The STRENGTH Study: A cluster randomised controlled trial of the effect of a behaviour change intervention added to cardiac rehabilitation on physical activity adherence

Background: Coronary heart disease is the leading cause of global mortality, imposing significant health and economic burdens. Cardiac rehabilitation, including physical activity, can reduce coronary heart disease-related morbidity and mortality. We tested whether the addition of a behaviour change intervention to cardiac rehabilitation could promote and maintain physical activity achieved during cardiac rehabilitation, beyond standard care timeframes. Methods: A cluster randomised controlled trial was conducted across six community-based maintenance stage cardiac rehabilitation classes. A total of 96 participants (mean age 65.04 ± 8.38 years; 75% male) received either standard care or a behaviour change intervention, with physical activity, measured with an ActiGraph GT3X+ accelerometer as the primary outcome. Results: No significant differences in daily minutes of moderate-to-vigorous physical activity and steps per day, or any secondary outcomes, including self-rated health, quality of life, and mental wellbeing, were observed between the intervention and control groups at six months follow-up. These findings suggests that the behaviour change intervention did not significantly impact physical activity or health outcomes during maintenance cardiac rehabilitation. This may be attributed to high baseline physical activity levels among participants, and the extended cardiac rehabilitation support provided to both groups, potentially masking any intervention effects. Conclusion: A behaviour change intervention added to standard maintenance stage cardiac rehabilitation did not improve physical activity or health outcomes. However, continued access to cardiac rehabilitation sustained high physical activity levels. Future research should disentangle the independent effects of behaviour interventions and ongoing cardiac rehabilitation support. Trial registration: ClinicalTrials.gov NCT05705310