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Background High sedentary times (ST) is highly prevalent in patients with coronary artery disease (CAD), highlighting the need for behavioural change interventions that effectively reduce ST. We examined the immediate and medium-term effect of the SIT LESS intervention on changes in ST among CAD patients enrolled in cardiac rehabilitation (CR). Methods CAD patients participating in CR at 2 regional hospitals were included in this randomized controlled trial (1:1, stratified for gender and hospital). The control group received CR, whereas SIT LESS participants additionally received a 12-week hybrid behaviour change intervention. The primary outcome was the change in accelerometer-derived ST from pre-CR to post-CR and 3 months post-CR. Secondary outcomes included changes in ST and physical activity characteristics, subjective outcomes, and cardiovascular risk factors. A baseline constrained linear mixed-model was used. Results Participants (23% female; SIT LESS: n  = 108, control: n  = 104) were 63 ± 10 years. Greater ST reductions were found for SIT LESS compared to control post-CR (-1.7 (95% confidence interval (CI): -2.0; -1.4) versus − 1.1 (95% CI: -1.4; -0.8) h/day, p interaction =0.009), but not at 3 months post-CR (p interaction =0.61). Besides, larger light-intensity physical activity (LIPA) increases were found for SIT LESS compared to control post-CR (+ 1.4 (95% CI: +1.2; +1.6) versus + 1.0 (95% CI: +0.8; +1.3) h/day, p interaction =0.020). Changes in other secondary outcomes did not differ among groups. Conclusion SIT LESS transiently reduced ST and increased LIPA, but group differences were no longer significant 3 months post-CR. These findings highlight the challenge to induce sustainable behaviour changes in CAD patients without any continued support. Trial registration Netherlands Trial Register: NL9263. Registration Date: 24 February 2021.

PurposeThermal perception, including thermal sensation (TS), influences exercise performance in the heat. TS is a widely used measure and we examined the impact of initial TS (iTS) on performance loss during exercise in simulated Tokyo environmental conditions among elite athletes.Methods105 Elite outdoor athletes (endurance, skill, power and mixed trained) participated in this crossover study. Participants performed a standardized exercise test in control (15.8 ± 1.2 °C, 55 ± 6% relative humidity (RH)) and simulated Tokyo (31.6 ± 1.0 °C, 74 ± 5% RH) conditions to determine performance loss. TS was assessed ± 5 min prior to exercise (iTS) and every 5 min during the incremental exercise test (TS). Based on iTS in the Tokyo condition, participants were allocated to a neutral (iTS = 0, n = 11), slightly warm (iTS = 1, n = 50), or warm-to-hot (iTS = 2/3, n = 44) subgroup.ResultsFor the whole cohort iTS was 1 [1–2] and TS increased to 3 [3–3] at the end of exercise in the Tokyo condition. Average performance loss was 26.0 ± 10.7% in the Tokyo versus control condition. The slightly warm subgroup had less performance loss (22.3 ± 11.3%) compared to the warm-to-hot subgroup (29.4 ± 8.5%, p = 0.003), whereas the neutral subgroup did not respond different (28.8 ± 11.0%, p = 0.18) from the slightly warm subgroup.ConclusioniTS impacted the magnitude of performance loss among elite athletes exercising in hot and humid conditions. Athletes with a warm-to-hot iTS had more performance loss compared to counterparts with a slightly warm iTS, indicating that pre-cooling strategies and/or heat acclimation may be of additional importance for athletes in the warm-to-hot iTS group to mitigate the impact of heat stress.

Background The COVID-19 lockdown negatively impacted physical activity (PA) and sedentary behaviour (SB) levels of the Dutch patients with cardiovascular diseases (CVD), but little is known whether these levels returned to pre-pandemic levels. In this study, we evaluated changes in SB and moderate-to-vigorous PA (MVPA) in CVD patients before, during, and after the COVID-19 pandemic and investigated which factors contributed to not returning to pre-pandemic sedentary levels. Methods 1,028 Dutch CVD patients participated in this prospective cohort study, where we assessed SB and MVPA before (2018), during (2020), and after (2023) the COVID-19 pandemic using validated questionnaires. Linear mixed model analyses were used to investigate changes over time. Binary logistic regression analyses were performed to examine factors associated with not returning to pre-pandemic SB levels. Results SB levels significantly increased from 7.8 h/day at pre-pandemic assessment to 8.7 h/day during lockdown and then significantly decreased to 8.5 h/day at the post-pandemic assessment, but did not return to pre-pandemic levels ( p  = 0.006). MVPA did not significantly change over time. Lower pre-pandemic SB levels, a larger increase in SB during lockdown, self-reported residual complaints after COVID-19, and diagnosis of arrhythmias at baseline were associated with not returning to pre-pandemic SB levels. Conclusion Sedentary time in CVD patients did not return to pre-pandemic levels, 3 years following initial COVID-19 lockdown, while levels of MVPA did not change over time. These findings suggest that lifestyle interventions could be considered to reactivate CVD patients and lower their risk of disease progression and adverse health outcomes. SB bij CVD-patiënten keerde niet terug naar het niveau van voor de pandemie, drie jaar na de eerste COVID-19 lockdown, terwijl MVPA onveranderd bleef. Deze bevindingen suggereren dat leefstijlinterventies overwogen kunnen worden om CVD-patiënten opnieuw te activeren en hun risico op ziekteprogressie en nadelige gezondheidseffecten te verlagen.