Sedentary behaviour in people with cardiovascular disease: a pilot randomised controlled trial

Intervention – the ‘Stand up for heart health’ program: Intervention: In week 2 of the 6 week cardiac rehabiliation (CR) program, participants in the intervention group will attend a one hour individual session in addition to the `standard' CR sessions. The intervention will consist of a one on one face to face session where participants are guided through three activities: 1) review of their assessed sedentary time; 2) normative feedback on sedentary time, using percentiles to compare an average Australian of similar age; and 3) guided goal setting to reduce sedentary time and increase the number of breaks in prolonged sitting time. The guided goal setting will involve a 'small steps' approach, whereby each participant will choose 5 to 6 ways to decrease their sitting time from a list which combines pre-specified behavioural items with suggestions of their own arising from the interview. One goal will be integrated into the participant's habitual behaviour each week for six weeks (e.g. Week 1 goal 'I am going to stand up during the ad breaks on TV, Week 2 goal 'I am going to stand up while I talk on the phone'). Each step is designed to be easily achievable and to reduce sitting time by about 10 to 15 minutes per day. A summary of the specific goal setting plan will be mailed to participants following the face to face session. Participants will be required to self-monitor their goals daily with the completion of a simple checklist (e.g. 'Today, did you achieve your goal of standing up during the TV ad breaks? Yes/No. If not, why not?'). Weekly phone calls will be completed to provide support, and remind participants to build on their previous week's goal. The intervention has been informed by constructs from self-determination theory (Ryan and Deci 2000) which argues that enduring behaviour change arises from universal and innate human needs for competence (i.e. mastery of one’s activities and environments), autonomy (i.e. choicefully endorsing one’s actions), and psychological relatedness (i.e. interacting with and being cared for by others). The program captures each of these needs, for example: * Competence: the ‘small steps’ are incremental, modest and easily achievable, which would be expected to support the progressive development of participants’ perceptions of competence, * Autonomy: participants suggest and choose their own weekly small steps, which would align with increased perceptions of autonomy related to behaviour, and * Relatedness: phone calls with the research team will be completed weekly to promote regular interaction. The phone calls will be provided in a need-supportive way, with participants who do not achieve their goals being supported with a non-judgemental and empathetic approach, rather than focussing on controlling behaviours. This approach would be expected to promote participants’ feelings of being cared for (relatedness), making it more likely that participants will internalise the views of others (Ryan and Deci 2000).