Explanatory Variables of Objectively Measured 24 h Movement Behaviors in Coronary Heart Disease Patients: A Systematic Review

Abstract

Aims

This study systematically examined the multilevel determinants influencing 24 h movement behaviors (physical activity, sedentary behavior, and sleep) in coronary heart disease patients on the basis of a socioecological model. The aim was to provide evidence-based recommendations for behavior modification in coronary heart disease patients.

Methods

We conducted this systematic review adhering to PRISMA 2020. Using the PICOS framework, we included observational studies of adults (≥ 18 years) with coronary heart disease, measuring 24 h movement behaviors (physical activity, sedentary behavior, sleep) objectively. Outcomes included behavioral time allocation and explanatory variables. We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library from inception to November 9, 2025. Data regarding study characteristics, behavioral measurement methods, and explanatory variables were independently extracted. Methodological quality was assessed using the Newcastle−Ottawa Scale for cohort studies and the Joanna Briggs Institute Critical Appraisal Checklist for cross-sectional studies. The socioecological model served as the analytical framework to organize extracted explanatory variables into four hierarchical levels: intrapersonal, interpersonal, environmental, and policy. This multilevel synthesis provided a systematic architecture for understanding behavioral heterogeneity, moving beyond the simplistic attribution of behaviors to individual physiology. Evidence synthesis and grading were performed using the method proposed by Sallis et al., which entailed calculating the proportion of studies supporting the hypothesized direction of association to evaluate the strength of evidence.

Results

A total of 24 studies were included, although none comprehensively explored 24 h movement behaviors in coronary heart disease patients. Only seven studies explored the determinants of two activity behaviors simultaneously, while the remaining 17 studies focused on isolated behaviors. The findings revealed that the primary explanatory variables were concentrated at the intrapersonal level, with aging significantly associated with reduced physical activity, while participation in cardiac rehabilitation was linked to increased physical activity. At the interpersonal level, social support moderated both physical activity levels and sedentary behavior. At the environmental level, residential characteristics were associated with 24 h movement behavior patterns; however, no significant associations were found at the policy level.

Conclusion

Guided by the socioecological model, this systematic review comprehensively identifies multi-level explanatory variables of 24 h movement behaviors in coronary heart disease patients. The factors showing the most consistent associations include participation in cardiac rehabilitation, younger age, spousal support, and residential environment. At the intrapersonal level, personalized encouragement to promote patients' participation in cardiac rehabilitation can serve as a core component of behavioral interventions. At the interpersonal and environmental levels, leveraging spousal support and actively optimizing exercise-related environments in medical facilities and communities are promising directions for intervention.