amongst the participants was lower than reported in previous studies in adults with obesity, 75,76 even compared with a similar BMI profile 77 and in an Irish context 78 .…”

Effective management of sedentary behavior among Indian university students: An empirical exploration into health-related behavior

“…Hybrid interventions, which integrate various strategies, such as digital platforms, personalized coaching, and in-person sessions, offer the advantage of targeting different aspects of behavior change and engaging participants through diverse channels. [ 64 65 ]…”

“…An increase in remote studies, which were conducted to implement management strategies for sedentary behavior, was observed. [ 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 ] Given the notable rise in sedentary behaviors and the increasing prevalence of obesity,[ 71 ] there is a compelling need for research on interventions that promote active and healthier lifestyles. Continual research is warranted to regularly update the data pertaining to the physical activity levels of school-age children, adolescents, and adults, as well as their respective sedentary behaviors.…”

A multiple technology-based and individually-tailored Sit Less program for people with cardiovascular disease: A randomized controlled trial study protocol

“…This multifaceted strategy offers a low-cost, sustainable method for sedentary behavior reduction for CVD patients, who are typically over 60 years old, yet lacks widespread implementation in this age group. While some research has focused on reducing sedentary behavior in CVD patients [ 8 , 9 , 26 , 27 ], it predominantly involves individuals already participating in cardiac rehabilitation. Given that these participants tend to be motivated and exhibit higher physical activity and lower sedentary time during rehabilitation, there is a lack of information on how to extend these findings to the broader CVD patient population who may not be as inclined to enroll in cardiac rehabilitation programs.…”