Gymnastik- och idrottshögskolan, GIH

OBJECTIVE: The objective of this study was to assess the agreement, diagnostic properties and predictive ability of self-reported coronary heart disease in the 45 and Up Study using record linkage.

METHODS: Baseline Australian 45 and Up Study data (2006-2009) were linked to hospital administrative data from the New South Wales Admitted Patient Data Collection and New South Wales Emergency Department Data Collection (2005-2009). Participants were aged ≥45 years with and without self-reported coronary heart disease (n=49,844). Coronary heart disease diagnosis was determined from responses to four questions. Agreement of the individual and combined questions from the 45 and Up Study with relevant diagnostic and procedure codes from the Admitted Patient Data Collection and Emergency Department Data Collection were explored using agreement, sensitivity, specificity and predictive-ability statistics.

RESULTS: Sensitivities for the individual and combined questions varied between 16.7 and 93.9% and specificities between 74.8 and 98.1%. Kappa values ranged from 0.07 to 0.52 for the individual and combined questions. Overall, the combination of all four questions more accurately identified participants with coronary heart disease than the individual questions.

CONCLUSIONS: Self-report of coronary heart disease diagnosis using a combination of four questions was able to identify participants with coronary heart disease with moderate agreement and moderate to high sensitivity and specificity compared to available hospital administrative data collections.

IMPLICATIONS FOR PUBLIC HEALTH: Identifying participants with coronary heart disease from self-report is useful for studies investigating health outcomes in this population.

OBJECTIVES: To examine the dose-response relationship between moderate-to-vigorous physical activity (MVPA) and sitting time trajectories with cardiac and all-cause mortality in a cohort of middle-aged and older-adults after a diagnosis of coronary heart disease (CHD).

DESIGN: This prospective cohort study comprised Australian participants aged ≥45-years with CHD (2006-2020) who had self-reported MVPA (min/wk) and sitting time (hr/day) data from at least two survey waves.

METHODS: MVPA and sitting time trajectories were categorised as remaining high, decreasing, increasing, and remaining low. Cardiac and all-cause mortality were the main outcomes. Associations were explored using Cox regression models.

RESULTS: The cohort included 9430 participants (mean (SD) age, 70 (10) years; 3557 females (38 %)). During a median follow-up of 4.4 (IQR, 6.1) years, 540 cardiac and 2843 all-cause deaths were recorded. Compared with individuals that remained inactive, remaining active was associated with a 36 % and 49 % lower risk of cardiac and all-cause death, respectively. Decreasing or increasing MVPA over time was associated with a 20-33 % lower risk of all-cause death. Compared with high sitting time, individuals that maintained low sitting time or decreased their sitting time over time reduced the associated risk of cardiac and all-cause death by 33-38 %.

CONCLUSIONS: Regardless of pre-CHD diagnosis movement behaviours, individuals' post-CHD diagnosis can reduce their risk of cardiac and all-cause mortality by achieving the physical activity thresholds at any time and reducing their sitting time over-time. Further research is needed to confirm the physical activity and sitting time thresholds to receive these benefits.

BACKGROUND: Moderate-to-vigorous physical activity (MVPA) and limiting time in sedentary behaviour (SB) are recommended for the secondary prevention of coronary heart disease (CHD). Little is known about MVPA and SB changes and recurrent cardiovascular events. This study explores the associations between changes in MVPA and SB for recurrent cardiovascular events among individuals with CHD.

METHODS: Prospective cohort study based on individuals with CHD. MVPA and SB were self-reported, and recurrent cardiovascular events were identified using health registers (2006-2022). Changes in MVPA and SB were categorized as remaining high, decreasing, increasing, and remaining low. Associations were explored using Cox proportional regression models.

RESULTS: There were 9430 Australians, 62 % males with a mean age of 70 (SD = 10) years. During the follow-up, with a median time of 4.9 (IQR = 6.1) years, 508 non-fatal cardiac events, 951 total cardiac events, and 2481 major adverse cardiovascular events (MACE) occurred. The risk of recurrent cardiovascular events was 32-39 % lower when MVPA remained high compared to remaining low. An increase in MVPA was associated with a 30 % lower risk of total cardiac events and a 26 % lower risk of MACE, while a decrease was associated with a 16 % lower risk of MACE. Keeping low SB was associated with a 25-29 % lower risk of total cardiac events and MACE than SB remained high. A decrease in SB was associated with a 25 % lower risk of MACE.

CONCLUSION: Supporting individuals with CHD to remain high or improve levels of MVPA and low levels of SB is important in secondary prevention.

BACKGROUND: The dose-response relationship between physical activity and sedentary behaviour (SB) with mortality in people with coronary heart disease (CHD) is unclear. The aim was to identify moderate-to-vigorous physical activity (MVPA) and SB thresholds for mortality risk.

METHODS: This prospective cohort study comprised Australian participants aged ≥ 45 years with self-reported CHD (2006-2020). Self-reported MVPA (min/wk) and SB (hr/day) were the exposures. Cardiac and all-cause mortality were the main outcomes. Survival regression trees identified MVPA and SB thresholds influencing mortality survival rate. Cox regression models and the C-statistic were used to examine the thresholds, comparing them to public health guidelines.

RESULTS: The cohort included 40,156 participants (mean (SD) age, 70.3(10.3) years; 15,278 females (38%)). During a median follow-up of 11.1 (IQR,6.2-14.4) years, 2,497 cardiac and 12,240 all-cause deaths were recorded. The threshold for MVPA and all-cause and cardiac mortality was ≥ 146 min/wk and ≥ 96 min/wk, respectively. For SB, the threshold for mortality was < 5-6 h/day. Sex-specific differences in thresholds for MVPA and SB were found. All MVPA and SB thresholds had equivalent associated risk reductions and predictive abilities for cardiac and all-cause mortality to the public health guidelines.

CONCLUSION: The newly identified thresholds suggest that the public health physical activity guidelines are suitable for reducing risks of all-cause mortality in people with CHD. For reducing risks of cardiac mortality, the threshold is suggested to be much lower. The SB suggested thresholds for reducing risks of mortality are 5-6 h/day. Further research is required to explore these thresholds and sex-specific differences.

BACKGROUND: Digital interventions offering behaviour change support are warranted to prevent and treat non-communicable diseases, and have been evaluated rigorously in controlled settings. Effectivenss, factors influencing the uptake of scaled-up interventions-such as reach, received dose, usability and acceptability- and predictors and mediators of efficiency are rarely explored in research. The study described herein aims to evaluate the effectiveness of a personally tailored digital intervention (the app EviBody®), intended to support healthy and sustained lifestyle behaviours among the adult population, on well-being and behaviour change. Further aims are to explore context and uptake factors, predictors and mediators for behaviour change over 24 months.

METHODS: This is a real-world study, employing a quasi-experimental design and a process evaluation. EviBody® will be marketed and managed by its owner. A four-armed design will allow for comparison between three levels of intervention (basic, standard and premium) and a control group. Adults who sign up for the app will be invited to the research study including sharing app data and answering questionnaires at 0, 1, 3, 6, 12, 18, and 24 months. Study start is Autumn 2025. Controls (n = 200 to evaluate the primary endpoint well-being at 6 months) will be recruited through advertisements on social media and asked to answer the same questionnaires at 0 and 6 months provided by email. For predicting and mediating analyses the intention is to recruit 1500 app users. Well-being (measured with the WHO-5 Well-Being Index), goal achievement, physical activity, eating habits, mental health, mediators (motivation, self-efficacy, and perceived barriers), and demographics will be self-reported. Uptake will be collected using analytics and ratings of usability and acceptability, and described by demographics. Mixed models for repeated measures and structural equation modelling will be employed for data analysis.

DISCUSSION: Besides evaluating the effectivenss of a digital intervention, this study also applies a theory-based evaluation to understand which mediators are effective, for whom they are effective, and the specific conditions under which they are most beneficial.

TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT05973383 on 8 July 2023.

Objective: Explore the independent and joint associations between sedentary behaviour and physical activity with cardiovascular events, among individuals with coronary heart disease (CHD). Methods: Cohort study including Australians >= 45 years with CHD (2006-2020). Time in sedentary behaviour, walking, moderate-, and vigorous- physical activity were self-reported. Cardiovascular events were identified using health registers (2006-2022). Cox proportional hazard regressions explored the association. Restricted cubic splines explored the shape of the association. Results: There were 40,156 individuals included, with a mean age of 70 (SD=10) years old, 62 % men. During a median of 8.3 (IQR = 10.03) years, 3260 non-fatal-, 5161 total cardiac events, and 14,383 major adverse cardiovascular events (MACE) were recorded. Sedentary behaviour of 7-10.4 h/day was associated with a 15 % lower risk of total cardiac events and MACE compared to >= 10.5 h/day. A higher level of moderate-to-vigorous physical activity was associated with a lower risk of cardiovascular events, with 14-21 % lower risk for 1-149 min/week compared to 0 min/week. A similar pattern was seen for walking and activities at a moderate- or vigorous intensity. The joint association of >= 150 min/week of moderate-to-vigorous physical activity and <7 h/ day in sedentary behaviour had the lowest risk (29-48 % lower) for cardiovascular events compared to the reference group. However, moderate-to-vigorous physical activity seems to be of greater importance and partly modifies the risk of sedentary behaviour in the joint association. Sedentary behaviour hours were linearly associated with risks of non-fatal and total cardiac events. Meanwhile time in physical activity had a curvilinear association with cardiovascular events, with the greatest benefits at the beginning of the curve. Conclusion: More time in physical activity and less time in sedentary behaviour are associated with a lower risk of cardiovascular events. This emphasizes the importance of providing recommendations for both physical activity and sedentary behaviour to people with CHD.

BACKGROUND: There are no diagnosis-specific guidelines for moderate-to-vigorous physical activity (MVPA) and sedentary behaviour (SB) for coronary heart disease (CHD). This study aims identifying thresholds of MVPA and SB associated with cardiovascular events.

METHODS: Cohort study including individuals with CHD. MVPA and SB were self-reported, and health registers identified cardiovascular events (2006-2022). Survival tree analyses identified thresholds of time associated with the risk of cardiovascular events. Thresholds were explored in Cox regression models.

RESULTS: There were 40,156 Australians, 62% men, mean age 70 years. Over 8.3 median years, 3260 non-fatal cardiac events, 5161 total cardiac events, and 14,383 major adverse cardiovascular events (MACE) occurred. Thresholds for MVPA were 122 minutes/week for non-fatal cardiac events and 94 minutes/week for total cardiac events and MACE. Meeting MVPA thresholds was associated with an 18% lower risk for non-fatal cardiac events, 29% lower risk of total cardiac events, and 23% lower risk of MACE than not reaching the thresholds. Thresholds for SB were 4 and 10 hours/day respectively for risk of total cardiac events and MACE. SB below thresholds was associated with a 14% lower risk of total cardiac events and an 18% lower risk of MACE. There were sex-specific thresholds for MVPA and SB.

CONCLUSION: To lower cardiovascular event risk, identified MVPA thresholds were lower (94-122 minutes/week) than the public health guidelines (150 minutes/week) in individuals with CHD. The SB thresholds associated with a lower risk of total cardiac events and MACE varied between 4-10 hours/day.

Heart disease in women is currently under-recognised, under-diagnosed, under-treated, and under-researched, despite coronary heart disease (CHD) being the leading cause of mortality for women globally.1 Women face specific barriers in accessing treatment for heart disease including healthcare professionals and patients tending to underestimate their cardiovascular risk.2 There are psychological, social, economic, and cultural risk factors that disproportionately affect women such as depression, intimate partner violence, and sociocultural roles. Conditions specific to women can also increase cardiovascular disease risk such as premature menopause, gestational hypertension, and diabetes. Additionally, there are sex-specific differences in how women present clinically with heart disease, being less likely to present with chest pain, and more likely to have pain in the jaw, neck, shoulder or fatigue, and nausea. Together, these factors contribute to timely presentation and appropriate treatment for women during and after a myocardial infarction,2 resulting in women less likely to receive appropriate treatment and more likely to die in hospital compared to men.

OBJECTIVES: To elucidate physical activity in the first year after myocardial infarction (MI), and to explore differences in various subgroups, delineated by age, participation in exercise-based cardiac rehabilitation (exCR), or restrictions due to the covid-19 pandemic. Secondly, to explore associations between changes in physical activity variables with blood pressure and lipid levels.

METHODS: A longitudinal study in 2017-2023. Physical activity variables were assessed via accelerometers at two- and twelve months post-MI. The intensity was divided into, sedentary, light, moderate, and vigorous-intensity physical activity, according to established cut-offs. Blood pressure and lipids were measured by standardized procedures at the same time points.

RESULTS: There were 178 patients included at baseline, 81% male, mean age of 64 (9 SD) years. Patients spent 72% of their time sedentary, followed by light (19%), moderate (8%), and vigorous physical activity (1%). Patients included during covid-19 restrictions and younger patients had a higher level of moderate-intensity physical activity compared to patients included during non-pandemic restrictions and older patients. At 12-month follow-up, patients overall increased time (1%) in sedentary behavior (p = 0.03) and decreased time (0.6%) in moderate-intensity physical activity (p = 0.04), regardless of participation in exCR or age. There was a positive association between the change in mean physical activity intensity and HDL-cholesterol (p = 0.047).

CONCLUSIONS: Participants had a low fraction of time in moderate-to-vigorous-intensity physical activity two months post-MI, which deteriorated during the first year. This emphasizes the need for improved implementation of evidence-based interventions to support and motivate patients to perform regular physical activity.

BACKGROUND: Little is known about the relationship between physical activity (PA) and sedentary behavior (SB) with death in people with coronary heart disease. The aim was to examine the independent and joint associations of PA and SB with death.

METHODS AND RESULTS: This is a prospective cohort study including Australian participants aged ≥45 years with self-reported coronary heart disease (2006-2020). Self-reported PA (min/wk) and SB (h/d) were the exposures. Cardiac and all-cause death were the main outcomes. The cohort included 40 156 participants (mean age, 70.3 (SD, 10.3) years; 15 278 women [38%]). During a median follow-up of 11.1 (interquartile range, 6.2-14.4) years, 2497 cardiac and 12 240 all-cause deaths were recorded. Compared with no PA, a 20% to 30% lower risk of cardiac and all-cause death was associated with any level of PA. Walking and moderate to vigorous PA at 150 to 300 min/wk was associated with a 43% to 44% lower risk of cardiac death and 35% to 40% lower risk of all-cause death. Compared with ≥10.5 h/d of SB, participants who were sedentary for 7 to 10.4 h/d experienced an ≈25% reduced associated risk of cardiac and all-cause death. A 56% associated reduction in all-cause mortality risk was found if SB was limited to <3.4 h/d. If participants completed >150 min/wk moderate to vigorous PA and spent <7 h/d in SB, the associated risk of cardiac and all-cause death was reduced by ≈70%.

CONCLUSIONS: All people with coronary heart disease should be encouraged to meet the PA guidelines and limit SB to <7 h/d, noting any increase in physical activity and decrease in SB is better than none to prevent premature death.