Device-based 24-hour movement behaviours in adult phase III cardiac rehabilitation service-users during the COVID-19 pandemic: a mixed-methods prospective observational study

PurposeTo examine changes in device-based 24-hour movement behaviours (MB), and facilitators and barriers to physical activity (PA) and exercise, during remotely-delivered cardiac rehabilitation (RDCR).Materials and methodsThis prospective observational study used wrist-worn GENEActiv accelerometers to assess MB of 10 service-users (63 +/- 10 years) at the start, middle, and end of three-months of RDCR. Barriers and facilitators to PA and exercise were explored through self-report diaries and analysed using content analysis.ResultsAt start, service-users were sedentary for 12.6 +/- 0.7 h <middle dot> day-1 and accumulated most PA at a light-intensity (133.52 +/- 28.57 min <middle dot> day-1) - neither changed significantly during RDCR. Sleep efficiency significantly reduced from start (88.80 +/- 4.2%) to the end (86.1 +/- 4.76%) of CR, with values meeting health-based recommendations (>= 85%). Barriers to RDCR exercise included exertional discomfort and cardiac symptoms, and reduced confidence when exercising alone. Setting meaningful PA goals, self-monitoring health targets, and having social support, facilitated PA and exercise during RDCR.ConclusionsOur RDCR programme failed to elicit significant changes in MB or sleep. To increase the likelihood of successful RDCR, it is important to promote a variety of exercise and PA options, target sedentary time, and apply theory to RDCR design, delivery, and support strategies. Practitioners should work with service-users to understand how best to support them to maximise the benefit(s) of remotely/hybrid delivered services.Facilitating easy (and regular) access to health professionals during remotely/hybrid delivered cardiac rehabilitation (CR) will support the development of service-users' physical activity (PA) and exercise self-efficacy (i.e., confidence).Remotely/hybrid delivered CR should be informed by theory and/or behaviour change techniques to support increased PA, reduced sedentary time and improved sleep during and after CR.It is important to include strategies to reduce sedentary time in addition to targeting PA and exercise in remotely-delivered CR.