News items A modified rehabilitation program reduces sitting time in patients with cardiovascular disease

17 February 2023

Sitting for too long is unhealthy, especially for patients with cardiovascular diseases. A modified rehabilitation program significantly reduces sitting time in these patients. This is shown by a study led by Thijs Eijsvogels of the Radboud university medical center, supported by the Dutch Heart Foundation.  

You've probably heard it before: sitting too much is unhealthy. For example, people who sit more than 9.5 hours per day have a higher chance of dying, especially from cardiovascular disease. So reducing sitting time is beneficial, especially for patients who already suffer from cardiovascular diseases. This is compounded by the fact that these patients sit approximately one hour longer per day than individuals from the general population. So there is a lot to gain in this group. Research conducted at Radboud university medical center now shows that specific additions to the standard rehabilitation program greatly reduce sitting time of patients with cardiovascular disease.

Standing up for every goal

First author of the study Bram van Bakel, who is physician-researcher at the Department of Physiology examined over two hundred patients who underwent cardiac rehabilitation. More than three-quarters of them just had a heart attack. The patients were divided into two groups. Both groups followed the regular rehabilitation program for three months, but additional attention was paid to sitting less in the intervention group. Van Bakel explains what this entailed: ‘These patients were informed about the risks of sitting too much and, together with the rehabilitation nurse, set concrete goals to reduce their sitting time. They also received a smart activity tracker that was linked to their smartphone. This gave both patients and nurses insight into sitting behavior. Moreover, the tracker vibrated if the patient sat continuously for half an hour.' The participants were highly motivated and showed creativity. Van Bakel: ‘One patient, an avid soccer fan, told me that he stood up for every goal during the World Cup. He even got his friends and family to do the same!’

Reduced sitting time

The intervention paid off. After three months, more than half of this group sat for less than 9.5 hours per day, compared with only a quarter of the control group that underwent just the regular rehabilitation program. The average sitting time decreased by 1.6 hours in the intervention group, compared with a 1.2-hour reduction in the control group. Study lead Thijs Eijsvogels: 'We found that the decrease in sitting time was also very profound in the control group. We did not expect that. Possibly, the rehabilitation nurses were so enthusiastic about the intervention that some parts of the intervention trickled through to the regular rehabilitation program. Furthermore, patients from both groups saw each other regularly during exercise training sessions. Perhaps this influenced the control group, causing them to sit less as well. Either way, it is good news that patients reduced their sitting time.’ 

Behavioral change

The researchers are already looking to the future. Eijsvogels: 'Almost everyone we approached for the study wanted to participate. This means that these patients are really willing to change their behavior. Our study also shows that you can change sitting behavior quite easily, but not if you leave people to their own devices. Now that we have demonstrated that it is possible to drastically reduce sitting time, we are going to set up a new study to establish the health benefits of this intervention. We will need larger groups of patients for this purpose. I am convinced that in the end, this approach will reduce the severity of cardiovascular disease and prevent mortality.’

About the publication

This study was published in the International Journal of Behavioral Nutrition and Physical Activity: 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. B.M.A. van Bakel, S.H. Kroesen, E.A. Bakker, R.V. van Miltenburg, A. G√ľnal, A. Scheepmaker, W.R.M. Aengevaeren, F.F. Willems, R. Wondergem, M.F. Pisters, M. de Bruin, M.T.E. Hopman, D.H.J. Thijssen, T.M.H. Eijsvogels. DOI: 10.1186/s12966-023-01419-z.

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