Background and Aims: Compliance to physical activity is of great concern for cardiac rehabilitation (CR) and secondary prevention programs. While it is well established that CR exercise therapy allows reduction of major cardiovascular risk factors and improves functional capacity, adherence and participation to traditional CR programs are low. The objectives of this study were to evaluate the impact of the pedometer-based activity program led by clinical nurse specialists (CNS) on PA behaviour at 3, 6, 9 and 12 months after an acute coronary syndrome (ACS) and to assess the impact of the intervention on cardiovascular risk factors at 6 and 12 months following ACS.
Methods and Material: This was a randomised clinical trial. Sixty-six subjects (58 +/- 11 years) were recruited during hospitalisation following an ACS. A psychosocial approach and a pedometer (SW-200) were used by the CNS. The intervention aims to enhance perception of self-efficacy expectation through an accessible, low cost and pleasant program permitting the combination of personal interests and activities which the person feels confident undertaking. The control group (N=34) received usual care. PA behaviour was measured by blinded pedometers with a 7-day memory (NL 2000) associated with a log book. Cardiovascular risk factors were measured by blood tests and physical examinations conform to medical guidelines. Both groups were similar regarding socio-demographic and health characteristics. At baseline, PA was comparable between groups (experimental group 5846+/-3246 steps/day; control group 6037+/-3055 steps/day) and all subjects increased significantly (p<0.001) their level of PA at 3 months follow-up (experimental group+ 3388 steps/day; control group+2095 steps/day). The increment in PA level in the experimental group corresponds to 30 minutes of walking at moderate intensity. The experimental group maintained PA behaviour around 10 000 steps/day until 12 months follow-up; whereas the control group decreased their PA to baseline level after 6 months. Level of PA was different (p<0.05) between groups at 6, 9 and 12 months follow-up. Treatment targets of the cardiovascular risk factors were achieved in both groups but the changes in LDL-C, CT/HDL-C and wait circumference was better in the experimental group than the control group.
Conclusion: We conclude that the pedometer-based activity program led by a CNS improve adherence to PA until 12 months after an ACS. This effect was accompanied by a better evolution of main cardiovascular risk factors. This home-based program is an efficient addition to a traditional in-patient CR program.