Residential Greenness has an Important Contribution to Physical Activity Among Coronary Artery Bypass Graft (Cabg) Patients Not Participating in Cardiac Rehabilitation

Maya Sadeh Department of Epidemiology and Preventive Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel Alexandra Chudnovsky Department of Geography, Tel Aviv University, Tel Aviv, Israel Michael Brauer School of Population and Public Health, University of British Columbia, Vancouver, Canada Arnona Ziv The Information and Computerization Unit, The Gertner Institute, Ramat Gan, Israel Rachel Dankner Cardiovascular Epidemiology Unit, The Gertner Institute, Ramat Gan, Israel

Background:

Physical activity (PA) is associated with improved cardiovascular health and reduced mortality after CABG surgery. Although patients are encouraged to participate in cardiac rehabilitation (CR) for improved prognosis, CR is greatly underutilized. We investigate whether residential greenness, is associated with PA among CABG patients not participating in CR.

Methods:

This is a historical cohort study, utilizing population data from a cohort of CABG patients who underwent CABG surgery at 7 hospitals throughout Israel during 2004–07. The cohort was interviewed and examined once during pre-surgical hospitalization and a second time a year later at their home. Information on sports-related PA was collected via a validated questionnaire. Exposure to greenness in a buffer of 300 meter around patient`s home address was calculated using the Normalized Difference Vegetation Index (NDVI). Logistic regression analysis revealed the association between residential greenness and sports-related PA during follow-up, adjusting for age, sex, education, baseline PA and hospitalizations during follow-up.

Results:

The cohort comprised of 846 CABG patients, 78% men and 22% women, of whom 29.2% participated in CR during the year following the surgery. Patients who did not participate in CR were older, less educated, with lower income and lower levels of physical fitness. No difference was found between NDVI levels among CR participants compared to CR non-participants (mean±SD 0.169±0.050 vs 0.167±0.053). In patients not participating in CR each 1 interquartile range NDVI increment was associated with a 73% increased odds of being physically active vs being sedentary (adjusted OR=1.73, 95%CI: 1.31-2.28). No such association was demonstrated among patients not participating in CR (adjusted OR=0.91, 95%CI: 0.56-1.45).

Conclusion:

We found greenness to positively associate with PA among post CABG patients not attending CR. Increasing greenness in the built environment may be a beneficial health intervention for recovery, especially when barriers prevent participation in CR.









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