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March 26, 2026PLoS ONE0 citationsOpen Access

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

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CDClare T. M. DohertyMTMark A. TullyJWJason J. Wilson

Key Result

A behaviour change intervention added to standard maintenance cardiac rehabilitation did not significantly improve daily moderate-to-vigorous physical activity or steps per day at 6 months.

Key Points

  • The aim is to determine if adding a behaviour change intervention to cardiac rehabilitation improves physical activity adherence.
  • Conducted a cluster randomised controlled trial across six cardiac rehabilitation classes.
  • Included 96 participants, receiving either standard care or a behaviour change intervention.
  • Measured physical activity using an ActiGraph GT3X+ accelerometer as the primary outcome.
  • No significant differences in daily minutes of physical activity or steps per day between groups.
  • Secondary outcomes, including self-rated health and quality of life, showed no notable differences.
  • High baseline physical activity levels among participants may have masked any effects of the intervention.

Study Design

Type

RCT (n=96)

Randomization

Cluster

Multicenter

Yes

Structured PICO

Does a behaviour change intervention added to cardiac rehabilitation improve physical activity adherence in patients with coronary heart disease?

P
Population
Participants in community-based maintenance stage cardiac rehabilitation classes (mean age 65.04, 75% male)
I
Intervention
Behaviour change intervention added to standard maintenance stage cardiac rehabilitation
C
Comparator
Standard care (standard maintenance stage cardiac rehabilitation)
O
Outcome
Physical activity measured with an ActiGraph GT3X+ accelerometer (daily minutes of moderate-to-vigorous physical activity and steps per day)surrogate

Adding a behavior change intervention to standard maintenance cardiac rehabilitation did not significantly increase physical activity at 6 months, likely due to high baseline activity levels.

Limitations

  • High baseline physical activity levels among participants
  • Extended cardiac rehabilitation support provided to both groups potentially masking any intervention effects
  • high baseline physical activity levels among participants
  • extended cardiac rehabilitation support provided to both groups, potentially masking any intervention effects

Abstract

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

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Cite This Study

Doherty et al. (2026) conducted an RCT in Coronary heart disease (n=96). Behaviour change intervention added to cardiac rehabilitation vs. Standard care was evaluated on Physical activity measured with an ActiGraph GT3X+ accelerometer (daily minutes of moderate-to-vigorous physical activity and steps per day). A behaviour change intervention added to standard maintenance cardiac rehabilitation did not significantly improve daily moderate-to-vigorous physical activity or steps per day at 6 months.

synapsesocial.com/papers/69c4cc98fdc3bde448918047https://doi.org/10.1371/journal.pone.0345293
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The STRENGTH Study: A cluster randomised controlled trial of the effect of a behaviour change intervention added to cardiac rehabilitation on physical activity adherence.2026
  2. 2Understanding participants’ experiences of a behaviour change intervention within cardiac rehabilitation: A nested process evaluation within the STRENGTH randomised controlled trial2026
  3. 3Lifestyle behaviour change of patients following cardiac rehabilitation: the BENEFIT intervention study with one-year follow-up2025 · 2 citations
  4. 4Behavioural intervention to increase physical activity in adults with coronary heart disease in Jordan2016 · 47 citations
  5. 5Physical activity and sedentary behaviour changes during and after cardiac rehabilitation: Can patients be clustered?2023 · 2 citations