Physical Activity and Sedentary Behavior in Cardiac Rehabilitation: Does Body Mass Index Matter?

The analysis included only participants who completed standard cardiac rehabilitation and had usable accelerometer data, so it does not describe those who dropped out or could not wear the monitor. Participants with obesity had fewer successful accelerometer measurements at the end of rehabilitation (63.2% vs 75.3% overweight and 82.9% normal weight), although average wear time was similar. Physical activity intensity cut-offs were developed for healthy populations, so activity intensity may be underestimated in participants with obesity. Because standard cardiac rehabilitation included exercise, education, and optional counseling, the study cannot attribute changes to any single component. This is a secondary observational analysis of trial data, not a randomized comparison of BMI classes, so it cannot show that obesity caused the differences. For long-term follow-up, 181 participants who received experimental intervention after standard rehabilitation were excluded, leaving 178, so maintenance results are based on a smaller subgroup. Height was self-reported, so BMI classification could be imprecise. The parent trial excluded severe comorbidities, psychological or cognitive impairments that could interfere with rehabilitation, and heart pumping function below 40%, so results may not apply to more medically complex patients.

Funded by Capri Cardiac Rehabilitation, Zilveren Kruis Healthcare Insurance Company, and the Dutch Organization for Health Research and Development; the paper states that the funders played no role in design, conduct, or reporting.

Do not read similar improvement as evidence that standard cardiac rehabilitation is sufficient for patients with obesity. They started 952 steps per day lower and 28 minutes per day more sedentary, and similar gains did not close that gap.