(Ivanhoe Newswire) -- Depressive symptoms improved among women with
coronary heart disease who participated in a motivationally-enhanced cardiac
rehabilitation program exclusively for women.
Depression often occurs with heart disease and is more likely to affect women
than men. Depression 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," lead author Theresa Beckie, Ph.D., professor at the
University of South Florida's College of Nursing in Tampa, FL, was quoted as
saying. "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 . . . 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, said Beckie.
The 5-year randomized clinical trial studied 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 and compared them with outcomes for women who attended a
12-week traditional cardiac rehabilitation program comprised of education and
exercise.
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 women in 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 six-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
six-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."
"We didn't push them if they weren't ready to make the changes," Beckie said.
"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. . . . You can't treat
everyone the same when it comes to changing health behaviors."
SOURCE: Presented at the American Heart Association's Scientific Sessions,
November 2009
