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Tsai KZ, Liu PY, Lin YP, Chu CC, Huang WC, Sui X, Lavie CJ, Lin GM. Do the American guideline-based leisure time physical activity levels for civilians benefit the mental health of military personnel? Front Psychiatry 2023; 14:1255516. [PMID: 38034917 PMCID: PMC10682789 DOI: 10.3389/fpsyt.2023.1255516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Backgrounds This study aimed to clarify the association of American guideline-based leisure time physical activity (PA) level with mental health in 4,080 military personnel in Taiwan. Methods The moderate intensity PA level was assessed according to the total running time per week (wk) reported in a self-administered questionnaire over the previous 6 months and was categorized into PA level <150, 150-299, and ≥300 min/wk. Mental stress was assessed by the Brief Symptom Rating Scale (BSRS)-5 for which ≥15 points were classified as great mental stress. Suicide ideation (SI) was graded as 1 for mild, 2 for moderate, and 3 or 4 for severe. Multivariable logistic regression analysis was employed to determine the association between PA and mental health while adjusting for demographics, smoking, alcohol intake, betel nut chewing, and obesity. Results As compared to participants with a PA level of <150 min/wk., those with PA levels 150-299 min/wk. and ≥ 300 min/wk. had a lower possibility of SI ≥1 [odds ratios (ORs) and 95% confidence intervals (CIs): 0.58 (0.40-0.83) and 0.23 (0.14-0.36), respectively] and SI ≥1 and/or BSRS-5 ≥ 15 [ORs: 0.55 (0.39-0.79) and 0.21 (0.13-0.34), respectively]. The possibilities were more significantly lower for SI ≥2 [ORs: 0.37 (0.20-0.68) and 0.10 (0.04-0.26), respectively] and SI ≥2 and/or BSRS-5 ≥ 15 [ORs: 0.35 (0.20-0.62) and 0.10 (0.04-0.25), respectively]. Conclusion Our findings indicate that participating in moderate-intensity leisure time PA level for ≥150 min/wk. may have a positive effect on mental health among military personnel. The impact appears to be even more significant when engaging in a higher PA level of ≥300 min/wk.
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Affiliation(s)
- Kun-Zhe Tsai
- Department of Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan
- Department of Stomatology of Periodontology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Pang-Yen Liu
- Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yen-Po Lin
- Department of Critical Care Medicine, Taipei Tzu Chi Hospital, New Taipei City, Taiwan
| | - Chen-Chih Chu
- Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Xuemei Sui
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Carl J. Lavie
- Ochsner Clinical School, John Ochsner Heart and Vascular Institute, The University of Queensland School of Medicine, New Orleans, LA, United States
| | - Gen-Min Lin
- Department of Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan
- Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Lin C, Howard VJ, Nanavati HD, Judd SE, Howard G. The association of baseline depressive symptoms and stress on withdrawal in a national longitudinal cohort: the REGARDS study. Ann Epidemiol 2023; 84:8-15. [PMID: 37182817 PMCID: PMC10524111 DOI: 10.1016/j.annepidem.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE To measure the association of baseline psychological symptoms (depressive symptoms and perceived stress) with withdrawal from a cohort study. METHODS Depressive symptoms and perceived stress were obtained using validated measures during the baseline computer-assisted telephonic interview for the REasons for Geographic and Racial Differences in Stroke study a national longitudinal cohort (≥45 years, 42% Black, 55% women) recruited between 2003 and 2007. Participants who completed follow-up after September 1, 2019, were considered active. Primary outcome was time to study withdrawal. The association of psychological symptoms and time-to-withdrawal was measured using Cox proportional hazard regression models with incremental adjustments by demographic and clinical factors. RESULTS Out of 29,964 participants included in the analysis, 11,111 (37.1%) participants withdrew over the follow-up period (median: 11 years). Compared to participants with low depressive symptoms, those with moderate symptoms had 5% higher risk (aHR= 1.05; 95% CI= 1.00-1.10) and those with high level of depressive had 19% higher risk (aHR= 1.19; 95% CI= 1.11-1.27) of withdrawal in fully adjusted models. No significant association between perceived stress and withdrawal risk was observed. CONCLUSIONS Depressive symptoms were significantly associated with withdrawal. Prevalence of depressive symptoms at baseline is an important indicator of participant retention in large prospective cohorts.
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Affiliation(s)
- Chen Lin
- Department of Neurology, University of Alabama at Birmingham, Birmingham.
| | - Virginia J Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham
| | - Hely D Nanavati
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham
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Association of obesity and cardiovascular disease and progress in pharmacotherapy: what is next for obesity? Int J Rehabil Res 2023; 46:14-25. [PMID: 36727942 DOI: 10.1097/mrr.0000000000000565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Obesity has recently emerged as one of the most severe health concerns. Obesity is a key autonomous risk factor for heart failure and contributes to cardiovascular disease (CVD) risk factors such as hypertension, type 2 diabetes, and metabolic abnormalities. Obesity is caused by a metabolic imbalance, which occurs when calories burnt are fewer than the number of calories consumed. There are several pathways accountable for the adverse impacts of obesity on the cardiovascular system. Inflammatory cell infiltration develops in the adipose tissue, the pancreas, and other issues similar to the progression of obesity. Inflammation is triggered by immune cells that invade dysfunctional adipose tissue. The atherosclerotic inflammation phase, related to obesity, induces coronary calcification. Obesity is linked to elevated levels of leptin and high blood pressure. Leptin causes systemic vasoconstriction, sodium retention, and increased blood pressure by influencing the synthesis of nitric oxide and activating the sympathetic nervous system. Obesity is a well-known risk factor for CVD and is one of the leading causes of the greater risk of diseases, including dyslipidemia, hypertension, depression, metabolic syndrome, atrial fibrillation, and heart failure in adults and children. When used with dietary improvements, antiobesity drugs improve the probability of experiencing clinically healthy (5%) weight loss. This review aimed to address the consequences of obesity on cardiac structure and function, risk factors, the impact of the obesity paradox, pharmacological treatment strategies for managing and recommended exercise and diet.
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Lavie C, Abelhad N, Kachur S, Sanchez A, Milani R. Impact of cardiac rehabilitation on psychological factors, cardiorespiratory fitness, and survival: A narrative review. HEART AND MIND 2023. [DOI: 10.4103/hm.hm_58_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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5
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Wu M, Zhu Y, Lv J, Guo Y, Yang L, Chen Y, Tang W, Xiang S, Sun X, Chen J, Chen Z, Yu C, Li L. Association of anxiety with cardiovascular disease in a Chinese cohort of 0.5 million adults. J Affect Disord 2022; 315:291-296. [PMID: 35934218 DOI: 10.1016/j.jad.2022.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Anxiety might be a potentially modifiable risk factor of cardiovascular diseases (CVDs). Evidence relating anxiety symptoms and generalized anxiety disorder (GAD) to CVDs from prospective cohort study was still lacking in China. METHODS Participants aged 30 to 79 years old from 10 areas across China were recruited during 2004-2008 and were followed up until 2017. 487,209 participants without CVDs at baseline remained for analyses. Anxiety symptoms (panic attacks and continuous anxiety) during the past 12 months were identified in a face-to-face interview. Participants with continuous anxiety were further assessed for GAD using Composite International Diagnostic Interview-Short Form. The primary outcomes were incident CVD, ischaemic heart disease (IHD), haemorrhagic stroke (HS), and ischaemic stroke (IS). RESULTS During 4.7 million person-years of follow-up, we documented 140,365 incident cases of CVD. For panic attacks, the multivariable-adjusted HRs (95 % CI) were 1.08 (1.04-1.13), 1.10 (1.02-1.19), 1.20 (1.05-1.38) and 1.20 (1.11-1.30) for CVD, IHD, HS and IS, respectively. Continuous anxiety was positively associated with incident CVD and IHD, and the corresponding HRs were 1.12 (1.04-1.20) and 1.21 (1.07-1.37). LIMITATIONS Anxiety symptoms were examined according to self-reported questionnaires, which could constitute key study limitations. CONCLUSIONS Among the Chinese adults, those with anxiety symptoms or GAD might be important at-risk population of CVD.
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Affiliation(s)
- Man Wu
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Yunqing Zhu
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Jun Lv
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China; Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China
| | - Yu Guo
- Fuwai Hospital Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Ling Yang
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford OX3 7LF, United Kingdom; Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
| | - Yiping Chen
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford OX3 7LF, United Kingdom; Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
| | - Wei Tang
- Emergency Department, Pengzhou Traditional Chinese Medical Hospital, Pengzhou 611930, Sichuan, China
| | | | - Xiaohui Sun
- NCDs Prevention and Control Department, Qingdao CDC, Qingdao 266033, Shandong, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing 100022, China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
| | - Canqing Yu
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China; Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China.
| | - Liming Li
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China; Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China
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Defining the importance of stress reduction in managing cardiovascular disease - the role of exercise. Prog Cardiovasc Dis 2022; 70:84-93. [DOI: 10.1016/j.pcad.2022.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 01/29/2022] [Indexed: 12/14/2022]
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Review of Recent Cardiac Rehabilitation Research Related to Enrollment/Adherence, Mental Health, and Other Populations. J Cardiopulm Rehabil Prev 2021; 41:302-307. [PMID: 34461620 DOI: 10.1097/hcr.0000000000000649] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This review overviews three topic areas observed to be highly active in the cardiac rehabilitation (CR) research literature published in 2019 and 2020. Topics summarized were enrollment or adherence in CR programs; mental health, particularly depression, stress, and anxiety of patients participating in CR programs; and patients participating in CR programs with diagnoses other than coronary artery bypass graft, myocardial infarction, or percutaneous coronary interventions.
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Carbone S, Kim Y, Kachur S, Billingsley H, Kenyon J, De Schutter A, Milani RV, Lavie CJ. Peak Oxygen Consumption Achieved at the End of Cardiac Rehabilitation Predicts Long-Term Survival in Patients with Coronary Heart Disease. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 8:361-367. [PMID: 33895797 DOI: 10.1093/ehjqcco/qcab032] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cardiac rehabilitation (CR) improves survival in patients with coronary heart disease (CHD), which is largely mediated by the improvements in cardiorespiratory fitness (CRF) defined as peak oxygen consumption (VO2). Therefore, measuring CRF is essential to predict long-term outcomes in this population. It is unclear, however, whether peak VO2 achieved at the end of CR (END-peak VO2) predicts survival or whether the changes of CRF achieved during CR provide a greater prognostic value. OBJECTIVES To determine whether END-peak VO2 independently predicts long-term survival in patients with CHD undergoing CR. We also aimed at identifying cut-offs for END-peak VO2 that could be used in clinical practice. METHODS Retrospective analysis of 853 patients with CHD referred to CR who completed a maximal cardiopulmonary exercise test. Survival analysis was performed to examine the risk of all-cause mortality (average follow-up years: 6.65) based on peak VO2. The Contal and O'Quigley's method was used to determine the optimal cutoff of END-peak VO2 based on the log-rank statistic. RESULTS END-peak VO2 was inversely associated with mortality risk (hazard ratio [HR]=0.84; 95% CI = 0.78-0.90), independent of changes in peak VO2 adjusted for the baseline peak VO2. The estimated cutoff of end-peak VO2 at ≥ 17.6 mL/kg/min best predicted the survival with high predictive accuracy and patients with END-peak VO2 under the cutoff had a greater risk of mortality (HR = 2.93; 95% CI = 1.81-4.74). CONCLUSIONS In patient with CHD undergoing CR, END-peak VO2 is an independent predictor for long-term survival. Studies utilizing higher intensity CR programs, with and without pharmacologic strategies, to increase peak VO2 to a greater degree in those achieving a suboptimal END-peak VO2, are urgently needed.
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Affiliation(s)
- Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA.,VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA
| | - Youngdeok Kim
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA
| | - Sergey Kachur
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA
| | - Hayley Billingsley
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA.,VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA
| | - Jonathan Kenyon
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA
| | - Alban De Schutter
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA
| | - Richard V Milani
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA
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Benasi G, Fava GA, Rafanelli C. Kellner's Symptom Questionnaire, a Highly Sensitive Patient-Reported Outcome Measure: Systematic Review of Clinimetric Properties. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:74-89. [PMID: 32050199 DOI: 10.1159/000506110] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/23/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Patient-reported outcomes (PROs) are of increasing importance in clinical medicine. However, their evaluation by classic psychometric methods carries considerable limitations. The clinimetric approach provides a viable framework for their assessment. OBJECTIVE The aim of this paper was to provide a systematic review of clinimetric properties of the Symptom Questionnaire (SQ), a simple, self-rated instrument for the assessment of psychological symptoms (depression, anxiety, hostility, and somatization) and well-being (contentment, relaxation, friendliness, and physical well-being). METHODS The PRISMA guidelines were used. Electronic databases were searched from inception up to March 2019. Only original research articles, published in English, reporting data about the clinimetric properties of the SQ, were included. RESULTS A total of 284 studies was selected. The SQ has been used in populations of adults, adolescents, and older individuals. The scale significantly discriminated between subgroups of subjects in both clinical and nonclinical settings, and differentiated medical and psychiatric patients from healthy controls. In longitudinal studies and in controlled pharmacological and psychotherapy trials, it was highly sensitive to symptoms and well-being changes and discriminated between the effects of psychotropic drugs and placebo. CONCLUSIONS The SQ is a highly sensitive clinimetric index. It may yield clinical information that similar scales would fail to provide and has a unique position among the PROs that are available. Its use in clinical trials is strongly recommended.
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Affiliation(s)
- Giada Benasi
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Chiara Rafanelli
- Department of Psychology, University of Bologna, Bologna, Italy,
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Varghese TP, Kumar AV, Varghese NM, Chand S. Depression Related Pathophysiologies Relevant in Heart Disease: Insights into the Mechanism Based on Pharmacological Treatments. Curr Cardiol Rev 2020; 16:125-131. [PMID: 31775601 PMCID: PMC7460711 DOI: 10.2174/1573403x15666191127104520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/05/2019] [Accepted: 11/21/2019] [Indexed: 01/08/2023] Open
Abstract
Depressive symptoms are highly prevalent in patients with cardiac diseases. Co-morbid Depression in cardiac patients causes a significant reduction in health-related quality of life for the patients and inflicts an economic burden on the society. Two types of mechanisms that may explain the link between depression and cardiac diseases are the psychosocial and physiopathological mechanisms. Physiopathological mechanisms are direct biological mechanisms, which include hyperactivity of non-adrenergic and Hypothalamic Pituitary Adrenal Axis (HPA), abnormal platelet activation, endothelial dysfunction, and inflammatory process. Psychosocial factors include behavioral or lifestyle factors like smoking alcoholism and physical inactivity. Pharmacologic and therapeutic interventions are effective at reducing symptoms of depression in patients with cardiac disorders. Among pharmacological treatment, SSRIs seems to be effective for the reduction of depressive symptoms among patients with cardiac disorders because of their good efficacy and minimal cardiovascular side effects. Mechanisms of action of SSRI’s in depressive patients with cardiac disorders are associated with their ability to reduce inflammation, platelet, and endothelial dysfunction. This review focuses on the potential pathophysiological and psychosocial links between cardiac diseases and depression, the treatment options, and the importance of routine screening of depressive symptoms in cardiac settings.
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Affiliation(s)
- Treesa P Varghese
- Department of Pharmacy Practice, NGSMIPS, Nitte (Deemed to be University), Mangaluru, Karnataka 575018, India
| | - Anand V Kumar
- Department of Pharmacology, JSS College of Pharmacy, Ooty, Tamilnadu, India
| | - Nila M Varghese
- Department of Pharmaceutics, St. Johnes College of Pharmaceutical Sciences and Research, Idukki, Kerala, India
| | - Sharad Chand
- Department of Pharmacy Practice, NGSMIPS, Nitte (Deemed to be University), Mangaluru, Karnataka 575018, India
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Jackson A, Rogerson M, Le Grande M, Thompson D, Ski C, Alvarenga M, Amerena J, Higgins R, Raciti M, Murphy BM. Protocol for the development and validation of a measure of persistent psychological and emotional distress in cardiac patients: the Cardiac Distress Inventory. BMJ Open 2020; 10:e034946. [PMID: 32532770 PMCID: PMC7295398 DOI: 10.1136/bmjopen-2019-034946] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Distress is experienced by the majority of cardiac patients, yet no cardiac-specific measure of distress exists. The aim of this project is to develop and validate the Cardiac Distress Inventory (CDI). Using the CDI, health professionals will be able to identify key clusters of psychological, emotional and social concern to address with patients, postcardiac event. METHODS AND ANALYSIS An item pool will be generated through: identification of items by a multidisciplinary group of clinician researchers; review of generic and condition-specific distress measures; focus group testing with cardiac rehabilitation professionals; feedback from patients. The COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) criteria will be used to inform the development of the methodology for determining the CDI's psychometric properties. The item pool will be tested with 400 cardiac patients and responses subjected to exploratory factor analysis, Rasch analysis, construct validity testing and latent class analysis. Receiver operating characteristic analysis will be used to identify the optimal CDI cut-off score for distinguishing whether a person experiences clinically significant distress. ETHICS AND DISSEMINATION Approved by the Monash Health Human Research Ethics Committee (approval number-RES-19-0000631L-559790). The CDI will be made available to clinicians and researchers without charge. The CDI will be translated for use internationally. Study findings will be shared with cardiac patient support groups; academic and medical communities via publications and presentations; in the training of cardiac secondary prevention professionals; and in reports to funders. Authorship for publications will follow the uniform requirements for manuscripts submitted to biomedical journals.
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Affiliation(s)
- Alun Jackson
- Australian Centre for Heart Health, North Melbourne, Victoria, Australia
- Deakin University Faculty of Health, Burwood, Victoria, Australia
| | - Michelle Rogerson
- Australian Centre for Heart Health, North Melbourne, Victoria, Australia
| | - Michael Le Grande
- Australian Centre for Heart Health, North Melbourne, Victoria, Australia
- Centre for Behaviour Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - David Thompson
- Australian Centre for Heart Health, North Melbourne, Victoria, Australia
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Chantal Ski
- Australian Centre for Heart Health, North Melbourne, Victoria, Australia
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Marlies Alvarenga
- School of Health and Life Sciences, Federation University Australia - Berwick Campus, Berwick, Victoria, Australia
- Monash Cardiovascular Research Centre, MonashHeart, Melbourne, Victoria, Australia
| | - John Amerena
- Cardiac Services, Barwon Health, Geelong, Victoria, Australia
- Deakin School of Medicine, Geelong, Victoria, Australia
| | - Rosemary Higgins
- Australian Centre for Heart Health, North Melbourne, Victoria, Australia
- Deakin University Faculty of Health, Burwood, Victoria, Australia
| | - Michela Raciti
- Australian Centre for Heart Health, North Melbourne, Victoria, Australia
| | - Barbara M Murphy
- Australian Centre for Heart Health, North Melbourne, Victoria, Australia
- Deakin University Faculty of Health, Burwood, Victoria, Australia
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Hamieh N, Meneton P, Zins M, Goldberg M, Wiernik E, Empana JP, Limosin F, Melchior M, Lemogne C. Hostility, depression and incident cardiac events in the GAZEL cohort. J Affect Disord 2020; 266:381-386. [PMID: 32056903 DOI: 10.1016/j.jad.2020.01.164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/25/2019] [Accepted: 01/28/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Psychological factors such as hostility and depression have been associated with cardiovascular disease. However, their role in predicting incident cardiac events independently one of another is not clear. METHODS Among 10,304 GAZEL middle-aged workers free of cardiovascular diseases in 1993, 581 incident cardiac events were validated from 1994-2014. Hostile traits (cognitive hostility, behavioral hostility, irritability and negativism) were assessed with the Buss and Durkee Hostility Inventory at baseline. Depressive symptoms were assessed at baseline and every three years with the Center for Epidemiological Studies Depression scale. We used Cox proportional hazards models to calculate hazard ratios (HR) of hostile traits for incident cardiac events adjusting for baseline self-reported socio-demographics and family history of coronary heart diseases (model 1), then additionally for time-dependent depressive symptoms (either as a binary or continuous variable) (model 2) and for yearly self-reported modifiable cardiovascular risk factors (physical activity, smoking, body mass index, diabetes, dyslipidemia and hypertension) (model 3). RESULTS In Model 1, the only hostile trait associated with incident cardiac events was irritability (HR for one interquartile range: 1.16, 95% confidence interval: 1.02-1.32). This association was no longer statistically significant when further adjusting for depressive symptoms. Depressive symptoms, in turn, remained significant predictors of cardiac events with HRs ranging from 1.40-1.49 (binary). LIMITATIONS Hostility traits were measured only once. CONCLUSIONS Depressive symptoms might explain the association between irritability and cardiac events and should therefore be prioritized in interventions aiming to prevent cardiovascular disease. Further research is needed to identify the mechanisms underlying this association.
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Affiliation(s)
- Nadine Hamieh
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Équipe de Recherche en Épidémiologie Sociale, F75012, Paris, France.
| | - Pierre Meneton
- INSERM U1142 LIMICS, UMRS 1142, Sorbonne Universities, UPMC University of Paris 06, University of Paris 13, Paris, France
| | - Marie Zins
- Université de Paris, Faculty of Medicine, Paris, France; INSERM, Population-based Epidemiological Cohorts Unit, UMS 011, Villejuif, France
| | - Marcel Goldberg
- Université de Paris, Faculty of Medicine, Paris, France; INSERM, Population-based Epidemiological Cohorts Unit, UMS 011, Villejuif, France
| | - Emmanuel Wiernik
- INSERM, Population-based Epidemiological Cohorts Unit, UMS 011, Villejuif, France
| | | | - Frederic Limosin
- Université de Paris, Faculty of Medicine, Paris, France; AP-HP.Centre-Université de Paris, Hôpital européen Georges-Pompidou, Service de psychiatrie et d'addictologie de l'adulte et du sujet âgé, Paris, France; Université de Paris, INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Paris
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Équipe de Recherche en Épidémiologie Sociale, F75012, Paris, France
| | - Cedric Lemogne
- Université de Paris, Faculty of Medicine, Paris, France; AP-HP.Centre-Université de Paris, Hôpital européen Georges-Pompidou, Service de psychiatrie et d'addictologie de l'adulte et du sujet âgé, Paris, France; Université de Paris, INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Paris
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Mental consequences and behavioral health 18 month after outpatient cardiac rehabilitation in three separated profiles at baseline. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Farooqi A, Khunti K, Abner S, Gillies C, Morriss R, Seidu S. Comorbid depression and risk of cardiac events and cardiac mortality in people with diabetes: A systematic review and meta-analysis. Diabetes Res Clin Pract 2019; 156:107816. [PMID: 31421139 DOI: 10.1016/j.diabres.2019.107816] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 07/23/2019] [Accepted: 08/12/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the association of comorbid occurrence of diabetes and depression with risk of cardiovascular endpoints including cardiovascular mortality, coronary heart disease and stroke. RESEARCH DESIGN AND METHODS A systematic review and metaanalysis. We searched PUBMED/MEDLINE, Medscape, Cochrane Library, CINAHL, EMBASE and Scopus databases assessing cardiac events and mortality associated with depression in diabetes up until 1 December 2018. Pooled hazard ratios were calculated using random- effects models. RESULTS Nine studies met the inclusion criteria. The combined pooled hazard ratios showed a significant association of cardiac events in people with depression and type 2 diabetes, compared to those with type 2 diabetes alone. For cardiovascular mortality the pooled hazard ratio was 1.48 (95% CI: 1.185, 1.845), p = 0.001, for coronary heart disease 1.37 (1.165, 1.605), p < 0.001 and for stroke 1.33 (1.291, 1.369), p < 0.001. Heterogeneity was high in the meta-analysis for stroke events (I-squared = 84.7%) but was lower for coronary heart disease and cardiovascular mortality (15% and 43.4% respectively). Meta-regression analyses showed that depression was not significantly associated with the study level covariates mean age, duration of diabetes, length of follow-up, BMI, sex and ethnicity (p < 0.05 for all models). Only three studies were found that examined the association of depression in type 1 diabetes, there was a high degree of heterogeneity and data synthesis was not conducted for these studies. CONCLUSIONS We have demonstrated a 47.9% increase in cardiovascular mortality, 36.8% increase in coronary heart disease and 32.9% increase in stroke in people with diabetes and comorbid depression. The presence of depression in a person with diabetes should trigger the consideration of evidence-based therapies for cardiovascular disease prevention irrespective of the baseline risk of cardiovascular disease or duration of diabetes.
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Affiliation(s)
- A Farooqi
- Birmingham City University, Faculty of Business, Law and Social Sciences, Birmingham B4 7BD, UK.
| | - K Khunti
- Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK.
| | - S Abner
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK.
| | - C Gillies
- Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK.
| | - R Morriss
- University of Nottingham, Institute of Mental Health, Nottingham NG8 1BB, UK.
| | - S Seidu
- Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK.
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O'Keefe EL, O'Keefe JH, Lavie CJ. Exercise Counteracts the Cardiotoxicity of Psychosocial Stress. Mayo Clin Proc 2019; 94:1852-1864. [PMID: 31451292 DOI: 10.1016/j.mayocp.2019.02.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/15/2019] [Accepted: 02/19/2019] [Indexed: 12/12/2022]
Abstract
Physical inactivity and psychosocial stress are prevalent in residents of the United States. The purpose of this article is to review the interaction between these 2 conditions and examine the effects of exercise on stress and cardiovascular (CV) health. A query of scientific references between 1974 to 2018 was performed using the PubMed search engine accessing the MEDLINE database using the search terms psychosocial stress, CV disease (CVD), physical activity, exercise, cardiac rehabilitation, and team sports. Psychosocial stress is a strong independent risk factor for adverse CV events. Conversely, people who experience CV events subsequently have drastically elevated rates of new-onset mental health disorders, including depression and anxiety. Psychosocial stress and CVD often trigger self-reinforcing feedback loops that can worsen mental health and cardiac prognosis. Exercise predictably improves CV health and prognosis and also is effective at lowering levels of psychosocial stress. Group exercise in particular seems to provide social support while at the same time boosting fitness levels and, thus, may be the single most important intervention for patients with concomitant CVD and emotional stress. Collaborative physical activity, such as group exercise, team sports, interactive physical play, and cardiac rehabilitation programs, have the potential to improve mental health and CV prognosis.
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Affiliation(s)
- Evan L O'Keefe
- Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - James H O'Keefe
- University of Missouri-Kansas City and Saint Luke's Mid America Heart Institute, New Orleans, LA
| | - Carl J Lavie
- Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA; Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, New Orleans, LA.
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16
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Kachur S, Lavie CJ, Morera R, Ozemek C, Milani RV. Exercise training and cardiac rehabilitation in cardiovascular disease. Expert Rev Cardiovasc Ther 2019; 17:585-596. [DOI: 10.1080/14779072.2019.1651198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sergey Kachur
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, USA
| | - Carl J. Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, USA
| | - Rebecca Morera
- Department of Graduate Medical Education, Ocala Regional Medical Center, Ocala, FL, USA
| | - Cemal Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Richard V. Milani
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, USA
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Adherence to Treatment of Female Patients With Coronary Heart Disease After a Percutaneous Coronary Intervention. J Cardiovasc Nurs 2019; 34:410-417. [PMID: 31365439 DOI: 10.1097/jcn.0000000000000592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adherence to treatment is essential to prevent the progression of coronary heart disease (CHD), which is the most common cause of death among women. Coronary heart disease in women has special characteristics: the conventional risk factors are more harmful to women than men, accumulation of risk factors is common, and women have nontraditional risk factors such as gestational diabetes and preeclampsia. In addition, worse outcomes, higher incidence of death, and complications after percutaneous coronary intervention have been reported more often among females than among male patients. OBJECTIVE The aim of this study was to test a model of adherence to treatment among female patients with CHD after a percutaneous coronary intervention. METHODS A cross-sectional, descriptive, and explanatory survey was conducted in 2013 with 416 patients with CHD, of which the 102 female patients were included in this substudy. Self-reported instruments were used to assess female patient adherence to treatment. Data were analyzed using descriptive statistics and a structural equation model. RESULTS Motivation was the strongest predictor for female patients' perceived adherence to treatment. Informational support, physician support, perceived health, and physical activity were indirectly, but significantly, associated with perceived adherence to treatment via motivation. Furthermore, physical activity was positively associated with perceived health, whereas anxiety and depression were negatively associated with it. CONCLUSIONS Secondary prevention programs and patient education have to take into account individual or unique differences. It is important to pay attention to issues that are known to contribute to motivation rather than to reply on education alone to improve adherence.
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18
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Sever S, Harrison AS, Golder S, Doherty P. Determinants of depression in patients with comorbid depression following cardiac rehabilitation. Open Heart 2019; 6:e000973. [PMID: 31168379 PMCID: PMC6519417 DOI: 10.1136/openhrt-2018-000973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/23/2019] [Accepted: 03/04/2019] [Indexed: 11/08/2022] Open
Abstract
Background A prior history of depression, at the point patients start cardiac rehabilitation (CR), is associated with poor outcomes; however, little is known about which factors play a part in determining the extent of benefit following CR. Therefore, we aim to identify and evaluate determinants of CR depression outcomes in patients with comorbid depression. Methods An observational study of routine practice using the British Heart Foundation National Audit of Cardiac Rehabilitation data between April 2012 and March 2017. Baseline characteristics were examined with independent samples t-test and χ2 test. A binary logistic regression was used to predict change in depression outcome following CR. Results The analysis included 2715 CR participants with depression history. The determinants of Hospital Anxiety and Depression Scale (HADS) depression measurement post-CR were higher total number of comorbidities (OR 0.914, 95% CI 0.854 to 0.979), a higher HADS anxiety score (OR 0.883, 95% CI 0.851 to 0.917), physical inactivity (OR 0.707, 95% CI 0.514 to 0.971), not-smoking at baseline (OR 1.774, 95% CI 1.086 to 2.898) and male gender (OR 0.721, 95% CI 0.523 to 0.992). Conclusion Baseline characteristics of patients with comorbid depression such as higher anxiety, higher total number of comorbidities, smoking, physical inactivity and male gender were predictors of their depression levels following CR. CR programmes need to be aware of comorbid depression and these related patient characteristics associated with better CR outcomes.
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Affiliation(s)
| | | | - Su Golder
- Health Sciences, University of York, York, UK
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19
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De Schutter A, Kachur S, Lavie CJ, Menezes A, Shum KK, Bangalore S, Arena R, Milani RV. Cardiac rehabilitation fitness changes and subsequent survival. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 4:173-179. [PMID: 29701805 DOI: 10.1093/ehjqcco/qcy018] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/25/2018] [Indexed: 02/07/2023]
Abstract
Aims Assessments of cardiac rehabilitation (CR) in coronary heart disease (CHD) cohorts usually examine mortality in aggregate. This study examines the prognosis and characteristics of patients who enrolled and completed CR, stratified by their level of improvement in cardiorespiratory fitness (CRF) by examining the characteristics, outcomes and predictors of non-response in CRF (NonRes) compared with low-responders (LowRes) and high-responders (HighRes) after CR. Methods and results A total of 1171 CHD patients were referred for a phase II CR programme after therapy for an acute coronary syndrome, coronary artery bypass graft procedure or a percutaneous coronary intervention between 1 January 2000 and 30 June 2013 underwent cardiopulmonary exercise testing before and after CR. This cohort was divided according to absolute improvements in CRF (i.e. change in peak oxygen consumption expressed in mL⋅kg-1⋅min-1). Mortality was analysed after 0.5-13.4 years of follow-up (mean 6.4 years). A total of 266 (23%) subjects were NonRes. After adjustment for body mass index, age, gender, left ventricular ejection fraction and baseline CRF, NonRes, and LowRes had a statistically significant three-fold and two-fold higher mortality, respectively, when compared with HighRes (HighRes 8% vs. LowRes 17% vs. NonRes 22%; P < 0.001). Age, female gender, baseline CRF, hostility, and presence of diabetes were significant predictors of NonRes and LowRes. In addition, higher waist circumference was a predictor of NonRes. Conclusion Significant proportions of subjects referred to CR have no/low improvement in CRF and higher associated mortality risks. Greater attention is required to increase improvements in CRF following CR and avoid NonRes.
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Affiliation(s)
- Alban De Schutter
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, USA
| | - Sergey Kachur
- Department of Graduate Medical Education, Ocala Regional Medical Center, 1431 SW 1st Ave, Ocala, FL, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, USA
| | - Arthur Menezes
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, USA
| | - Kelly K Shum
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, USA
| | - Sripal Bangalore
- Leon H. Charney Division of Cardiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA
| | - Ross Arena
- Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W Taylor St, Chicago, IL, USA
| | - Richard V Milani
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, USA
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20
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Gathright EC, Busch AM, Buckley ML, Stabile L, DeAngelis J, Whited MC, Wu WC. Improvements in Depressive Symptoms and Affect During Cardiac Rehabilitation: PREDICTORS AND POTENTIAL MECHANISMS. J Cardiopulm Rehabil Prev 2019; 39:27-32. [PMID: 30142128 PMCID: PMC6309925 DOI: 10.1097/hcr.0000000000000346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE Depression is indicative of poor prognosis in cardiac patients. Reductions in depression have been observed following cardiac rehabilitation (CR). Whether similar improvements in positive and negative affect occur is unknown. Greater understanding of depressive symptom and affect change is needed to enhance facilitators of emotional improvement after a cardiac event. METHODS Cardiac rehabilitation attendees (n = 637) completed measures of depressive symptoms, affect, health status, and social support at CR intake and discharge. Body mass index, metabolic equivalents, and blood pressure were also measured. Relationships between changes in psychosocial and physical health indicators and depressive symptoms, positive affect, and negative affect were examined. RESULTS From intake to discharge, depressive symptoms (d = 0.40, P < .001) and negative affect (d = 0.26, P < .001) decreased. Positive affect increased (d = 0.34, P < .001). In multivariate regression, predictors of depressive symptom reduction were increased vitality (β = -.26) and decreased bodily pain (β = -.08). Predictors of positive affect increase were increased vitality (β = .25), social support (β = .16), and physical role functioning (β = .09). Predictors of negative affect reduction were increased vitality (β = -.23) and social support (β = -.10). Changes in indicators of physical health were not related to depressive symptom or affect change. CONCLUSIONS Depressive symptom and affect improvements following CR were observed and most strongly associated with improvements in vitality and social support. Future research should explore how enhancement of these mechanisms may further improve depressive symptom and affect during CR.
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Affiliation(s)
- Emily C. Gathright
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI
| | - Andrew M. Busch
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI
| | - Maria L. Buckley
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI
- The Miriam Hospital, Providence RI
| | | | | | | | - Wen-Chih Wu
- The Miriam Hospital, Providence RI
- Department of Medicine, Alpert Medical School, Brown University, and Veterans Affairs Hospital, Providence, RI
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Kazukauskiene N, Burkauskas J, Macijauskiene J, Duoneliene I, Gelziniene V, Jakumaite V, Brozaitiene J. Mental Distress Factors and Exercise Capacity in Patients with Coronary Artery Disease Attending Cardiac Rehabilitation Program. Int J Behav Med 2018; 25:38-48. [PMID: 28702757 DOI: 10.1007/s12529-017-9675-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE There is still insufficient data on mental distress factors contributing to exercise capacity (EC) improvement before and after cardiac rehabilitation (CR) in patients with coronary artery disease (CAD). The aim of our study was to evaluate the associations between various mental distress factors and EC before and after exercise-based CR (EBCR). METHODS Over 12 months, 223 CAD patients (70% men, mean age 58 ± 9 years) were evaluated for socio-demographic, clinical, and mental distress symptoms as measured by the Hospital Anxiety and Depression scale (HADS), Beck Depression Inventory-II (BDI-II), and Spielberger State-Trait Anxiety Inventory (STAI). Patients were tested for EC at baseline and after EBCR. RESULTS In a multivariate linear regression model, EC before EBCR was associated with HADS anxiety subscale (β = -.186, p = .002) and BDI-II somatic/affective subscale (β = -.249, p < .001). EC after EBCR was associated with HADS anxiety and depression subscales (β = -.198, p < .001; β = -.170, p = .002, respectively) and BDI-II (β = -.258, p < .001). The BDI-II somatic/affective subscale was the best predictor of reduced EC before and after EBCR. CONCLUSIONS Mental distress and somatic/affective symptoms of depression are strongly associated with EC both at the beginning and after EBCR. Analysis of possible mediating or moderating factors was beyond the scope of our study. Future studies should focus on comprehensive evaluation of EC risk factors including other mental distress characteristics, subjectively experienced fatigue, and post-operative CAD symptoms.
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Affiliation(s)
- Nijole Kazukauskiene
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Vyduno al. 4, LT-00135, Palanga, Lithuania
| | - Julius Burkauskas
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Vyduno al. 4, LT-00135, Palanga, Lithuania.
| | - Jurate Macijauskiene
- Faculty of Nursing, Lithuanian University of Health Sciences, A. Mickeviciaus str. 9, LT-44313, Kaunas, Lithuania
| | - Inga Duoneliene
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Vyduno al. 4, LT-00135, Palanga, Lithuania
| | - Vaidute Gelziniene
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Vyduno al. 4, LT-00135, Palanga, Lithuania
| | - Vilija Jakumaite
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Vyduno al. 4, LT-00135, Palanga, Lithuania
| | - Julija Brozaitiene
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Vyduno al. 4, LT-00135, Palanga, Lithuania
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Caru M, Curnier D, Bousquet M, Kern L. Evolution of depression during rehabilitation program in patients with cardiovascular diseases. Disabil Rehabil 2018; 42:378-384. [PMID: 30299991 DOI: 10.1080/09638288.2018.1499824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Cardiovascular diseases represent the main cause of death in the world. Rehabilitation through exercise is more and more used in cardiac patients. Given that these patients suffer from depressive symptoms, the risk of having recurrent cardiovascular problems increases. Thus, the aim of this study is to identify the effects of a rehabilitation program on the physiological and psychological parameters; with a particular attention on the depression scores between the scales.Methods: Twenty-eight cardiac patients participated in this study during a cardiovascular rehabilitation program. They are tested at their entry and at their exit with an evaluation of their physical fitness on an electromagnetic cycle ergometer and by four depression scales (Beck Depression Inventory, Hospital Anxiety and Depression Scale (HADS), Center for Epidemiologic Studies - Depression and Geriatric Depression Screening).Results: We observe that 21.4-50% of these patients have depressive symptoms, according to depression scales. The women have depression scores significantly higher than the men. The rehabilitation program improves their maximal oxygen consumption and their maximal aerobic power. At the end of the rehabilitation program, our analysis identifies a significant decrease in the depression score for the HADS. Regardless of the physical deconditioning level and of the improvement of the maximal oxygen consumption, our results show an effect of the rehabilitation program on the depression scores. No correlation between the physical deconditioning and the different depression scores is observed.Conclusions: This study shows the importance of measuring depression and its severity to improve the care of patients. Our findings show that between 21.4% and 50% of patients have depressive symptoms which challenges the categorical approach of the self-report depression scales.Implications for rehabilitationDepression and cardiovascular diseases have an impact on the patients' physical fitness.The rehabilitation program, primarily based around exercise, reduces depressive symptoms.As soon as cardiovascular diseases patients enter in a rehabilitation program, the depression should be measured by a psychologist.Taking into account the depressive symptoms of the patients as soon as their cardiac event occurs makes it possible to improve the care of patients.
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Affiliation(s)
- M Caru
- Department of Psychology, University of Paris Nanterre, Nanterre, France.,Department of Kinesiology, Laboratory of Pathophysiology of EXercise (LPEX), University of Montreal, Montreal, Canada.,Laboratoire EA 4430 - Clinique Psychanalyse Developpement (CliPsyD), University of Paris Ouest Nanterre La Defense, Nanterre, France
| | - D Curnier
- Department of Kinesiology, Laboratory of Pathophysiology of EXercise (LPEX), University of Montreal, Montreal, Canada.,University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
| | - M Bousquet
- Saint-Orens Cardiovascular and Pulmonary Rehabilitation Center, Saint-Orens-de-Gameville, France
| | - L Kern
- Laboratoire EA 4430 - Clinique Psychanalyse Developpement (CliPsyD), University of Paris Ouest Nanterre La Defense, Nanterre, France.,Department of Science and Technology of Physical Activities and Sports, University of Paris Nanterre, Nanterre, France.,Laboratoire EA 2931 - Centre de recherches sur le sport et le mouvement (CeRSM), UFR STAPS, University of Paris Nanterre, Nanterre, France
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Carlsen T, Salvesen Ø, Sui X, Lavie CJ, Blair SN, Wisløff U, Ernstsen L. Long-term Changes in Depressive Symptoms and Estimated Cardiorespiratory Fitness and Risk of All-Cause Mortality: The Nord-Trøndelag Health Study. Mayo Clin Proc 2018; 93:1054-1064. [PMID: 29625728 DOI: 10.1016/j.mayocp.2018.01.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/20/2017] [Accepted: 01/12/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess the independent and combined associations of long-term changes in depressive symptoms (DSs) and estimated cardiorespiratory fitness (eCRF) with all-cause mortality. PARTICIPANTS AND METHODS This is a longitudinal cohort study of 15,217 middle-aged and older individuals attending both the second (from August 15, 1995, through June 18, 1997) and third (from October 3, 2006, through June 25, 2008) health surveys of the Nord-Trøndelag Health Study, Norway, and followed until December 31, 2014. Depressive symptoms were estimated using the validated Hospital Anxiety and Depression Scale, and a validated nonexercise model estimated eCRF. Hazard ratios (HRs) were computed using Cox regression. All-cause mortality was ascertained using the Norwegian Cause of Death Registry. RESULTS The mean age was 63.3±8.9 years, and 7932 (52.1%) were women. During the follow-up period of 7.1±1.1 years, 1157 participants (7.6%) died. Multivariable-adjusted analyses revealed that persistently low DSs were independently associated with a 28% risk reduction of all-cause mortality (HR, 0.72; 95% CI, 0.56-0.92; P=.008) as compared with persistently high DSs. Persistently high eCRF independently predicted a 26% lower risk of death (HR, 0.76; 95% CI, 0.66-0.88; P<.001) relative to low eCRF. Analyses of changes in DSs and eCRF revealed that persistently high eCRF combined with decreased or persistently low DSs decreased mortality risk by 49% (HR, 0.51; 95% CI, 0.28-0.91; P=.02) and 47% (HR, 0.53; 95% CI, 0.37-0.76, P=.001), respectively. CONCLUSION Maintaining low DSs and high eCRF was independently associated with a lower risk of all-cause mortality. The lowest mortality risk was observed for persistently high eCRF combined with decreased or persistently low DSs. These results emphasize the effect of preventing DSs and maintaining high CRF on long-term mortality risk, which is potentially important for long-term population health.
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Affiliation(s)
- Trude Carlsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Xuemei Sui
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Steven N Blair
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia
| | - Ulrik Wisløff
- K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia
| | - Linda Ernstsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
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Qian Z, Lv D, Lv Y, Bi Z. Modeling and Quantification of Impact of Psychological Factors on Rehabilitation of Stroke Patients. IEEE J Biomed Health Inform 2018; 23:683-692. [PMID: 29993937 DOI: 10.1109/jbhi.2018.2827100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The brain damage could lead to the loss of the central nervous system, so a stroke patient may lose the function of dominating his/her body. The rehabilitation aims to maximize the potential to restore a patient who has an impairment. Traditional rehabilitation is to train a patient's muscles and joints under the guidance of doctors to improve the strength of muscles and restore the motor function of joints. However, stroke patients are usually depressed, lonely, and irritable, and they might easily generate negative emotions during a rehabilitation process. With a sole goal of helping patients restore their body functions from the physiology perspective, the traditional rehabilitation took little consideration on the impact of rehabilitation, which is reflected and measured from the perspective of emotions. Therefore, we suggest adding affective regulation to the stroke rehabilitation; in such a way, the patients' exercise could be completed with high intrinsic motivation, and the performance of the rehabilitation process can be enhanced. Two main contributions in the presented works are: 1) the expanded emotional model to represent the status of stroke patients where the impact of psychological factors can be taken into consideration and 2) the quantifiable measurement of rehabilitation performance as well as the corresponding design of experiments to verify the positive impact of psychological adjustment on human subjects. Note that due to the limited conditions, the experimental verification was performed on healthy college students. Since our work focused on modeling and quantification of psychological factors, it is reasonable to expend our work to other human subjects including stoke patients.
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Correlates of memory loss and depression among myocardial infarction patients in Al-Qassim, Saudi Arabia. J Saudi Heart Assoc 2018; 30:240-246. [PMID: 29983498 PMCID: PMC6026394 DOI: 10.1016/j.jsha.2018.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/20/2018] [Accepted: 04/18/2018] [Indexed: 11/21/2022] Open
Abstract
Background After myocardial infarction (MI), patients have an elevated risk for depression, which has a negative impact on morbidity and mortality for patients. As depression and memory function are associated, we examined them in the context of one another. Our objectives were to determine the proportion of patients with either depression only, memory loss only, or both depression and memory loss and to examine the correlates with each outcome. Methods This study was a cohort of 264 patients who had myocardial infarction. Data sources included medical records and phone interviews. Results The participants’ mean age was 62 ± 12.2 years and mean body mass index was 28.4 ± 5.8 kg/m2. Of the participants, 6.4% had memory loss alone, 23.17% had depression alone, and 6.1% had combined memory loss and depression. Activity level and poor health were significantly associated with depression only (p < 0.05). Poor health was significantly associated with combined memory loss and depression (p < 0.05). Conclusion Activity level and poor health were identified as correlates of depression as well as combined memory loss and depression. Future studies should aim to improve screening for depression among post-MI patients and develop appropriate interventions to raise the level of activity.
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Lavie CJ, Sui X, Milani RV. Emotional distress after myocardial infarction: Importance of cardiorespiratory fitness. Eur J Prev Cardiol 2018; 25:906-909. [DOI: 10.1177/2047487318770516] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, USA
| | - Xuemei Sui
- Department of Exercise Science, University of South Carolina, USA
| | - Richard V Milani
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, USA
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Nedeljkovic I. Assessment of depression and anxiety in patients before and after percutaneous coronary intervention: A step forward in cardiac rehabilitation? Eur J Prev Cardiol 2018; 25:1015-1016. [PMID: 29707962 DOI: 10.1177/2047487318774094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ivana Nedeljkovic
- 1 Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.,2 School of Medicine, University of Belgrade, Serbia
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Spatola CAM, Cappella EAM, Goodwin CL, Castelnuovo G, Cattivelli R, Rapelli G, Malfatto G, Facchini M, Mollica C, Molinari E. Cross-Lagged Relations Between Exercise Capacity and Psychological Distress During Cardiac Rehabilitation. Ann Behav Med 2018; 52:963-972. [DOI: 10.1093/abm/kax069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Chiara A M Spatola
- Psychology Research Laboratory, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Emanuele A M Cappella
- Psychology Research Laboratory, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | | | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Roberto Cattivelli
- Psychology Research Laboratory, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Giada Rapelli
- Psychology Research Laboratory, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Gabriella Malfatto
- Cardiology Division, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Mario Facchini
- Cardiology Division, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Chiara Mollica
- Cardiology Division, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Enrico Molinari
- Psychology Research Laboratory, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
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Xie B, Su Z, Zhang W, Cai R. Chinese Cardiovascular Disease Mobile Apps' Information Types, Information Quality, and Interactive Functions for Self-Management: Systematic Review. JMIR Mhealth Uhealth 2017; 5:e195. [PMID: 29242176 PMCID: PMC5746618 DOI: 10.2196/mhealth.8549] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/16/2017] [Accepted: 11/02/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND China has a large population with cardiovascular disease (CVD) that requires extensive self-management. Mobile health (mHealth) apps may be a useful tool for CVD self-management. Little is currently known about the types and quality of health information provided in Chinese CVD mobile apps and whether app functions are conducive to promoting CVD self-management. OBJECTIVE We undertook a systematic review to evaluate the types and quality of health information provided in Chinese CVD mobile apps and interactive app functions for promoting CVD self-management. METHODS Mobile apps targeting end users in China with CVD conditions were selected in February 2017 through a multi-stage process. Three frameworks were used to evaluate the selected apps: (1) types of health information offered were assessed using our Health Information Wants framework, which encompasses 7 types of information; (2) quality of information provided in the apps was assessed using the 11 guidelines recommended by the National Library of Medicine of the National Institutes of Health; and (3) types of interactive app functions for CVD self-management were assessed using a 15-item framework adapted from the literature, including our own prior work. RESULTS Of 578 apps identified, 82 were eligible for final review. Among these, information about self-care (67/82, 82%) and information specifically regarding CVD (63/82, 77%) were the most common types of information provided, while information about health care providers (22/82, 27%) and laboratory tests (5/82, 6%) were least common. The most common indicators of information quality were the revealing of apps' providers (82/82, 100%) and purpose (82/82, 100%), while the least common quality indicators were the revealing of how apps' information was selected (1/82, 1%) and app sponsorship (0/82, 0%). The most common interactive functions for CVD self-management were those that enabled user interaction with the app provider (57/82, 70%) and with health care providers (36/82, 44%), while the least common interactive functions were those that enabled lifestyle management (13/82, 16%) and psychological health management (6/82, 7%). None of the apps covered all 7 types of health information, all 11 indicators of information quality, or all 15 interactive functions for CVD self-management. CONCLUSIONS Chinese CVD apps are insufficient in providing comprehensive health information, high-quality information, and interactive functions to facilitate CVD self-management. End users should exercise caution when using existing apps. Health care professionals and app developers should collaborate to better understand end users' preferences and follow evidence-based guidelines to develop mHealth apps conducive to CVD self-management.
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Affiliation(s)
- Bo Xie
- School of Nursing, The University of Texas at Austin, Austin, TX, United States
- School of Information, The University of Texas at Austin, Austin, TX, United States
| | - Zhaohui Su
- School of Advertising and Public Relations, The University of Texas at Austin, Austin, TX, United States
| | - Wenhui Zhang
- School of Nursing, The University of Texas at Austin, Austin, TX, United States
- Department of Statistics and Data Science, The University of Texas at Austin, Austin, TX, United States
| | - Run Cai
- Chongqing Cancer Institute, Chongqing, China
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Smith PJ, Sherwood A, Mabe S, Watkins L, Hinderliter A, Blumenthal JA. Physical activity and psychosocial function following cardiac rehabilitation: One-year follow-up of the ENHANCED study. Gen Hosp Psychiatry 2017; 49:32-36. [PMID: 29122147 PMCID: PMC5726411 DOI: 10.1016/j.genhosppsych.2017.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/25/2017] [Accepted: 05/02/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To examine the long-term association between physical activity (PA) and psychosocial functioning following completion of cardiac rehabilitation (CR) among participants in the ENHANCED study. METHOD ENHANCED was a 3-month clinical trial examining standard CR with and without stress management training (SMT). Participants completed the Leisure-Time Exercise Questionnaire (LTEQ), Beck Depression Inventory-II (BDI-II), and the Spielberger State-Trait Anxiety Inventory (STAI) at baseline, 3- and 12-months after randomization. Prospective associations between physical activity and psychosocial function, as well as treatment group differences, were examined using repeated measures mixed modeling. RESULTS One hundred nineteen participants were available at 12month follow-up. During the 12-month follow-up, PA remained higher compared to baseline (P<0.001), with the majority of participants reporting that they engaged in PA on a regular basis. Depressive and anxious symptoms continued to remain lower than baseline (Ps<0.001) Higher levels of PA at 12-month follow-up were associated with lower depressive (P=0.032) and anxious (P=0.003) symptoms. CONCLUSIONS Higher physical activity levels following CR are associated with lower depressive and anxious symptoms. Encouraging patients to sustain higher levels of PA may promote both cardiovascular and mental health.
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Affiliation(s)
- Patrick J. Smith
- Department of Psychiatry and Behavioral Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stephanie Mabe
- Department of Psychiatry and Behavioral Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lana Watkins
- Department of Psychiatry and Behavioral Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alan Hinderliter
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Kachur S, Rahim F, Lavie CJ, Morledge M, Cash M, Dinshaw H, Milani R. Cardiac Rehabilitation and Exercise Training in the Elderly. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0224-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rethorst CD, Leonard D, Barlow CE, Willis BL, Trivedi MH, DeFina LF. Effects of depression, metabolic syndrome, and cardiorespiratory fitness on mortality: results from the Cooper Center Longitudinal Study. Psychol Med 2017; 47:2414-2420. [PMID: 28414015 PMCID: PMC6036919 DOI: 10.1017/s0033291717000897] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Depression and metabolic syndrome (MetS) are frequently comorbid disorders that are independently associated with premature mortality. Conversely, cardiorespiratory fitness (CRF) is associated with reduced mortality risk. These factors may interact to impact mortality; however, their effects have not been assessed concurrently. This analysis assessed the mortality risk of comorbid depression/MetS and the effect of CRF on mortality in those with depression/MetS. METHODS Prospective study of 47 702 adults in the Cooper Center Longitudinal Study. Mortality status was attained from the National Death Index. History of depression was determined by patient response (yes or no) to a standardized medical history questionnaire. MetS was categorized using the American Heart Association/National Heart, Lung, and Blood Institute criteria. CRF was estimated from the final speed/grade of a treadmill graded exercise test. RESULTS 13.9% reported a history of depression, 21.4% met criteria for MetS, and 3.0% met criteria for both MetS and history of depression. History of depression (HR = 1.24, p = 0.003) and MetS (HR = 1.28, p < 0.001) were independently associated with an increased mortality risk, with the greatest mortality risk among individuals with both a history of depression and MetS (HR = 1.59, p < 0.001). Higher CRF was associated with a significantly lower risk of mortality (p < 0.001) in all individuals, including those with MetS and/or a history of depression. CONCLUSIONS Those with higher levels CRF had reduced mortality risk in the context of depression/MetS. Interventions that improve CRF could have substantial impact on the health of persons with depression/MetS.
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Affiliation(s)
- C. D. Rethorst
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | - M. H. Trivedi
- Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Turner KM, Winder R, Campbell JL, Richards DA, Gandhi M, Dickens CM, Richards S. Patients' and nurses' views on providing psychological support within cardiac rehabilitation programmes: a qualitative study. BMJ Open 2017; 7:e017510. [PMID: 28864707 PMCID: PMC5589022 DOI: 10.1136/bmjopen-2017-017510] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To explore patients' and nurses' views on the feasibility and acceptability of providing psychological care within cardiac rehabilitation services. DESIGN In-depth interviews analysed thematically. PARTICIPANTS 18 patients and 7 cardiac nurses taking part in a pilot trial (CADENCE) of an enhanced psychological care intervention delivered within cardiac rehabilitation programmes by nurses to patients with symptoms of depression. SETTING Cardiac services based in the South West of England and the East Midlands, UK. RESULTS Patients and nurses viewed psychological support as central to good cardiac rehabilitation. Patients' accounts highlighted the significant and immediate adverse effect a cardiac event can have on an individual's mental well-being. They also showed that patients valued nurses attending to both their mental and physical health, and felt this was essential to their overall recovery. Nurses were committed to providing psychological support, believed it benefited patients, and advocated for this support to be delivered within cardiac rehabilitation programmes rather than within a parallel healthcare service. However, nurses were time-constrained and found it challenging to provide psychological care within their existing workloads. CONCLUSIONS Both patients and nurses highly value psychological support being delivered within cardiac rehabilitation programmes but resource constraints raise barriers to implementation. Consideration, therefore, should be given to alternative forms of delivery which do not rely solely on nurses to enable patients to receive psychological support during cardiac rehabilitation. TRIAL REGISTRATION NUMBER ISCTRN34701576.
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Affiliation(s)
- Katrina M Turner
- Population Health Sciences, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), Bristol, UK
| | - Rachel Winder
- University of Exeter Medical School, Exeter, Devon, UK
| | | | | | - Manish Gandhi
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Suzanne Richards
- University of Exeter Medical School, Exeter, Devon, UK
- Leeds Institute of Health Research, Leeds, UK
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Impact of cardiac rehabilitation and exercise training programs in coronary heart disease. Prog Cardiovasc Dis 2017; 60:103-114. [PMID: 28689854 DOI: 10.1016/j.pcad.2017.07.002] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/04/2017] [Indexed: 12/14/2022]
Abstract
Cardiovascular rehabilitation (CR) is the process of developing and maintaining an optimal level of physical, social, and psychological well-being in order to promote recovery from cardiovascular (CV) illness. It is a multi-disciplinary approach encompassing supervised exercise training, patient counseling, education and nutritional guidance that may also enhance quality of life. Beneficial CV effects may include improving coronary heart disease risk factors; particularly exercise capacity, reversing cardiac remodeling, and favorably modifying metabolism and systemic oxygen transport. We review the historical basis for contemporary CR, the indications and critical components of CR, as well as the potential salutary physiological and clinical effects of exercise-based CR.
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Sui X, Ott J, Becofsky K, Lavie CJ, Ernstsen L, Zhang J, Blair SN. Cardiorespiratory Fitness and All-Cause Mortality in Men With Emotional Distress. Mayo Clin Proc 2017; 92:918-924. [PMID: 28499513 PMCID: PMC5524050 DOI: 10.1016/j.mayocp.2017.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 01/03/2017] [Accepted: 01/27/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Mental health and emotional disorders are often associated with higher mortality risk. Whether higher cardiorespiratory fitness (CRF) reduces the risk for all-cause mortality in individuals with emotional distress is not well known. PATIENTS AND METHODS Participants were 5240 men (mean age 46.5±9.5 years) with emotional distress (including depression, anxiety, thoughts of suicide, or a history of psychiatric or psychological counseling) who completed an extensive medical examination between 1987 and 2002, and were followed for all-cause mortality through December 31, 2003. Cardiorespiratory fitness was quantified as maximal treadmill exercise test duration and was grouped for analysis as low, moderate, and high. Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% CIs. RESULTS During a median of 8.7 years (range, 1.0-16.9 years) and 46,217 person-years of follow-up, there were 128 deaths from any cause. Age- and examination year-adjusted all-cause mortality rates per 10,000 person-years according to low, moderate, and high CRF groups were 64.7 (95% CI, 44.9-89.3), 28.0 (95% CI, 23.8-31.5), and 19.6 (95% CI, 17.1-21.6) (trend P<.001) in men who reported any emotional distress. Overall, the multivariable-adjusted HRs and 95% CIs across incremental CRF categories were 1.00 (referent), 0.54 (0.32-0.90), and 0.47 (0.26-0.85), linear trend P =.03. CONCLUSION Among men with emotional distress, higher CRF is associated with lower risk of dying, independent of other clinical mortality predictors. Our findings underscore the importance of promoting physical activity to maintain a healthful level of CRF in individuals with emotional distress.
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Affiliation(s)
- Xuemei Sui
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Reprints and Correspondence: Xuemei Sui, MD, MPH, PhD, 921 Assembly Street, Columbia, SC 29208; Telephone: 803-777-3881; Fax: 803-777-2504;
| | - John Ott
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Reprints and Correspondence: Xuemei Sui, MD, MPH, PhD, 921 Assembly Street, Columbia, SC 29208; Telephone: 803-777-3881; Fax: 803-777-2504;
| | - Katie Becofsky
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA
| | - Carl J. Lavie
- Department of Cardiovascular Diseases, John Ochsner Hearth and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA
| | - Linda Ernstsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Steven N. Blair
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
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Abstract
INTRODUCTION Treatment of patients suffering from major depression could be highly challenging for psychiatrists. Intractability as well as relapse is commonly seen among these patients, leading to functional impairment and poor quality of life. The present review discusses some of the novel investigational drugs that are under pre-clinical or clinical phases in the treatment of major depression. Areas covered: Molecules belonging to different classes such as triple reuptake inhibitors, opioid receptors, ionotropic and metabotropic glutamate receptors, and neurotrophin in the treatment of major depression are covered in this article. Expert opinion: Although the historical discovery of earlier antidepressant molecules (iproniazid and imipramine) is through serendipitous discovery, the present research focuses on discovering novel molecules based on our current pathophysiological knowledge of the disease condition. The fast-acting antidepressant property of N-methyl-d-aspartate (NMDA) receptor molecules, including ketamine is an exciting area of research. Other drug molecules such as amitifadine (triple reuptake inhibitor), ALKS-5461 (kappa receptor antagonist and mu opioidergic receptor agonist), rapastinel (NMDA glutamatergic receptor modulator) are under Phase-III clinical trials and could be approved in the near future for the treatment of major depression.
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Affiliation(s)
- Ashish Dhir
- a Department of Neurology, School of Medicine , University of California Davis , Sacramento , CA , USA
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