Depression and anxiety in cardiac rehabilitation: differential associations with changes in exercise capacity and quality of life

Abstract

Background: Cardiac rehabilitation (CR) has been successful in improving exercise capacity (EC) and quality of life (QoL). However, depression and anxiety are highly prevalent among cardiac patients and might represent risk factors for rehabilitation outcomes. The aim of this study was to investigate the role of depression and anxiety as possible independent risk factors for CR outcomes. Methods: The study applied a pre-post-design. The sample comprised N = 3'434 cardiac disease patients taking part in a Swiss inpatient CR center. Variables measured at the beginning (T1) and end of rehabilitation (T2) included depression and anxiety (HADS), EC, and QoL (MacNew). A path analysis was conducted.Results: Depression at T1 had a significant negative relationship with improvements in EC and in all aspects of QoL during rehabilitation. Anxiety at T1 was positively related to improvements in EC and in emotional and physical QoL. Improvements in depression during CR were positively related with improvements in all outcomes. Improvements in anxiety showed no significant association with the outcomes. Conclusion: Depression and anxiety should be screened for during CR. Depression should be treated due to the negative association found with rehabilitation outcomes. Underlying mechanisms of the positive association of anxiety with rehabilitation outcomes need further investigation.

The role of daily adjustment disorder, depression and anxiety symptoms for the physical activity of cardiac patients

“…Quality of life was measured at the beginning of rehabilitation with the MacNew Heart Disease Quality of Life Questionnaire (MacNew Heart;Höfer, Lim, Guyatt, & Oldridge, 2004). The subscales follow the factorial structure proposed by Bermudez et al (2021a). Tania Bermudez et al…”

“…Thus, one potential explanation for the direction of the associations might be the high correlations at the interindividual level between anxiety, adjustment disorder and depressive symptoms (see Table 2). Yet, given that previous studies reported positive effects of anxiety symptoms on improvements in exercise capacity and in physical quality of life during rehabilitation (Bermudez et al, 2021a), a second explanation might still be that the strong overlap between depression symptoms, adjustment disorder and anxiety might mask the unique effects that only show when the other constructs are controlled for. Yet, all results should be interpreted very carefully at the interindividual level given the very high interindividual correlations between the different symptoms, and the association between anxiety and PA/SB should surely be investigated further.…”

“…Thus, based on these findings a negative association between anxiety symptoms and PA could be expected. Nevertheless, studies also found a positive effect of general anxiety disorder on cardiac outcomes (Parker, Hyett, Hadzi-Pavlovic, Brotchie, & Walsh, 2011 ), as well as positive associations of anxiety with improvements in exercise capacity and in physical quality of life during inpatient cardiac rehabilitation, which are the basis for regular PA in everyday life (Bermudez, Bierbauer, Scholz, & Hermann, 2021a ).Therefore, there is also evidence supporting a positive association of anxiety symptoms with PA.…”

Differential associations of sex and age with changes in HRQoL during outpatient cardiac rehabilitation

“…Based on previous research and clinical experience, we controlled for the following psychosocial and disease-related covariates: housing situation (living alone vs. living with others), presence of a psychiatric disorder, change in 6-minute-walk distance (calculated using the difference between the walk distance at CR entry and discharge), ischemic heart disease and modifiable traditional cardiovascular risk factors (hypertension, dyslipidemia, overweight, smoking and type II diabetes). Social support (assessed with housing situation as a proxy) is reportedly associated with higher psychological well-being and prevention of emotional distress after cardiac disease [ 42 , 43 ], while the presence of a psychiatric disorder impacts negatively on CR outcomes [ 44 ]. With regard to the 6MWD, better 6MWD performance has been linked to greater HRQoL improvements [ 13 , 41 ].…”

The Influence of Self-Esteem Level on Predisposition to Cardiovascular Diseases

“…В основе понимания развития психосоматического компонента болезни лежит тезис: ответные реакции на стресс являются связующим звеном между мозгом, чувствами, поведением и биологическими реакциями, влияющие на физическое самочувствие [1][2][3].…”