Motivational 'women-only' cardiac rehab improves symptoms of depression

Nov 17, 2009

Depressive symptoms improved among women with coronary heart disease who participated in a motivationally-enhanced cardiac rehabilitation program exclusively for women, according to research presented at the American Heart Association's Scientific Sessions 2009.

Depression often co-occurs with and is found more often in women with heart disease than in men. Depression also interferes with adherence to lifestyle modifications and the willingness to attend rehabilitation.

"Women often don't have the motivation to attend cardiac rehab particularly if they're depressed," said Theresa Beckie, Ph.D., lead investigator and author of the study and professor at the University of South Florida's College of Nursing in Tampa, Florida. "Historically women have not been socialized to exercise and their attendance in cardiac rehabilitation programs has been consistently poor over the last several decades. This poor attendance may be partly due to mismatches in stages of readiness for behavior change with the health professional approaching from an action-oriented perspective and the women merely contemplating change - this is destined to evoke resistance."

Cardiac rehabilitation programs tailored to the needs of women and to their current level of readiness to change may improve adherence to such programs and potentially improve outcomes for women, she said.

The primary goals of the 5-year randomized clinical trial were to compare multiple physiological and psychosocial outcomes of women who participated in a 12-week stage-of-change matched, motivationally enhanced, gender-tailored cardiac rehabilitation program exclusively for women compared to women attending a 12-week traditional cardiac rehabilitation program comprised of education and exercise. of 225 women (average age 63) who completed this trial were examined after the interventions as well as after a 6-month follow-up period.

Participants completed the 20-item Center for Epidemiological Studies Depression Scale prior to beginning the intervention, one week after completing the intervention, and again six months later. The questionnaire asked them about how often in the past week they felt depressed, hopeful, lonely, happy and fearful.

Depression scores for the women participating in the traditional cardiac rehab dropped from 16.5 to 14.3 in 12 weeks, while scores in the augmented group dropped from 17.3 to 11.0 - "a significant decline compared to the traditional group," said Beckie.

After a 6-month follow-up, the traditional rehab group had an average score of 15.2 and those in the women-specific program had an average score of 13. Beckie said "we found that improvements in depressive symptoms were sustained at the 6-month follow-up in the augmented group while those in traditional cardiac rehab were essentially unchanged. This intervention also led to significantly better attendance and completion rates than those in the traditional cardiac rehabilitation program."

The intervention was guided by the transtheoretical model of behavior change and was delivered with motivational interviewing clinical methods. The motivationally-enhanced intervention began with an assessment of their stage of motivational readiness to change regarding three behaviors: healthy eating, physical activity, and stress management. The investigators then applied appropriate stage-matched strategies to promote the uptake of health behaviors.

"The stage-matched intervention used in conjunction with motivational interviewing applied the patient-centered principles of expressing empathy, rolling with resistance to change, respecting patient autonomy and supporting self-efficacy for change" Beckie said.

"We didn't push them if they weren't ready to make the changes," Beckie said. "We have found that if some patients receive long lists of behaviors they are expected to change immediately — such as quitting smoking, eating healthier, exercising regularly — they are overwhelmed. Pushing such patients who are not ready can lead them to tune out or drop out. Instead, for these women, we acknowledged their ambivalence about change and gave them strategies to move toward being ready by reinforcing their own motivations for changing. It's unrealistic to expect all patients to change their lifestyle all at once, right now in front of you."

The woman-centered program is a more individualized approach to rehabilitation.

"You can't treat everyone the same when it comes to changing health behaviors," she said.

Beckie hopes these results will lead to symptoms of depression being assessed more often in women suffering from heart disease and to more motivationally augmented, women-specific rehabilitation options. The participants may not be completely representative of the national population because they all had health insurance.

Beckie's co-author is Jason Beckstead, Ph.D. Author disclosures are on the abstract.

The National Institute of Nursing Research funded the 5-year study.

Source: American Heart Association (news : web)

Explore further: New toilets for India's poor, crime-hit village

add to favorites email to friend print save as pdf

Related Stories

Depression lingers for female heart attack victims

Jul 13, 2007

Women who have suffered heart attacks have higher rates of lingering depressive symptoms compared to their male counterparts, a University of Alberta and McGill University study shows.

Feeling down and out could break your heart, literally

Mar 09, 2009

New data published in the March 17, 2009, issue of the Journal of the American College of Cardiology suggest that relatively healthy women with severe depression are at increased risk of cardiac events, including sudden cardia ...

Walking often and far reduces risks in heart patients

May 11, 2009

An exercise program that burns a lot of calories reduced cardiac risk factors better than standard cardiac rehabilitation in overweight coronary patients, researchers report in Circulation: Journal of the American Heart As ...

Recommended for you

New toilets for India's poor, crime-hit village

46 minutes ago

More than 100 new toilets were unveiled Sunday in a poverty-stricken and scandal-hit village in northern India, where fearful and vulnerable women have long been forced to defecate in the open.

Can YouTube save your life?

Aug 29, 2014

Only a handful of CPR and basic life support (BLS) videos available on YouTube provide instructions which are consistent with recent health guidelines, according to a new study published in Emergency Medicine Australasia, the jo ...

Doctors frequently experience ethical dilemmas

Aug 29, 2014

(HealthDay)—For physicians trying to balance various financial and time pressures, ethical dilemmas are common, according to an article published Aug. 7 in Medical Economics.

AMGA: Physician turnover still high in 2013

Aug 29, 2014

(HealthDay)—For the second year running, physician turnover remains at the highest rate since 2005, according to a report published by the American Medical Group Association (AMGA).

Obese or overweight teens more likely to become smokers

Aug 29, 2014

A study examining whether overweight or obese teens are at higher risk for substance abuse finds both good and bad news: weight status has no correlation with alcohol or marijuana use but is linked to regular ...

User comments : 0