title: The long-term benefits of cardiac rehabilitation on depression, anxiety, physical activity and quality of life.
abstract: OBJECTIVE
  To investigate the long-term benefits of a six-week comprehensive cardiac rehabilitation programme on physical activity, psychological well-being and quality of life in patients with coronary heart disease.
  
  
  BACKGROUND
  Cardiac rehabilitation (CR) in short term improves exercise capacity and quality of life in patients with cardiac disease. However, the long-term benefits of CR are inconclusive.
  
  
  METHODS
  A prospective CR programme with repeated measures follow-up over 12 months.
  
  
  METHODS
  A six-week outpatient cardiac rehabilitation programme was conducted including 147 patients with coronary heart disease. Patients completed the physical activity energy expenditure (seven-day recall activity), MacNew Heart Disease Health-Related Quality of Life (MacNew) and Hospital Anxiety and Depression scale (HADs) at baseline, six weeks, six and 12 months.
  
  
  RESULTS
  One hundred and five (71%) patients (76 male) mean age of 61.8 (SD 9.7) completed the four-measurement points. Analysis of variance revealed that total energy expenditure (F (2, 231) = 131, p < 0.001), HADs (F (2, 237) = 19.3, p < 0.001), depression score (F (2, 235) = 21.06, p < 0.001), anxiety score (F (2,237) = 17.02, p < 0.001) and MacNew (F (2, 197) = 77.02, p < 0.001) were all statistically significant over time. Bonferroni pairwise follow-up confirmed significant positive differences (p < 0.05) between baseline values and all subsequent measures over time. Depression was independently explained in 22% of the variance in quality of life at 6 or 12 months. The energy expenditure was significantly higher for men compared to women (F (1, 103) = 31, p < 0.001).
  
  
  CONCLUSIONS
  A six-week cardiac rehabilitation programme is beneficial in improving quality of life, physical activity status, anxiety and depression. These benefits were maintained at 12 months. Elevated levels of depression were associated with impaired quality of life.
  
  
  CONCLUSIONS
  All relevant health care staff should be aware of the benefits of CR and routinely refer and encourage patients with cardiac disease to attend a cardiac rehabilitation programme. Depression and anxiety intervention strategies should be incorporated in cardiac rehabilitation programmes.
authors.affiliation: Manchester Metropolitan University-Physiotherapy, Elizabeth Gaskell Campus, Manchester, Lancashire, UK. A.yohannes@mmu.ac.uk
authors.forename: Abebaw M
authors.initials: AM
authors.lastname: Yohannes
authors.forename: Patrick
authors.initials: P
authors.lastname: Doherty
authors.forename: Christine
authors.initials: C
authors.lastname: Bundy
authors.forename: Ali
authors.initials: A
authors.lastname: Yalfani
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001007:Anxiety / Q000628:therapy*; D003327:Coronary Disease / Q000503:physiopathology* / Q000523:psychology / Q000534:rehabilitation; D003863:Depression / Q000628:therapy*; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life