Remote booster program after cardiac rehabilitation reduces daily sitting time  Improvement in lifestyle captured thanks to new intervention

After a cardiovascular event, it proves difficult to maintain a healthier, more active lifestyle over the long term. Although sedentary time decreases after participation in a cardiac rehabilitation lifestyle program, it regains within three months thereafter. Research from Radboud university medical center shows that a short remote booster program for chronic cardiovascular patients leads to a clear reduction in sedentary time and an increase in light physical activity, which lowers the risk of cardiovascular diseases. 

It turns out to be a significant challenge to maintain an active lifestyle after acute coronary syndrome. During cardiac rehabilitation, patients receive supervised exercise training from a physiotherapist, and they are often motivated to adopt a healthier lifestyle. However, these lifestyle improvements, including sitting less, often fade within a few months, as previous research from Radboudumc has shown. Since sitting less and moving more reduces the risk of new cardiovascular events and mortality, this raises the question: how can people effectively maintain a healthier, more active lifestyle in the long term? 

A remote booster program 

Physiologists at Radboudumc therefore investigated the effects of a lifestyle booster program, two years after graduation from cardiac rehabilitation, on daily activity patterns. In this study, 42 participants were invited for a booster program focusing on reducing daily sedentary time. Half of the patients received usual care, while the other half used an app to monitor their daily sedentary time and received three coaching sessions via phone and digital communication from a researcher. In this group, sedentary time decreased by more than an hour per day. Additionally, this group increased light physical activity by nearly an hour per day. 

A hopeful result, says Sophie Kroesen, the first author of this study: ‘Using an accelerometer, we found a clear improvement in the people who were coached. They sat significantly less, and the increase in light physical activity suggests that they were indeed moving more. So, offering a booster program to people after a while, even if it's completely remote and digital, makes sense.’ 

Prevention 

The question now is how long the effects of this refresher course last, and how often it should be repeated to achieve long-term effects. Further research is warranted to address this. Exercise physiologist and lead researcher Thijs Eijsvogels comments: ‘Maintaining a healthy lifestyle over the long term is difficult, as has been shown time and again. We hope that with this intervention, we've found a simple way to encourage people to maintain a more active lifestyle, which reduces the risk of cardiovascular events. Even if you have coronary artery disease, prevention is better than cure.’

Sit less advice

• Take phone calls standing or while walking. 
• Go for a 15-minute walk after eating. 
• Watching TV? Stand up during each commercial break or after every goal in a football match. 
• Set an alarm on your phone or smartwatch every half hour. 
• Involve those around you. Doing it together provides more motivation. 

Interested in participating in a study?  

If you are interested in participating in follow-up research on moving more and sitting less, visit the Radboudumc step research page (link: https://www.radboudumc.nl/lopende-onderzoeken/burgeronderzoek-stappen). Here you can find more information and sign-up opportunities. 

About the publication 

This research was published in the European Journal of Preventive Cardiology: A remote booster program to attenuate sedentary behavior in patients with coronary artery disease: A Randomized Controlled Trial – Sophie H. Kroesen, Bram M.A. van Bakel, Marijn de Bruin, Martijn F. Pisters, Francisco B. Ortega, Maria T.E. Hopman, Dick H.J. Thijssen, Esmée A. Bakker, Thijs M.H. Eijsvogels. DOI: 10.1093/eurjpc/zwaf162.

In this picture: the effects of the booster intervention.

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