Minor Improvement in Activity and Participation and Decline in Physical Activity Motivation After Cardiac Rehabilitation Discharge

Abstract

E xercise during cardiac rehabilitation (CR) provides numerous health benefits for people with cardiac conditions, including decreased hospital admissions and improved mental health, physical activity (PA), and healthrelated quality of life. [1][2][3][4] The core components of CR aim to reduce cardiovascular risks and promote healthy behaviors. 5 While exercise training is certainly important for CR, other core components, such as PA and nutrition counseling, tobacco cessation, and psychosocial management, are crucial to bolster the long-term benefits. Although PA counseling promotes increased PA in daily life, 6 it primarily focuses on moderate-to-vigorous-intensity PA (MVPA). This focus may present a barrier for middle-aged and older adults, as 66-87% of the waking time is spent in sedentary behaviors and only 0.5-2% for MVPA. 7 More concerning is that recent participants of a CR program spent 56% of waking time in sedentary behaviors and 5% in MVPA. 8 The remaining waking time was spent on light-intensity PA (the middle category between sedentary behaviors and MVPA). Higher sedentary time has been associated with an increased risk for cardiovascular disease, cancer, and type 2 diabetes incidence. 9,10 In addition, light-intensity PA has been associated with numerous health benefits. 11,12 Thus, examining only MVPA during and after CR may not reflect important activity changes to improve cardiovascular health.To allow a more comprehensive view, health professionals can incorporate activities and participation of the International Classification of Functioning, Disability and Health (ICF) that provides a unified international framework for health-related states. Activities in the ICF indicate the individual view of carrying out tasks, and participation indicates the societal view of participation in a life situation. 13 Essentially, activities and participation encompass everything humans perform in their daily lives, and allow us to comprehensively view what we do every day. Therefore, measuring activities and participation including related factors, such as mental and physical functions, may be a more robust and comprehensive method of assessing changes following the completion of CR.The purpose of this study was to examine the changes in comprehensive outcomes after the completion of traditional CR. Specifically, we investigated the changes in activities and participation including performance, limitation, and participation in activities, and mental and physical functions including depression, fatigue, cognition, motivation, and exercise capacity for 9 mo after CR among adults with chronic cardiac conditions. METHODSWe used a prospective observational design to investigate the changes that adults with chronic cardiac conditions experience post-CR. Participants were assessed at four different times: within 2-wk window of CR discharge date (DC), 1 mo (1M), 3 mo (3M), and 9 mo after discharge (9M).Participants were 25 adults with chronic cardiac conditions who were receiving CR at the outpatient cardiovascular P...

Self-report Versus Measured Physical Activity Levels During Outpatient Cardiac Rehabilitation

“…[5][6][7] After discharge from CR, maintaining health and recommended PA levels becomes even more difficult. 7,8 Patients with CAD overestimate their PA levels and may have a misperception of actual achievements. 9,10 Valid measurements are necessary to evaluate MVPA levels but remain challenging in daily practice.…”

“…Despite positive physical effects of CR, many patients with CAD do not achieve the recommended levels of MVPA during and after CR 5–7. After discharge from CR, maintaining health and recommended PA levels becomes even more difficult 7,8…”