Michelle Rogerson

“I don’t have the heart”: a qualitative study of barriers to and facilitators of physical activity for people with coronary heart disease and depressive symptoms

BackgroundPhysical activity has been shown to reduce depression in people with coronary heart disease (CHD), however many people with CHD do not engage in sufficient levels of physical activity to reap its positive effects. People with depression and CHD are at particular risk of non-adherence to physical activity. Little is known about the barriers to and facilitators of physical activity for people with CHD and depressive symptoms. Using qualitative interviews, the aim of this study was to explore the barriers to and facilitators of physical activity for cardiac patients with depressive symptoms.MethodsFifteen participants with CHD and depressive symptoms (assessed using the Cardiac Depression Scale) participated in in-depth semi-structured interviews. The interviews were focussed on investigating participants’ experiences of physical activity since their cardiac event. Interviews were content analysed to determine major themes.ResultsParticipants identified a number of barriers to and facilitators of physical activity. Barriers included having negative perceptions towards health and life changes as a result of the cardiac event, having low mood and low motivation to exercise, feeling physically restricted towards or fearful of exercise, lacking knowledge regarding exercise and perceiving external barriers. Facilitators included having a reason for exercising, being able to identify the psychological benefits of exercise, having positive social support and using psychological strategies. ‘Inactive’ participants reported more barriers and fewer facilitators than did ‘active’ participants.ConclusionsThe barriers reported in this study were highly salient for a number of participants. Health professionals and researchers can use this information to assist people with CHD and depressive symptoms to identify and possibly overcome barriers to physical activity. Relevant barriers and facilitators could be taken into account to increase their effectiveness when designing interventions to encourage physical activity maintenance in this population.

Are poor health behaviours in anxious and depressed cardiac patients explained by sociodemographic factors

Introduction: While there is evidence of poor health behaviours in anxious and depressed cardiac patients, it is possible that sociodemographic factors explain these associations. Few previous studies have adequately controlled for confounders. The present study investigated health behaviours in anxious and depressed cardiac patients, while accounting for sociodemographic confounders. Method: A consecutive sample of 275 patients admitted to hospital after acute myocardial infarction (32%) or for coronary bypass surgery (40%) or percutaneous coronary intervention (28%) was interviewed six weeks after hospital discharge. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Smoking, physical activity, alcohol intake and dietary fat intake were assessed by self-report. Backward stepwise logistic regression was used to identify the factors independently associated with anxiety and depression. Results: In total, 41 patients (15.2%) were ‘depressed’ (HADS-D ≥8) while 68 (25.2%) were ‘anxious’ (HADS-A ≥8). Depressed patients reported higher rates of smoking (χ2 = 4.47, p = 0.034), lower physical activity (F = 8.63, p < 0.004) and higher dietary fat intake (F = 7.22, p = 0.008) than non-depressed patients. Anxious patients reported higher smoking rates (χ2 = 5.70, p = 0.024) and dietary fat intake (F = 7.71, p = 0.006) than non-anxious patients. In multivariate analyses, an association with depression was retained for both diet and physical activity, and an association with anxiety was retained for diet. Low social support and younger age were significant confounders with depression and anxiety respectively. Conclusions: While the high smoking rates evidenced in anxious and depressed patients were explained by sociodemographic factors, their poor diet and low physical activity (depressed patients only) were independent of these factors. Given the impact of lifestyle modification on survival after a cardiac event, anxious and depressed patients should be a priority for cardiac rehabilitation and other secondary prevention programmes.

Predicting mortality 12 years after an acute cardiac event: comparison between inhospital and 2-month assessment of depressive symptoms in women.

PURPOSE: Research demonstrates that depression at the time of a cardiac event predicts early mortality. However, the best time for depression screening is unknown. We investigated the prognostic importance of inhospital and 2-month depressive symptoms in predicting 12-year mortality in female cardiac patients. METHODS: A consecutive series of 170 women admitted to hospital after acute myocardial infarction or for coronary artery bypass graft surgery completed the Hospital Anxiety and Depression Scale inhospital and 2 months later. Hospital Anxiety and Depression Scales depression subscale scores of 4 to 7 were classified as “mild” depressive symptoms and 8+ as “moderate/severe” depressive symptoms. Mortality was tracked through the Australian National Death Index and other sources. RESULTS: One hundred sixty-three (96%) of the 170 women were successfully tracked after 12 years. Of these women, 136 (83%) completed the depression subscale of the Hospital Anxiety and Depression Scale at both assessments and were included in the analyses. Over 12 years, 45 (33%) women died. Using logistic regression and controlling for age, disease severity, and diabetes, mild inhospital depression predicted mortality (P = .02), whereas moderate/severe inhospital depression did not (P = .14). At 2 months, moderate/severe depression predicted mortality (P = .05), whereas mild depression did not (P = .09). Half the patients (49%) changed depression class by the 2-month assessment. The death rate was highest (64%) in those whose mild inhospital depressive symptoms increased to moderate/severe and lowest (14%) in those whose moderate/severe inhospital symptoms remitted. CONCLUSIONS: Mild inhospital depression and moderate/severe 2-month depression were predictive of 12-year deaths. The findings suggest a prognostic benefit in undertaking repeat depression screening 2 months after an acute cardiac event.

Television Viewing Time and 13-year Mortality in Adults with Cardiovascular Disease: Data from the Australian Diabetes, Obesity and Lifestyle Study (AusDiab)

BACKGROUND In the general population, excessive sedentary behaviour is associated with increased all-cause mortality. Few studies have examined this relationship in people with cardiovascular disease (CVD). Using a sample of people with CVD who were excluded from an analysis of the Australian Diabetes, Obesity and Lifestyle (AusDiab) study, we examined the relationship between sedentary behaviour and 13-year all-cause mortality. METHODS In the original AusDiab study, television viewing time was used as a marker of sedentary behaviour in 609 adults (≥45 years of age) with CVD. During 6,291 person-years of follow-up (median follow-up 13 years), there were 294 deaths (48% of sample). Using the time scale of attained age, the Cox proportional hazards model predicting all-cause mortality adjusted for sex, self-rated general health, leisure-time physical activity, smoking status, education, household income, body mass index, lipid levels, blood pressure, and diabetes mellitus was used. RESULTS Compared with a TV viewing time of <2hours per day, the fully adjusted hazard ratios for all-cause mortality were 1.18 (95% CI, 0.88 to 1.57) for ≥2 to <4hours per day and 1.52 (95% CI, 1.09 to 2.13) for >4hours per day. CONCLUSIONS Sedentary behaviour was associated with increased risk of all-cause mortality in people with CVD, independent of physical activity and other confounders. In addition to the promotion of regular physical activity, cardiac rehabilitation efforts which also focus on reducing sedentary behaviour may be beneficial.

Psychosocial Screening and Assessment Practice within Cardiac Rehabilitation: A Survey of Cardiac Rehabilitation Coordinators in Australia

BACKGROUND Many cardiac rehabilitation (CR) guidelines and position statements recommend screening for psychosocial risk factors, although there is wide variation in the recommended factors and recommended screening tools. Little is known about screening in CR in Australia. METHODS Cardiac rehabilitation coordinators at the 314 CR programs operating across Australia, drawn from the 2014 Australian Directory of Cardiac Rehabilitation Services were invited to participate in an online survey. RESULTS Of 165 complete responses, 157 (95%) CR coordinators indicated that they screened at entry with 132 (80%) screening on exit. At CR entry, programs screened for - depression (83%), anxiety (75%), stress (75%), and sleep disturbance (57%). The use of standardised instruments by those screening at entry varied from 89% for depression to only 9% for sleep disturbance. Organisational, resource and personal barriers inhibited the routine screening for many psychosocial factors. CONCLUSIONS Surveys such as this are useful for monitoring the rate of adoption of guideline recommendations and identifying barriers to implementation. Findings can also inform discussions about what should be included in minimum data sets for CR programs, and the identification of brief screening tools that have been validated not just in the general population but in cardiac patients.

Cardiac Rehabilitation Online Pilot: Extending Reach of Cardiac Rehabilitation.

Background: While cardiac rehabilitation (CR) is recommended for all patients after an acute cardiac event, limitations exist in reach. Objective: The purpose of the current study was to develop and pilot a flexible online CR program based on self-management principles “Help Yourself Online.” Methods: The program was designed as an alternative to group-based CR as well as to complement traditional CR. The program was based on existing self-management resources developed previously by the Heart Research Centre. Twenty-one patients admitted to Cabrini Health for an acute cardiac event were recruited to test the program. The program was evaluated using qualitative and quantitative methods. Results: Quantitative results demonstrated that patients believed the program would assist them in their self-management. Qualitative evaluation, using focus group and interview methods with 15 patients, showed that patients perceived the online CR approach to be a useful instrument for self-management. Conclusions: Broader implications of the data include the acceptability of the intervention, timing of intervention delivery, and patients’ desire for additional online community support.

Physical inactivity at leisure and work: a 12-month study of cardiac patients.

PURPOSE: Physical inactivity has been identified as a distinct health risk. However, little is known about how this can vary at leisure and work in cardiac patients. The aim of this study was to examine the prevalence and predictors of inactivity during leisure and work in the 12 months following a cardiac event in Australian cardiac patients. METHODS: A total of 346 patients consecutively admitted to hospital with acute coronary syndrome or to undergo coronary artery bypass graft surgery were interviewed in hospital, and 4 and 12 months later. Leisure and occupational physical activity was measured using the Stanford Brief Activity Survey. Sociodemographic, psychosocial, and clinical data were also collected. RESULTS: The prevalence of leisure-time physical inactivity declined over time, with 52% inactive preevent and 29% inactive at 12 months. Approximately 50% of participants were physically inactive in their work, regardless of whether this was measured before or after the cardiac event. Logistic regression revealed that the significant predictors of leisure-time physical inactivity at 12 months were non–home ownership (OR = 2.19; P = .007) and physical inactivity in leisure-time prior to the event (OR = 2.44; P = .001). The significant predictors of occupational physical inactivity at 12 months were white-collar occupation (OR = 3.10; P < .001) and physical inactivity at work prior to the event (OR = 12.99; P < .001). CONCLUSIONS: Preevent physical inactivity, socioeconomic, and clinical factors predicted both leisure and work inactivity after an acute cardiac event. Effective interventions could be designed and implemented to target those most at risk of being physically inactive at work or leisure.

Cardiac Rehabilitation in Australia: A Brief Survey of Program Characteristics

BACKGROUND Defining cardiac rehabilitation (CR) program characteristics on a national level is crucial for decision-making on resource allocation and evaluation of service quality. Comprehensive surveys of CR programs have been conducted overseas, but, to date, no such profile had been conducted in Australia. METHODS A representative sample of 165 CR programs across Australia were asked to provide details on a range of program characteristics such as program location and size, program elements, and staffing profile. RESULTS Australian CR programs differ from their overseas counterparts in characteristics such as program length, number of sessions, number of specialities represented and extent of outreach. CONCLUSIONS The study findings point to a need for a routine comprehensive survey of CR programs throughout Australia.

Determinants of Physical Activity Guideline Attainment in Australian Cardiac Patients: A 12-Month Study.

PURPOSE: Little is known about the type and intensity of physical activity (PA) reported by cardiac patients during the first year after hospitalization and whether patients are meeting recommended PA guidelines. In addition, the achievement of PA guideline over the course of recovery is largely unknown. METHODS: A total of 136 patients consecutively admitted to 2 Australian hospitals after acute myocardial infarction (31%), or to undergo bypass surgery (29%) or percutaneous coronary intervention (40%), were interviewed at 6 weeks and at 4 and 12 months after admission. Physical activity at each time point was assessed by the Active Australia PA Survey. Medical and sociodemographic data, self-reported anxiety and depression, and cardiac rehabilitation attendance status were also recorded. Logistic regression was used to identify predictors of PA guideline attainment at each of the 3 time points. RESULTS: At all 3 time points, walking was regularly performed by more than 95% of patients, while moderate- and vigorous-intensity PA reached only 40% and 59% participation by 12 months, respectively. Significant predictors of PA guideline attainment at 6 weeks posthospitalization were physical functioning, depression, and mode of PA. As hypothesized, different predictors were found at 4 months (living arrangements, PA mode, and attainment of 6-week PA guidelines) and 12 months (living arrangements, socioeconomic resources, PA mode, and attainment of 6-week PA guidelines). CONCLUSIONS: The study highlighted the potential importance of modifying walking behavior in cardiac patients to achieve PA guidelines and the dynamic nature of variables influencing PA at various stages of recovery.