Cardiac rehabilitation: The psychological changes that predict health outcome and healthy behaviour

Abstract

Although there is good evidence that cardiac rehabilitation is effective in improving health outcomes, little is known about the psychological changes that may contribute to these outcomes. This study describes changes in cognition, emotion, behaviour, and health following cardiac rehabilitation and investigates predictors of health outcome and healthy behaviour. Sixty-two people were followed up 2 months after the end of a cardiac rehabilitation programme and 29 people were followed up for 8 months. Compared with before the programme, patients showed increased perceived control over their illness, more confidence in their ability to change their eating habits, and decreased anxiety and depression at both 2 and 8 months after the end of the programme. The increase in perceived control, predicted anxiety and depression 2 months after the course and increased confidence in change predicted better mental health 8 months after. The decrease in depression predicted lower anxiety at 8 weeks and lower anxiety, depression and better mental health at 8 months. The decrease in anxiety predicted lower depression at 8 weeks and lower anxiety, depression, and a trend towards better physical health at 8 months. These results suggest that changing health cognitions after myocardial infarction may reduce distress and this may have long-term benefits for physical health.

Those who perceive their disease as a physiological or psychological risk factor experience more anxiety at the beginning of the cardiac rehabilitation program

“…In contrast, the patients who deemed the physiological and psychological risk factors the reason behind their cardiac condition felt that they had no control over their present conditions and, therefore, suffered from higher anxiety levels. Accordingly, based on the theory of Michie et al (2005), higher anxiety among our cardiac patients can be predicted by their perceived lack of control over their illness (15). The other findings of the current study indicated no significant difference between the patients who related their cardiac condition to the biological or environmental factors and those who recognized the behavioral, physiological, and psychological factors as the cause of their disease.…”

“…The results demonstrated that those who regarded physiological and psychological factors as the cause of their disease showed more anxiety than those who considered behavioral factors as the reason for their disease. This finding can be clarified by a theory proposed by Michie et al (2005), who argued that in patients with MI, increased perceived control over the cardiac condition decreases anxiety and depression (15). Along the same lines, among our study population, it seems that the individuals who identified the behavioral risk factors such as unhealthy diet and physical inactivity as the underlying cause of their cardiac condition were no longer worried about the possible negative effects of these risk factors because they attributed their disease to one of these risk factors and, thus, sought to control them by improving their personal behaviors such as having a good diet and physical activity through rehabilitation programs.…”

Purposiveness, physical activity, and perceived health in cardiac patients

“…Moreover, even when cardiac rehabilitation is successful, the psychological mechanisms underlying positive health change are poorly understood [37]. Individuals who feel that their lives are meaningful and fulfilling may be motivated to comply with physicians' advice to engage in positive health behaviors [10,19].…”

Gender and quality of life and coping over one year after myocardial infarction: do men really have the upper hand?

“…This is a worrying finding that indicates loss of benefits gained from rehabilitation (in women, a similar effect was seen for the emotional QoL dimension). These benefits include the ability to control disease, reduction in anxiety and depression, and increased self-competence regarding modification of health-related behaviours [15]. Perhaps with good functioning of men, the therapeutic team is not alert enough and believes that the treatment goes well and prognosis is good.…”