The objective of this randomised controlled trial is to examine the effectiveness of a theory-driven behavioural change intervention on total sedentary time (primary outcomes), moderate-to-vigorous physical activity time, intention of behavioural change, future time perception, behavioural prepotency, self-regulation capacity, and exercise capacity in individuals with coronary heart disease. Hypotheses: Compared to the participants in the control group, participants in the intervention group will demonstrate: 1. Significantly less total sedentary time 2. Significantly improved MVPA time, 3. Significantly better intention of behavioural change, 4. Significantly higher level of behavioural prepotency, 5. Significantly enhanced self-regulation capacity, and 6. Significantly greater future time perception 7. Significantly better exercise capacity at the immediate post-intervention (T1), the 1-month post-intervention (T2), and the 6-month post-intervention (T3). Participants will: Participants in the intervention group will participate in a theory-driven behavioural change intervention over three months, comprising four individual face-to-face sessions (45 minutes each) and four individual telephone sessions (20 minutes each), along with the usual care. Participants in the attention control group will continue to have the usual care, which includes regular follow-up at the cardiac clinic. Education sessions, consisting of information about healthy lifestyles, except physical activity and sedentary behaviour, with the same schedule as the intervention group, will be provided to account for potential attention effects from contacts.
Coronary heart disease is a worldwide health problem and a major contributor to disability, with a high prevalence of 315 million cases globally in 2022. Promoting movement behaviours, which are characterised by having an adequate amount of physical activity and replacing sedentary behaviour with physical activity of all intensities, is beneficial for cardiometabolic health and thus secondary prevention. However, reviews of interventional studies indicate that currently available non-pharmacological interventions are effective in increasing the amount of physical activity, yet limited attention is given to the reduction of sedentary behaviour in current cardiac rehabilitation. Therefore, it is imperative to develop an non-pharmacological intervention targeting sedentary behaviour for adults with coronary heart disease based on the synthesised scientific evidence. The design of the theory-driven behavioural change intervention is based on the findings of our published systematic review and the implications of the qualitative study. This randomised controlled trial evaluate a theory-driven behavioural change intervention for individuals with coronary heart disease. The objective of the study aims to examine the effectiveness of the intervention in reducing total sedentary time (primary outcome) and improving MVPA, behavioural intentions, future time perception, behavioural prepotency, self-regulation capacity, and exercise capacity in a larger sample.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
232
A theory-driven behavioural change intervention is validated by an expert panel including professionals from various fields, such as nurse consultants, a specialty nurse in cardiology, an experienced registered nurse from a cardiac rehabilitation center in a regional hospital, a physiotherapist, and academia, focusing on strengthening intention to change (connected beliefs and temporal valuations), behavioral prepotency, and enhancing the self-regulatory capacity, as guided by the Temporal Self-Regulation Theory, and supplemented with a intervention booklet. The intervention is developed and facilitated by a registered nurse (principal investigator).
Participants in the attention control group will participate in education sessions consisting of information about healthy lifestyles, except physical activity and sedentary behaviour. Activities match the time and attention dedicated by the intervention group. Activities are designed to have no impact on sedentary behaviour and physical activity.
Total sedentary time
Total sedentary time (per day) will be measured using the ActiGraph accelerometer (ActiGraph,Pensacola, FL), wGT3X-BT (during participants' waking time over 7 consecutive days, including both weekdays and weekends).
Time frame: Pre-intervention, post-intervention (within 1 week immediately after intervention), and at 1-month and 6-month follow-ups.
Moderate-to-vigorous physical activity time
Moderate-to-vigorous physical activity time (per week) will be measured using the ActiGraph accelerometer (ActiGraph, Pensacola, FL), wGT3X-BT (during participants' waking time over seven consecutive days, including both weekdays and weekends).
Time frame: Pre-intervention, post-intervention (within 1 week immediately after intervention), and at 1-month and 6-month follow-ups.
Self-regulation capacity
Self-regulation capacity will be measured using the Chinese version of the Brief Self-Control Scale (BSCS).
Time frame: Pre-intervention, post-intervention (within 1 week immediately after intervention), and at 1-month and 6-month follow-ups.
Behavioural prepotency
Behavioural prepotency (on both MVPA and SB) will be measured using the Chinese version of the Self-Reported Behavioural Automaticity Index (SRBAI).
Time frame: Pre-intervention, post-intervention (within 1 week immediately after intervention), and at 1-month and 6-month follow-ups.
Future time perception
Future time perception will be measured using the Chinese version of the Consideration of Future Consequences Scale (CFCS-14).
Time frame: Pre-intervention, post-intervention (within 1 week immediately after intervention), and at 1-month and 6-month follow-ups.
Intention of behavioural change
Intention of behavioural change will be measured using three questions, including (1) I intend to ...; (2) I plan to ...; and (3) It is likely that I will ... Specifically, questions such as "I intend to do at least 150 minutes of MVPA in the coming week" and "I intend to engage in less than 8 hours of total sedentary time per day in the coming week" will be asked, and participants will respond on a 7-point Likert scale ranging from "strongly disagree" to "strongly agree." The sum average will be calculated. Higher scores represent higher intention.
Time frame: Pre-intervention, post-intervention (within 1 week immediately after intervention), and at 1-month and 6-month follow-ups.
Functional exercise capacity
Functional exercise capacity will be measured using Six-Minute Walk Test, a exercise test that refletsfunctional capacity in daily activity. The test was conducted in a flat, straight, indoor corridor of 30 meters. Participants were instructed to walk back and forth along the corridor, covering as much distance as possible within six minutes, at a self-selected pace, with the option to slow down or rest if necessary. Standardized encouragement was provided at regular intervals. The total distance walked (Six-Minute Walk Distance), measured in meters, was recorded. Heart rate, oxygen saturation, blood pressure, and perceived exertion were monitored before and immediately after the test to ensure participant safety.
Time frame: Pre-intervention, post-intervention (within 1 week immediately after intervention), and at 1-month and 6-month follow-ups.
Waist circumference
Waist circumference will be measured twice at the midpoint between the last rib and the iliac crest. The increased waist circumference correlates with greater visceral adiposity and increased cardiometabolic risk.
Time frame: Pre-intervention, post-intervention (within 1 week immediately after intervention), and at 1-month and 6-month follow-ups.
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