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We show that a commonly used approach to SSI that we term SSI with variance reweighting generally leads to a loss in power. On the contrary, our proposed method for SSI that does not perform variance reweighting fully accounts for imputation uncertainty, while achieving better power.AIMS Physical activity (PA) and systematic efforts, such as cardiac rehabilitation, are recommended by several national guidelines for those who have received heart valve surgery. However, only a few studies have demonstrated real-world situations, such as changes in the PA leve