How Do Depression, Anxiety and Stress Affect Physical Activity After Cardiac Rehabilitation?

What you need to know

• Depression symptoms were associated with less physical activity and more sedentary behavior in cardiac patients.
• On days when patients had more adjustment disorder symptoms than usual, they engaged in less moderate-to-vigorous physical activity.
• Anxiety symptoms showed some positive associations with light physical activity, contrary to expectations.
• Screening for and treating adjustment disorder and depression symptoms during cardiac rehabilitation may help improve physical activity levels.

The importance of physical activity after cardiac events

Regular physical activity is crucial for people recovering from cardiac events or living with heart disease. Exercise helps strengthen the heart, improve circulation, and reduce the risk of future cardiac problems. That’s why cardiac rehabilitation programs focus heavily on helping patients establish healthy exercise habits.

However, many patients struggle to stick to physical activity recommendations after completing rehabilitation. This study aimed to understand how daily symptoms of depression, anxiety, and stress-related adjustment disorder might impact physical activity levels in cardiac patients during rehabilitation and in the weeks after returning home.

What the researchers did

The study included 129 cardiac patients who were completing inpatient rehabilitation programs at four clinics in Switzerland. For about 4 weeks, patients wore activity trackers and completed daily questionnaires about their mental health symptoms. This allowed the researchers to examine how symptoms and activity levels changed from day to day for each individual patient.

The key mental health symptoms measured were:

• Adjustment disorder: Stress-related symptoms like intrusive thoughts about one’s heart condition or difficulty adapting to life after a cardiac event.
• Depression: Feelings of sadness, hopelessness, or loss of interest in activities.
• Anxiety: Excessive worry or nervousness.

The activity trackers measured three main outcomes:

• Moderate-to-vigorous physical activity (MVPA): More intense exercise like brisk walking or cycling.
• Light physical activity (LPA): Gentle movement like slow walking.
• Sedentary behavior: Time spent sitting or lying down while awake.

Key findings on depression symptoms

Patients who reported higher depression symptoms overall engaged in less physical activity of all intensities and spent more time sedentary compared to those with lower depression levels.

On a day-to-day basis, when patients experienced more depression symptoms than usual for them personally, they did less moderate-to-vigorous and light physical activity that same day. They also spent more time sedentary on days when depression symptoms were higher.

These findings align with previous research showing depression is linked to lower physical activity levels. This study adds new insight by demonstrating these patterns occur on a daily basis within individuals, not just when comparing different people.

Effects of adjustment disorder symptoms

Adjustment disorder is not as well studied as depression in cardiac patients. This research found that on days when patients had more adjustment disorder symptoms than usual, they engaged in less moderate-to-vigorous physical activity and more sedentary behavior.

Interestingly, this link between adjustment disorder symptoms and reduced activity was stronger while patients were still in the rehabilitation clinic compared to when they returned home. This suggests adjustment disorder symptoms may interfere with patients getting the full benefits of structured exercise programs during rehab.

Surprising findings on anxiety symptoms

Contrary to the researchers’ expectations, anxiety symptoms showed some positive associations with physical activity. Patients who reported higher anxiety overall tended to do more light physical activity and spend less time sedentary compared to those with lower anxiety.

However, anxiety symptoms did not show significant day-to-day effects on activity levels within individuals. The researchers note these results should be interpreted cautiously, as anxiety, depression and adjustment disorder symptoms were all highly correlated.

Implications for cardiac rehabilitation

The findings highlight the importance of screening for and addressing mental health symptoms during cardiac rehabilitation. In particular, depression and adjustment disorder symptoms may be barriers to patients engaging in recommended levels of physical activity.

Cognitive behavioral therapy and other mental health treatments could potentially help improve activity levels in cardiac patients experiencing these symptoms. The study authors suggest cardiac rehab programs should consistently screen patients for adjustment disorder and depression using validated questionnaires.

Strengths and limitations of the study

Key strengths of this research include:

• Measuring symptoms and activity daily, allowing examination of day-to-day fluctuations.
• Using objective activity trackers rather than relying on self-reported exercise.
• Studying patients both during inpatient rehab and after returning home.

Some limitations to consider:

• The study was observational, so it can’t prove mental health symptoms directly caused changes in activity levels.
• Most participants had relatively mild mental health symptoms. Associations may be different in patients with more severe depression or anxiety.
• The daily questionnaires and activity trackers may have made patients more aware of their symptoms and exercise, potentially changing their behavior.

Conclusions

This study provides new insights into how common mental health symptoms may impact physical activity levels in cardiac patients on a day-to-day basis. The findings suggest:

• Depression symptoms are consistently associated with lower physical activity and more sedentary time.
• Adjustment disorder symptoms may interfere with exercise, particularly during inpatient rehabilitation.
• Anxiety shows some unexpected positive links to light physical activity that warrant further study.

Ultimately, this research underscores the importance of addressing mental health as part of cardiac rehabilitation. Helping patients manage symptoms of depression and stress-related adjustment disorder may be key to establishing lasting healthy exercise habits after cardiac events.