Cardiac Rehabilitation and Sedentary Behavior

Cardiac rehabilitation after a cardiac event or procedure is of key importance to physical
and psychological recovery. Cardiac rehabilitation comprises a standardized stepwise approach
to exercise in a supervised setting and is proven to reduce morbidity and mortality after a
cardiac event. However, cardiac rehabilitation does not necessarily change behavior in the
long-term and many do not attend cardiac rehabilitation due to lack of motivation, difficulty
accessing programs, and cost. These individuals loose an important opportunity to improve
their health, sense of well-being and outcomes. The investigators propose to test the effect
of a patient-centered approach to reduce sedentary behavior for aging adults added to usual
cardiac rehabilitation. In this study, the investigators will identify patients at their
introductory visit to cardiac rehabilitation and randomize to either a program to decrease
in-home sedentary behavior vs. a standard program to increase in-home exercise. Both groups
will receive additional support and encouragement to attend cardiac rehabilitation. Using
motivational interviewing techniques in both groups the investigators will assist the
patients in recognizing their potential and goal-setting. Patients will be monitored using
the ActivPAL monitor, a new technology that quantifies sedentary time and steps/day. Patients
will be monitored four times as they proceed through cardiac rehabilitation for a total of 13
weeks and receive 3 educational and goal setting sessions. Those in the intervention group
will have sedentary behavior change emphasized with feedback from the ActivPAL monitor. The
control group will focus on standard exercise recommendations and feedback from his/her
exercise diary. Outcomes include change in sedentary time and steps/day. Anticipated results
include a significant change in the intervention group vs. the control: a decrease in in-home
sedentary time, an increase in steps/day. The results of this study will provide the basis
for designing a larger randomized controlled trial to investigate the effects of an
intervention to reduce sedentary behavior as an adjunct to cardiac rehabilitation especially
for older adults. Additional investigation will be warranted for those who do not attend
cardiac rehabilitation but are able to follow a post-cardiac event program to reduce in-home
sedentary behavior.

Inclusion Criteria:

- Patients enrolled in Cardiac Rehabilitation

- Age 50 years old or greater

- Short Physical Performance Battery (SPPB) score equal or less than 10

Exclusion Criteria:

- Hypoxia

- Orthopedic Disease that limits mobility

- Neurologic Disease that limits mobility

- Metastatic Cancer

- Life expectancy of <6 months

- Depression

- Montreal Cognitive Assessment less than 24

- Left Ventricular Assist Device (LVAD)

- Cardiac Transplant

- Patient Health Questionnaire-9 (PHQ-9) of 15 or greater