“As du Coeur” study: a randomized controlled trial on physical activity maintenance in cardiovascular patients

Abstract

BackgroundThe benefits of supervised physical activity programs in cardiac rehabilitation have been amply demonstrated, but the quantity of physical activity often declines quickly once supervision ends. This trial assesses the effectiveness of an experimental intervention drawing on habit formation theory to maintain physical activity.MethodsCardiovascular patients (N = 47) were randomly assigned to one of two groups. The first group participated in two supervised physical activity (SPA) sessions per week for 20 weeks. The second group was offered a progressively autonomous physical activity (PAPA) program as follows: the same supervised program as the SPA group for 10 weeks and then a further 10 weeks with one supervised session replaced by a strategy to build and sustain the habit of autonomous physical activity. The International Physical Activity Questionnaire (IPAQ; Craig et al. Med Sci Sports Exerc 35(8):1381–1395, 2003) was used to measure the quantity of physical activity, which was the primary outcome. The number of participants was limited, and we thus took multiple IPAQ measurements (at 0, 5, 7, 9 and 12 months after the start of the intervention) and used a mixed model for analysis. Physical condition, automaticity of the physical activity behavior, motivation, and quality of life were examined for changes.ResultsNo significant between-group differences were noted for physical activity behaviors after the program, physical condition, motivation, or behavioral automaticity. The PAPA group nevertheless completed more PA sessions during the intervention, and their quality of life was significantly higher than that of the SPA group at 12 months.ConclusionAlthough the number of supervised sessions was lower, the progressively autonomous PA program resulted in the same or even higher positive outcomes than the fully supervised PA program.Trial registrationCurrent Controlled Trials ISRCTN77313697, retrospectively registered on 20 November 2015.

Intervention to Modify Habits: A Scoping Review

“…The primary outcomes of the habit formation interventions in the data set varied with five studies listing dual primary outcomes. The most common primary outcomes of importance across the data set were weight loss (Beeken et al, 2017; Carels et al, 2011; Castelnuovo et al, 2010; Lally, Chipperfield, & Wardle, 2008) and physical activity (Fleig, Pomp, Schwarzer, & Lippke, 2013; Fournier, d’Arripe, Longueville, & Radel, 2017; Fournier et al, 2018; Gillison et al, 2014; Kaushal, Rhodes, Spence, & Meldrum, 2017; Kwasnicka et al, 2017). Habit formation was the primary outcome in three studies (Fleig et al, 2013; Fournier et al, 2017; Fritz et al, 2019; McGowan et al, 2013).…”

“…Habit formation was a secondary outcome in 12 out of the 18 studies, and there was great heterogeneity among the habits queried. Three studies queried the automaticity of physical activity habits as a secondary outcome (Fleig et al, 2016; Fournier et al, 2018; Kwasnicka et al, 2017), three studies focused on dietary-related habits (Castelnuovo et al, 2010; McGowan et al, 2013; Rompotis et al, 2014), three studies examined other behaviors such as water intake (Gomez et al, 2013), automaticity of checking blood glucose (Pyatak et al, 2018), or microwaving a dish sponge (Mullan et al, 2014). Three studies assessed the automaticity of multiple behaviors as a secondary outcome (Beeken et al, 2017; Lally et al, 2008).…”

“…Three studies assessed the automaticity of multiple behaviors as a secondary outcome (Beeken et al, 2017; Lally et al, 2008). Clinical endpoints (e.g., blood pressure, blood glucose) were secondary outcomes in four studies (Beeken et al, 2017; Castelnuovo et al, 2010; Fournier et al, 2018; Fritz et al, 2019). Seven studies listed secondary outcomes that included measures of factors hypothesized to mediate the treatment effect on habit formation, such as self-monitoring, intentions, action planning, goal achievement, or use of environmental cues (Carels et al, 2011; Castelnuovo et al, 2010; Fleig et al, 2016; Fleig et al, 2013; Gillison et al, 2014; Kaushal et al, 2017; Pyatak et al, 2018).…”

“As du Coeur” study: a randomized controlled trial on quality of life impact and cost effectiveness of a physical activity program in patients with cardiovascular disease

“…The “As du Coeur” study design, settings and randomization process have already been detailed elsewhere [8, 9]. …”

“…The “As du Coeur” study is a French monocentric, two-arm, randomized study to compare a standard supervised physical activity program (SPA) and a progressively autonomous physical activity (PAPA) intervention in cardiovascular patients [8]. The first objective of the “As du Coeur study” was to compare the two interventions on physical activity maintenance [9]. The second objective was to establish the cost effectiveness of the program.…”