Rationale:

Surprisingly, little is known about typical physical activity (PA) levels in patients with CAD. What is known comes mostly from studies of individuals enrolled in cardiac rehabilitation (CR). PA data obtained from CR patients may not be representative since most CAD patients do not participate. The Tracking Exercise After Cardiac Hospitalization (TEACH) Study is a prospective cohort study designed to examine predictors and patterns of PA in CAD patients.

Objectives:

In the current study we: (1) explore the trajectory of PA behaviour in the year following hospitalization for CAD; and (2) examine the effects of key demographic, medical, and activity-related factors on the trajectory.

Methods Used:

Seven hundred and eighty-two patients were recruited during hospitalization from cardiac centres in Ottawa and Kingston. The dependent variable was PA (weekly leisure time activity energy expenditure) measured two, six and 12 months after hospitalization. Six independent variables (gender, age group, education level, reason for hospitalization, co-morbidities and PA level before hospitalization) were assessed during hospitalization. A seventh independent variable, participation in CR, was measured at each follow-up point. The trajectory for PA behaviour was assessed using repeated measures ANCOVA. The effect of independent variables was determined using a series of two-way mixed model ANCOVAs.

Results:

Participants were mostly men with a mean age of 62 years. Overall, 31% participated in CR. Mean leisure time activity energy expenditure was 1948 +/- 1450, 1676 +/- 1290, and 1637 +/- 1486 kilocalories/week at two, six and 12 months, respectively. There was a significant negative effect of time from hospitalization on PA (P < .001). PA levels declined between two and six months (P < .001), however, there was no significant difference between six and 12 months (P =.13). Interactions were found between age and time (P =.012) and between education and time (P = .001). Significant main effects were noted for gender (men were more active than women; P < .001), reason for hospitalization (CABG patients were more active than PCI patients; P = .033), co-morbidities (those without co-morbidities were more active; P < .001), and prior level of PA (those who were active before hospitalization were more active after hospitalization; P < .001). Participation in CR had a marginal effect on PA (P = .072).

Conclusions:

PA levels in patients with CAD decline over time in the first year after hospitalization, especially between two and six months. Activity energy expenditure is reduced by more than 300 kilocalories per week ([equivalent to]16%), an amount representing about 70 minutes of walking. Our data indicate PA interventions should be initiated early, ideally immediately post-hospitalization. Activity guidance should be tailored using demographic, medical and prior activity characteristics. PCI patients are at higher risk for relapse to inactivity and require additional support.

Section Description

For more information, contact Marilyn Thomas (204) 488-5854