STEPWISE

Research on physical activity patterns in patients undergoing cardiac surgery has highlighted significant differences in preoperative and postoperative activity levels, as well as the implications of these patterns for recovery and long-term health outcomes. Postoperatively, the transition to increased physical activity is crucial for recovery. The amount of physical activity after cardiac surgery has been related to the incidence of cardiovascular events and the rate of readmission (Takahashi et al., 2015). Therefore, evaluating postoperative physical activity patterns may be an important indicator for the prognosis. 

Preoperatively, many patients exhibit low levels of physical activity, often due to the chronic nature of their cardiac conditions and comorbidities, which can lead to frailty and decreased muscle mass (sarcopenia) (Yuenyongchaiwat et al., 2020). In the Netherlands, only about 44% of the adults met the activity guidelines in 2022 (CBS and RIVM, 2022). This is concerning, since a sedentary lifestyle is associated with worse outcomes after cardiac surgery (Nery et al., 2007; Noyez et al., 2013). However, others have found that an active lifestyle prior to cardiac surgery is associated with improved outcomes as survival (Giaccardi et al., 2011; Nery et al., 2007; Rengo et al., 2010). 

Furthermore, being placed on a waiting list places a psychological burden on the patient and can significantly alter physical activity patterns. The longer a patient stays on the waiting list for cardiac surgery, the more it leads to stress, anxiety and even depression, causing patients to reduce their leisure activities (Rosenfeldt et al., 2011; Underwood et al., 1993). Elevated depressive and anxiety symptoms also lead to worse health related quality of life and increased mortality following cardiac surgery (Tully et al., 2008; Tully et al., 2009), possibly mediated by a reduction in physical activity. Additionally, patients are often told to cease exercise while waiting for their surgery to prevent severe coronary and valvular lesions ("Guidelines for rehabilitation in patients with cardiovascular disease (JCS 2012)," 2014), even though there is rising evidence that patients with severe cardiac conditions can safely undergo exercise (Argunova et al., 2022; Boidin et al., 2019; Tueller et al., 2010).

Taken together, the physical activity patterns and change hereof related to psychological distress in patients undergoing cardiac surgery could provide relevant information for prognosis. However, this has currently not been investigated yet. Therefore, the aim of the current study is to investigate the change of the physical activity and psychological burden over time, from preoperative, to being placed on the waiting list, to postoperative in patients undergoing elective cardiac surgery. 

Primary Objective: To investigate the change of objectively measured physical activity over time, from preoperative, to being placed on the waiting list for cardiac surgery, to postoperative. 

Secondary Objective(s): To investigate the change of the psychological burden over time and assess the relation with changes in physical activity over time. Furthermore, the difference in self-reported physical activity over time will be assessed. 

This will be an observational longitudinal study where physical activity patterns and psychological burden will be assessed at four time points: 1 month preoperatively (in retrospect), when being placed on the waiting list, 1 and 3 months postoperatively. 

Participants will undergo cardiac surgery following regular care.

This will take only a limited time for the participants. There are no other burdens or risks associated with the participation.