{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T18:09:08Z","timestamp":1784052548404,"version":"3.55.0"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality, and physical activity (PA) is central to secondary prevention. However, factors associated with PA among individuals with CVDs remain poorly understood, with few studies using accelerometer-based methods. This cross-sectional study examined the associations between accelerometer-measured PA and demographic, socioeconomic, lifestyle factors, and comorbidity in a large Swedish cohort of individuals with CVDs. Participants aged between 50 and 64 years with a confirmed diagnosis of angina pectoris, myocardial infarction, atrial fibrillation and flutter, heart failure, or stroke were included. Moderate-to-vigorous physical activity was measured using hip-worn triaxial accelerometers over seven consecutive days and categorized into tertiles of low, medium and high PA level. Demographic, socioeconomic, lifestyle factors, and comorbidities were assessed through questionnaires and registry data. Associations with PA levels were analyzed using multiple ordinal logistic regression. A total of 1,484 participants (32% women; median age 60.2 years) were included. Being in the oldest age group was significantly associated with lower odds of having a higher PA level (OR = 0.59; 95% CI [0.44, 0.77]), as well as female sex (OR = 0.73; 95% CI [0.59, 0.91]), regular\/occasional smoking (OR = 0.37; 95% CI [0.26, 0.52]), and having one (OR = 0.61; 95% CI [0.48, 0.77]) or more comorbidities (OR = 0.45; 95% CI [0.30, 0.68]). A healthy diet was significantly associated with higher PA levels (OR = 1.84; 95% CI [1.46, 2.31]). Financial strain, level of education and alcohol consumption had no association with PA. Using data from a representative sample of middle-aged adults, the findings indicate that engagement in PA is primarily associated with lifestyle factors, demographic characteristics, and comorbidity. These identified characteristics may inform future research aimed at CVD populations with low PA. Further research should investigate mediating and moderating pathways to clarify how these factors influence PA.<\/jats:p>","DOI":"10.1371\/journal.pone.0352673","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T17:30:44Z","timestamp":1784050244000},"page":"e0352673","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Associations of demographic, socioeconomic, lifestyle factors and comorbidity with accelerometer-measured physical activity in adults with cardiovascular diseases"],"prefix":"10.1371","volume":"21","author":[{"given":"Adina","family":"K\u00f6nig","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Hagstr\u00f6mer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frida","family":"Bergman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"B\u00e4ck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Drake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Johansson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Rossen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8368-0341","authenticated-orcid":true,"given":"Philip","family":"von Rosen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"issue":"25","key":"pone.0352673.ref001","doi-asserted-by":"crossref","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global burden of cardiovascular diseases and risk factors, 1990\u20132019: update from the GBD 2019 study","volume":"76","author":"GA Roth","year":"2020","journal-title":"J Am Coll Cardiol"},{"issue":"5","key":"pone.0352673.ref002","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1038\/nrcardio.2014.26","article-title":"Epidemiological studies of CHD and the evolution of preventive cardiology","volume":"11","author":"ND Wong","year":"2014","journal-title":"Nat Rev Cardiol"},{"key":"pone.0352673.ref003","volume-title":"The global economic burden of non-communicable diseases","author":"DE Bloom","year":"2011"},{"issue":"10","key":"pone.0352673.ref004","doi-asserted-by":"crossref","first-page":"575","DOI":"10.4330\/wjc.v8.i10.575","article-title":"Physical activity in primary and secondary prevention of cardiovascular disease: overview updated","volume":"8","author":"AJ Alves","year":"2016","journal-title":"World J Cardiol"},{"key":"pone.0352673.ref005","doi-asserted-by":"crossref","first-page":"100146","DOI":"10.1016\/j.ajpc.2021.100146","article-title":"Physical activity and sedentary behaviour in secondary prevention of coronary artery disease: a review","volume":"5","author":"V Vasankari","year":"2021","journal-title":"Am J Prev Cardiol"},{"issue":"17","key":"pone.0352673.ref006","doi-asserted-by":"crossref","first-page":"1690","DOI":"10.1016\/j.jacc.2022.02.036","article-title":"Systematic review of physical activity trajectories and mortality in patients with coronary artery disease","volume":"79","author":"N Gonzalez-Jaramillo","year":"2022","journal-title":"J Am Coll Cardiol"},{"issue":"5","key":"pone.0352673.ref007","first-page":"406","article-title":"Correlates of objectively measured physical activity in cardiac patients","volume":"4","author":"W Byun","year":"2014","journal-title":"Cardiovasc Diagn Ther"},{"key":"pone.0352673.ref008","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1186\/1479-5868-5-56","article-title":"A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review","volume":"5","author":"SA Prince","year":"2008","journal-title":"Int J Behav Nutr Phys Act"},{"issue":"9838","key":"pone.0352673.ref009","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/S0140-6736(12)60735-1","article-title":"Correlates of physical activity: why are some people physically active and others not?","volume":"380","author":"AE Bauman","year":"2012","journal-title":"Lancet"},{"issue":"1","key":"pone.0352673.ref010","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1186\/s12889-017-4255-2","article-title":"Correlates associated with participation in physical activity among adults: a systematic review of reviews and update","volume":"17","author":"J Choi","year":"2017","journal-title":"BMC Public Health"},{"issue":"6","key":"pone.0352673.ref011","doi-asserted-by":"crossref","first-page":"397","DOI":"10.2165\/00007256-199928060-00003","article-title":"Factors associated with exercise adherence among older adults. An individual perspective","volume":"28","author":"RE Rhodes","year":"1999","journal-title":"Sports Med"},{"issue":"12","key":"pone.0352673.ref012","first-page":"1996","article-title":"Correlates of adults\u2019 participation in physical activity: review and update","volume":"34","author":"SG Trost","year":"2002","journal-title":"Med Sci Sports Exerc"},{"issue":"6","key":"pone.0352673.ref013","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1177\/216507990605400602","article-title":"Determinants of employee participation in physical activity: critical review of the literature","volume":"54","author":"T Kaewthummanukul","year":"2006","journal-title":"AAOHN J"},{"issue":"4","key":"pone.0352673.ref014","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/j.amepre.2010.12.015","article-title":"Occupation correlates of adults\u2019 participation in leisure-time physical activity: a systematic review","volume":"40","author":"MA Kirk","year":"2011","journal-title":"Am J Prev Med"},{"key":"pone.0352673.ref015","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1186\/1479-5868-8-142","article-title":"Determinants of physical activity and exercise in healthy older adults: a systematic review","volume":"8","author":"MA Koeneman","year":"2011","journal-title":"Int J Behav Nutr Phys Act"},{"issue":"18","key":"pone.0352673.ref016","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1136\/heartjnl-2022-321943","article-title":"Habitual physical activity levels of adults with heart failure: systematic review and meta-analysis","volume":"109","author":"C Jordan","year":"2023","journal-title":"Heart"},{"issue":"9","key":"pone.0352673.ref017","doi-asserted-by":"crossref","first-page":"1876","DOI":"10.1016\/j.apmr.2017.09.117","article-title":"Factors associated with post-stroke physical activity: a systematic review and meta-analysis","volume":"99","author":"S Thilarajah","year":"2018","journal-title":"Arch Phys Med Rehabil"},{"issue":"4","key":"pone.0352673.ref018","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1111\/1467-8721.01245","article-title":"The role of psychosocial processes in explaining the gradient between socioeconomic status and health","volume":"12","author":"NE Adler","year":"2003","journal-title":"Curr Directions in Psychological Science"},{"issue":"1","key":"pone.0352673.ref019","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1007\/s44337-025-00209-9","article-title":"Physical activity exercise behavior in individuals with a history of stroke: a retrospective study","volume":"2","author":"S Arora","year":"2025","journal-title":"Discov Med"},{"key":"pone.0352673.ref020","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.ypmed.2015.07.003","article-title":"Which modifiable health risk behaviours are related? A systematic review of the clustering of Smoking, Nutrition, Alcohol and Physical activity (\u2018SNAP\u2019) health risk factors","volume":"81","author":"N Noble","year":"2015","journal-title":"Prev Med"},{"issue":"1","key":"pone.0352673.ref021","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s12966-024-01586-7","article-title":"Lifestyle behaviors and risk of cardiovascular disease and prognosis among individuals with cardiovascular disease: a systematic review and meta-analysis of 71 prospective cohort studies","volume":"21","author":"J Wu","year":"2024","journal-title":"Int J Behav Nutr Phys Act"},{"issue":"2","key":"pone.0352673.ref022","doi-asserted-by":"crossref","first-page":"65","DOI":"10.3109\/13814789609162146","article-title":"Comorbidity or multimorbidity: what\u2019s in a name? A review of literature","volume":"2","author":"M van den Akker","year":"1996","journal-title":"Eur J Gen Pract"},{"issue":"19","key":"pone.0352673.ref023","doi-asserted-by":"crossref","first-page":"2149","DOI":"10.1016\/j.jacc.2018.03.022","article-title":"Multimorbidity in older adults with cardiovascular disease","volume":"71","author":"DE Forman","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"pone.0352673.ref024","doi-asserted-by":"crossref","first-page":"100903","DOI":"10.1016\/j.arr.2019.04.005","article-title":"Multimorbidity and quality of life: systematic literature review and meta-analysis","volume":"53","author":"TT Makovski","year":"2019","journal-title":"Ageing Res Rev"},{"issue":"8","key":"pone.0352673.ref025","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1123\/jpah.2024-0771","article-title":"Accelerometer-measured physical activity and sedentary behavior in individuals with and without chronic diseases: cross-sectional results of 27,890 adults from the swedish cardiopulmonary bioimage study cohort","volume":"22","author":"C Regan","year":"2025","journal-title":"J Phys Act Health"},{"issue":"5","key":"pone.0352673.ref026","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1111\/sms.14131","article-title":"Accelerometer derived physical activity patterns in 27.890 middle-aged adults: The SCAPIS cohort study","volume":"32","author":"E Ekblom-Bak","year":"2022","journal-title":"Scand J Med Sci Sports"},{"issue":"6","key":"pone.0352673.ref027","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1111\/joim.12384","article-title":"The Swedish CArdioPulmonary BioImage Study: objectives and design","volume":"278","author":"G Bergstr\u00f6m","year":"2015","journal-title":"J Intern Med"},{"issue":"9","key":"pone.0352673.ref028","doi-asserted-by":"crossref","first-page":"1821","DOI":"10.1007\/s40279-017-0716-0","article-title":"Accelerometer data collection and processing criteria to assess physical activity and other outcomes: a systematic review and practical considerations","volume":"47","author":"JH Migueles","year":"2017","journal-title":"Sports Med"},{"issue":"5","key":"pone.0352673.ref029","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.jsams.2011.04.003","article-title":"Validation and comparison of ActiGraph activity monitors","volume":"14","author":"JE Sasaki","year":"2011","journal-title":"J Sci Med Sport"},{"issue":"6","key":"pone.0352673.ref030","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1111\/j.1360-0443.1993.tb02093.x","article-title":"Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II","volume":"88","author":"JB Saunders","year":"1993","journal-title":"Addiction"},{"key":"pone.0352673.ref031","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.drugalcdep.2018.05.002","article-title":"Measurement invariance of the alcohol use disorders identification test: establishing its factor structure in different settings and across gender","volume":"189","author":"A Moehring","year":"2018","journal-title":"Drug Alcohol Depend"},{"key":"pone.0352673.ref032","doi-asserted-by":"crossref","DOI":"10.29219\/fnr.v68.10547","article-title":"A Swedish dietary guideline index, gut microbial \u03b1-diversity and prevalence of metabolic syndrome - observations in the Swedish CArdioPulmonary bioImage Study (SCAPIS)","volume":"68","author":"U Ericson","year":"2024","journal-title":"Food Nutr Res"},{"key":"pone.0352673.ref033","volume-title":"Swedish dietary guidelines - risk and benefit management report","author":"\u00c5B Konde","year":"2015"},{"issue":"6","key":"pone.0352673.ref034","doi-asserted-by":"crossref","DOI":"10.2196\/jmir.2458","article-title":"Two new meal- and web-based interactive food frequency questionnaires: validation of energy and macronutrient intake","volume":"15","author":"SE Christensen","year":"2013","journal-title":"J Med Internet Res"},{"key":"pone.0352673.ref035","doi-asserted-by":"crossref","first-page":"21","DOI":"10.2147\/CLEP.S282475","article-title":"Adaptation of the charlson comorbidity index for register-based research in Sweden","volume":"13","author":"JF Ludvigsson","year":"2021","journal-title":"Clin Epidemiol"},{"issue":"5","key":"pone.0352673.ref036","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"ME Charlson","year":"1987","journal-title":"J Chronic Dis"},{"issue":"3","key":"pone.0352673.ref037","doi-asserted-by":"crossref","DOI":"10.18637\/jss.v045.i03","article-title":"Mice: multivariate imputation by chained equations in R","volume":"45","author":"SV Buuren","year":"2011","journal-title":"J Stat Softw"},{"issue":"1","key":"pone.0352673.ref038","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/096228029900800102","article-title":"Multiple imputation: a primer","volume":"8","author":"JL Schafer","year":"1999","journal-title":"Stat Methods Med Res"},{"issue":"5","key":"pone.0352673.ref039","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1007\/s11135-006-9018-6","article-title":"A caution regarding rules of thumb for variance inflation factors","volume":"41","author":"RM O\u2019Brien","year":"2007","journal-title":"Qual Quant"},{"key":"pone.0352673.ref040","volume-title":"Ordinal-regression models for ordinal data","author":"RHB Christensen","year":"2025"},{"issue":"4","key":"pone.0352673.ref041","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1097\/JCN.0000000000000804","article-title":"Gender differences in factors associated with physical activity in patients with coronary artery disease","volume":"37","author":"W-T Huang","year":"2022","journal-title":"J Cardiovasc Nurs"},{"issue":"42","key":"pone.0352673.ref042","doi-asserted-by":"crossref","first-page":"3286","DOI":"10.1093\/eurheartj\/eht258","article-title":"Physical activity in patients with stable coronary heart disease: an international perspective","volume":"34","author":"R Stewart","year":"2013","journal-title":"Eur Heart J"},{"issue":"12","key":"pone.0352673.ref043","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1161\/CIRCRESAHA.123.322121","article-title":"Physical activity over the lifecourse and cardiovascular disease","volume":"132","author":"AS Perry","year":"2023","journal-title":"Circ Res"},{"issue":"3","key":"pone.0352673.ref044","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0265088","article-title":"The value of combining individual and small area sociodemographic data for assessing and handling selective participation in cohort studies: evidence from the Swedish CardioPulmonary bioImage Study","volume":"17","author":"C Bonander","year":"2022","journal-title":"PLoS One"},{"issue":"7","key":"pone.0352673.ref045","doi-asserted-by":"crossref","first-page":"9183","DOI":"10.3390\/s130709183","article-title":"Optimal placement of accelerometers for the detection of everyday activities","volume":"13","author":"I Cleland","year":"2013","journal-title":"Sensors (Basel)"},{"issue":"20","key":"pone.0352673.ref046","doi-asserted-by":"crossref","first-page":"2259","DOI":"10.1161\/01.cir.0000435708.67487.da","article-title":"Guide to the assessment of physical activity: clinical and research applications: a scientific statement from the American Heart Association","volume":"128","author":"SJ Strath","year":"2013","journal-title":"Circulation"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0352673","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T17:30:50Z","timestamp":1784050250000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0352673"}},"subtitle":[],"editor":[{"given":"Davor","family":"Plavec","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,14]]},"references-count":46,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0352673","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,14]]}}}