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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Does Psychological State Influence the Physiological Response to Cardiac Rehabilitation in Older Adults?
Karolina Kowalewska1, Kamil Radecki1, Błażej Cieślik2
1Institute of Physical Culture Sciences, Jan Dlugosz University, 42-200 Czestochowa, Poland.
Insights
Cardiac rehabilitation is more effective for patients without depression, who show greater improvements in exercise capacity. Addressing psychological factors like depression and stress enhances cardiac patient outcomes.
Area of Science:
- Cardiology
- Psychology
- Rehabilitation Medicine
Background:
- Cardiovascular diseases (CVDs) are a leading global cause of mortality, necessitating effective secondary prevention strategies.
- Mental health, particularly depression, significantly impacts CVD outcomes by increasing cardiovascular risk and reducing treatment adherence.
- Understanding the influence of psychological state on cardiac rehabilitation effectiveness is crucial for improving patient prognosis.
Purpose of the Study:
- To assess the impact of psychological state, specifically depressive symptoms, on the effectiveness of cardiac rehabilitation.
- To investigate the relationship between psychological factors and physiological improvements during cardiac rehabilitation.
Main Methods:
- A 3-week cardiac rehabilitation program involving 33 patients, retrospectively divided into groups with and without depressive symptoms.
- Functional status assessed via R.A.M.P. protocol exercise test (treadmill), measuring heart rate (HR), blood pressure (BP), and metabolic equivalent of task (MET).
- Psychological state evaluated using the Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS-10); stepwise regression used to identify predictors of physiological parameters.
Main Results:
- Patients without depressive symptoms showed significantly greater improvements in exercise HR, systolic blood pressure (SBP), and METs compared to those with depressive symptoms.
- Depressive symptoms (HADS-D) and perceived stress (PSS-10) were significant predictors for exercise HR, SBP, diastolic blood pressure (DBP), and METs.
- Psychological factors, including HADS-D and PSS-10, along with age, explained a significant portion of the variance in physiological parameters.
Conclusions:
- Cardiac rehabilitation benefits both psychological and physiological parameters, with superior outcomes observed in patients without depression.
- Depressive symptoms are identified as a significant predictor of poorer exercise HR, SBP, and METs, indicating their detrimental role in cardiac disease progression.
- Integrating psychological assessments and interventions for depression and stress within cardiac rehabilitation programs can enhance treatment effectiveness and improve patient outcomes.
Abstract:
Background and Objectives: Cardiovascular diseases (CVDs) are a major global cause of death. Effective secondary prevention is crucial, involving risk factor modification and cardiac rehabilitation. However, mental factors, particularly depression, exert a significant influence on CVD outcomes by increasing cardiovascular risk and impeding treatment adherence. Therefore, the aim of this study is to assess the impact of psychological state on the effectiveness of rehabilitation in cardiac patients. Materials and Methods: Thirty-three patients referred for cardiac rehabilitation participated in a 3-week program, retrospectively categorized into two groups: those with and without depressive symptoms. The functional status of the patients was assessed using the R.A.M.P. protocol exercise test, conducted on a treadmill, during which resting and exercise heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure, and metabolic equivalent of task (MET) measurements were taken. The Hospital Anxiety and Depression Scale (HADS) and the Perceived Stress Scale (PSS-10) were utilized to evaluate the patients' psychological state. Stepwise regression explored the psychological factors explaining physiological parameter variance. Results: Participants without depressive symptoms exhibited significantly greater improvements in exercise HR (15.58 vs. 1.07; p = 0.02), exercise SBP (7.93 vs. -2.05; p = 0.05), and exercise METs (1.52 vs. 0.50; p = 0.006) compared to those with depressive symptoms. The following predictors were found to be significant: for exercise HR-HADS-D (r2 = 12%; p = 0.04); for exercise DBP-PSS-10 (r2 = 27%; p = 0.002); and for METs-HADS-D and age (r2 = 26%; p = 0.01). Conclusions: In conclusion, cardiac rehabilitation improved psychological and physiological parameters in both groups, with greater effectiveness seen in those without depression. Depressive symptoms predicted exercise HR, SBP, and METs, highlighting their role in worsening cardiac disease. Emphasizing psychological factors, including depression and stress, in cardiac rehabilitation can enhance effectiveness and patient outcomes.
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