Discussion
comorbidity, HF,, sarcopenia, CVD, valvular disease
CVD, REGRESSION, VALVULAR HEART DISEASE, SARCOPENIA
The present study presented novel findings. First, the high SB group comprised 47.6% of the patients, indicating that about half of patients with CVD tended to spend long hours in SB. Second, characteristics of the patients such as smoking, HF as a main diagnosis and as a comorbidity, but not employment or medications, were observed among the patients with CVD who had higher levels of SB. Third, patients in the high SB group participating in phase I CR had significantly lower SPPB scores than patients in the low SB group. Finally, multiple regression analysis revealed that the SB remained an explanatory variable for total SPPB score. These findings suggest that high SB is present in about half of patients even in phase I CR, and hence, new strategies should be developed to stimulate patients with CVD to encourage more movement and less sitting.To our knowledge, this is the first report on the effects of SB in the present study population, although some studies have investigated the causes or frequency of SB and/or physical activity in hospitalized patientsIn terms of our study hypothesis, patients with CVD showed high SB compared to those with low SB, which may support the occurrence of adverse outcomesThe total sitting SB time in the high SB group was 733.6 min/day, which converts to approximately 12.2 h/day. A previous study reported that an objectively measured sitting SB time ≥ 9.5 h/day was associated with increased risk of all-cause mortalityThe mean total SPPB score was lower in the high SB group than that in the low SB group in the present study. It is important that early mobilization to reduce SB, early screening for sarcopenia, and aerobic exercise and resistance training during hospitalization be carried out during phase I CR. In a previous study, multivariate analysis showed pre-hospital walking level to be a strong influencing factor of low physical function as assessed by SPPB at hospital dischargeA score on the SPPB of < 7 points was associated with a larger risk of the combined endpoints of hospitalization and mortality for any cause (odds ratio = 3.6, 95% confidence interval; 1.0–12.9, p < 0.05) in patients with acute HFA previous study in post-acute cardiac patients suggested that an improvement in the total SPPB score of > 1 was identified as the minimum clinically important difference (MCID)The multiple linear regression analysis identified the factors significantly associated with total SPPB score to be age, smoking, marriage, HF, valvular disease as the main diagnosis, and SB. In addition, the adjusted RHF is the final common pathway of several etiologies such as ischaemic and valvular heart diseaseA hospitalized patient with high SB may be experiencing a decline in physical function as indicated by the SPPB. Therefore, it is important to address these behavioural changes in phase I CR by focusing not only on increasing physical function but also in reducing high SB.