title: Regular exercise behaviour and intention and symptoms of anxiety and depression in coronary heart disease patients across Europe: Results from the EUROASPIRE III survey.
abstract: Regular exercise lowers the risk of cardiovascular death in coronary heart disease (CHD) patients. We aimed to investigate regular exercise behaviour and intention in relation to symptoms of anxiety and depression in CHD patients across Europe.
  
  
  
  This study was based on a multicentre cross-sectional survey.
  
  
  
  In the EUROpean Action on Secondary and Primary Prevention through Intervention to Reduce Events (EUROASPIRE) III survey, 8966 CHD patients <80 years of age from 22 European countries were interviewed on average 15 months after hospitalisation. Whether patients exercised or intended to exercise regularly was assessed using the Stages of Change questionnaire in 8330 patients. Symptoms of anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale. Total physical activity was measured by the International Physical Activity Questionnaire in patients from a subset of 14 countries.
  
  
  
  Overall, 50.3% of patients were not intending to exercise regularly, 15.9% were intending to exercise regularly, and 33.8% were exercising regularly. Patients with severe symptoms of depression less frequently exercised regularly than patients with symptoms in the normal range (20.2%, 95% confidence interval (CI) 14.8-26.8 vs 36.7%, 95% CI 29.8-44.2). Among patients not exercising regularly, patients with severe symptoms of depression were less likely to have an intention to exercise regularly (odds ratio 0.62, 95% CI 0.46-0.85). Symptoms of anxiety did not affect regular exercise intention. In sensitivity analysis, results were consistent when adjusting for total physical activity.
  
  
  
  Lower frequency of regular exercise and decreased likelihood of exercise intention were observed in CHD patients with severe depressive symptoms. Severe symptoms of depression may preclude CHD patients from performing regular exercise.
authors: Institute of Public Health, Charité-Universitätsmedizin Berlin, Germany christof.prugger@charite.de.
authors: Christof
authors: C
authors: Prugger
authors: Institute of Epidemiology and Social Medicine, University of Münster, Germany.
authors: Jürgen
authors: J
authors: Wellmann
authors: Institute of Epidemiology and Social Medicine, University of Münster, Germany.|Institute of Occupational and Maritime Medicine, University Medical Centre Hamburg-Eppendorf, Germany.
authors: Jan
authors: J
authors: Heidrich
authors: Department of Public Health, Ghent University, Belgium.
authors: Dirk
authors: D
authors: De Bacquer
authors: Department of Public Health, Ghent University, Belgium.
authors: Delphine
authors: D
authors: De Smedt
authors: Department of Public Health, Ghent University, Belgium.
authors: Guy
authors: G
authors: De Backer
authors: Department of Internal Medicine, University Hospital Centre, School of Medicine, University of Zagreb, Croatia.
authors: Željko
authors: Ž
authors: Reiner
authors: Paris Cardiovascular Research Centre, University Paris Descartes, Sorbonne Paris Cité, France.
authors: Jean-Philippe
authors: JP
authors: Empana
authors: Department of Vascular Medicine, University Medical Centre Ljubljana, Slovenia.|Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia.
authors: Zlatko
authors: Z
authors: Fras
authors: Institute of Cardiovascular Diseases, University of Medicine and Pharmacy of Timisoara, Romania.
authors: Dan
authors: D
authors: Gaita
authors: Cardiovascular Medicine, Imperial College London, UK.
authors: Catriona
authors: C
authors: Jennings
authors: Cardiovascular Medicine, Imperial College London, UK.
authors: Kornelia
authors: K
authors: Kotseva
authors: Cardiovascular Medicine, Imperial College London, UK.
authors: David
authors: D
authors: Wood
authors: Institute of Epidemiology and Social Medicine, University of Münster, Germany.
authors: Ulrich
authors: U
authors: Keil
mesh_terms: D001007:Anxiety / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology*; D000072038:Cardiac Rehabilitation / Q000379:methods*; D003327:Coronary Disease / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology*; D005060:Europe; D005081:Exercise Therapy; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D033182:Intention; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D011322:Primary Prevention; D012189:Retrospective Studies; D055502:Secondary Prevention; D012648:Self Care; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: Coronary heart disease; anxiety; depression; exercise; physical activity