Physical Activity and Sedentary Behaviour Thresholds for Secondary Prevention of Coronary Heart Disease: Morbidity Survival Tree Analysis

Amanda Lönn; Theo Niyonsenga; Suzanne J Carroll; Adrian Bauman; Rachel Davey; Robyn Gallagher; Nicole Freene

doi:10.1016/j.cjca.2024.11.025

Physical Activity and Sedentary Behaviour Thresholds for Secondary Prevention of Coronary Heart Disease: Morbidity Survival Tree Analysis

Can J Cardiol. 2024 Nov 29:S0828-282X(24)01230-3. doi: 10.1016/j.cjca.2024.11.025. Online ahead of print.

Authors

Amanda Lönn¹, Theo Niyonsenga², Suzanne J Carroll², Adrian Bauman³, Rachel Davey², Robyn Gallagher⁴, Nicole Freene²

Affiliations

¹ Department of Physical Activity and Health, Swedish School of Sport and Health Sciences, Stockholm, Sweden; Health Research Institute, University of Canberra, Bruce, ACT, Australia. Electronic address: [email protected].
² Health Research Institute, University of Canberra, Bruce, ACT, Australia.
³ Sydney School of Public Health, University of Sydney, New South Wales, Australia.
⁴ Charles Perkins Centre, Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.

PMID: 39617049
DOI: 10.1016/j.cjca.2024.11.025

Abstract

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 aimed to identify thresholds of MVPA and SB associated with cardiovascular events.

Methods: This cohort study included individuals with CHD. MVPA and SB were self-reported, and health registries identified cardiovascular events in the years 2006-2022. Survival tree analyses identified thresholds of time associated with the risk of cardiovascular events. Thresholds were explored with the use of Cox regression models.

Results: There were 40,156 Australians, mean age 70 years, 62% men. Over a median 8.3 years, 3260 nonfatal cardiac events, 5161 total cardiac events, and 14,383 major adverse cardiovascular events (MACE) occurred. Thresholds for MVPA were 122 min/wk for nonfatal cardiac events and 94 min/wk for total cardiac events and MACE. Meeting MVPA thresholds was associated with an 18% lower risk for nonfatal 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 h/d, 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.

Conclusions: To lower cardiovascular event risk, identified MVPA thresholds were lower (94-122 min/wk) than the public health guidelines (150 min/wk) in individuals with CHD. The SB thresholds associated with a lower risk of total cardiac events and MACE varied from 4 to 10 h/d.