title: The effects of a tailored cardiac rehabilitation program on depressive symptoms in women: A randomized clinical trial.
abstract: BACKGROUND
  Depression is known to co-occur with coronary heart disease (CHD). Depression may also inhibit the effectiveness of cardiac rehabilitation (CR) programs by decreasing adherence. Higher prevalence of depression in women may place them at increased risk for non-adherence.
  
  
  OBJECTIVE
  To assess the impact of a modified, stage-of-change-matched, gender-tailored CR program for reducing depressive symptoms among women with CHD.
  
  
  METHODS
  A two-group randomized clinical trial compared depressive symptoms of women in a traditional 12-week CR program to those completing a tailored program that included motivational interviewing guided by the Transtheoretical Model of behavior change. Women in the experimental group also participated in a gender-tailored exercise protocol that excluded men. The Center for Epidemiological Studies Depression (CES-D) Scale was administered to 225 women at baseline, post-intervention, and at 6-month follow-up. Analysis of Variance was used to compare changes in depression scores over time.
  
  
  RESULTS
  Baseline CES-D scores were 17.3 and 16.5 for the tailored and traditional groups, respectively. Post-intervention mean scores were 11.0 and 14.3; 6-month follow-up scores were 13.0 and 15.2, respectively. A significant group by time interaction was found for CES-D scores (F(2, 446)=4.42, p=.013). Follow-up tests revealed that the CES-D scores for the traditional group did not differ over time (F(2, 446)=2.00, p=.137). By contrast, the tailored group showed significantly decreased CES-D scores from baseline to post-test (F(1, 223)=50.34, p<.001); despite the slight rise from post-test to 6-month follow-up, CES-D scores remained lower than baseline (F(1, 223)=19.25, p<.001).
  
  
  CONCLUSIONS
  This study demonstrated that a modified, gender-tailored CR program reduced depressive symptoms in women when compared to a traditional program. To the extent that depression hinders CR adherence, such tailored programs have potential to improve outcomes for women by maximizing adherence. Future studies should explore the mechanism by which such programs produce benefits.
authors.affiliation: University of South Florida, FL 33612, United States. tbeckie@health.usf.edu
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Beckie
authors.forename: Jason W
authors.initials: JW
authors.lastname: Beckstead
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Schocken
authors.forename: Mary E
authors.initials: ME
authors.lastname: Evans
authors.forename: Gerald F
authors.initials: GF
authors.lastname: Fletcher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003327:Coronary Disease / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D003376:Counseling / Q000458:organization & administration*; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D008875:Middle Aged; D009042:Motivation; D015403:Nursing Evaluation Research; D010347:Patient Care Planning / Q000458:organization & administration; D010349:Patient Compliance / Q000523:psychology; D015397:Program Evaluation; D016037:Single-Blind Method; D016896:Treatment Outcome; D014930:Women / Q000193:education / Q000523:psychology; D014932:Women's Health Services / Q000458:organization & administration*