Effects of a Cardiac and Psychosocial Rehabilitation Program on Anxiety, Depression, Self-Efficacy, Quality of Life, and Exercise Capacity in Young Adults With Fontan Circulation: A Randomized Controlled Trial

Abstract

BACKGROUND: Young adults with Fontan circulation (FC) face psychosocial, physical, and environmental challenges and are vulnerable to emotional distress. They need holistic intervention programs to face these problems and enhance their quality of life. This study developed and evaluated a cardiac and psychosocial rehabilitation (CPR) program for young adults with FC. METHODS AND RESULTS: Thirty-eight young adults with FC aged 18-23 years were prospectively recruited from an outpatient clinic and randomized into a CPR group (n = 12) that underwent eight weekly group-based sessions combining a psychosocial program based on cognitive behavioral therapy with home-based cardiac rehabilitation (CR), a CR group (n = 12) that received only home-based CR, and a usual care control group (n = 12). The study assessed CPR program effectiveness based on the Hospital Anxiety and Depression Scale, self-efficacy, quality of life, and exercise capacity testing at three time points: pre- intervention, post-intervention, and four weeks post-intervention. Participants' average ages were 19.75 (2.28), 19.65 (1.79), and 20.38 (1.85) years in the CPR, CR, and control groups, respectively; 50% (CPR group) to 53.8% (CR and control groups) of the participants were male. After eight weeks, depression and anxiety decreased, whereas self-efficacy and quality of life increased in the CPR group compared with the CR and control groups. The groups showed no differences in exercise capacity. CONCLUSION: CPR can be part of an intervention for alleviating psychological distress and improving self-efficacy in young adults with FC. Efforts should be made to increase the efficacy of home-based CR.