Impact of Home- and Hospital-Based Exercise in Cardiac Rehabilitation on Hopelessness in Patients With Coronary Heart Disease.
OBJECTIVE
Hopelessness is associated with increased adverse events and decreased survival in patients with coronary heart disease (CHD). The purpose of this research was to examine the effect of regular home- and hospital-based cardiac rehabilitation (CR) exercise on hopelessness levels in patients with CHD, hypothesizing that increased exercise in either setting would lead to decreased state hopelessness.


METHODS
A descriptive longitudinal design was used at a large teaching hospital in Michigan. A total of 324 patients provided data during hospitalization and at least 1 followup time point (3, 8, and 12 months).


RESULTS
The patients had persistent, modest levels of state and trait hopelessness across all time points. Among home exercisers with moderate to severe state hopelessness at baseline, both mean state (P = .002) and trait (P = .02) hopelessness were reduced at later time points compared with those who quit or did not start exercise. Multivariable models showed that when individuals had moderate to severe baseline state hopelessness, home exercise remained associated with decreases in state hopelessness compared with no exercise, even after adjusting for hospital exercise, depression, and demographic variables.


CONCLUSIONS
Exercise may be effective in reducing moderate to severe hopelessness in patients with CHD. Moderate to severe baseline state hopelessness was a predictor of attrition in this cohort, especially for home exercisers, but this was mediated in hospital-based programs. Further research is needed to determine how hopeless individuals can be encouraged to exercise and whether home- or a hospital-based CR exercise is superior in impacting hopelessness.
College of Nursing, Michigan State University, East Lansing (Dr Dunn); Departments of Kinesiology (Dr Dunn) and Nursing (Mss Rieth, Olamijulo, Swieringa, and Holden), Hope College, Holland, Michigan; Mercy Health Saint Mary's, Grand Rapids, Michigan (Ms Rieth); New York Presbyterian Hospital, New York (Ms Olamijulo); Sparrow Health System, Lansing, Michigan (Ms Swieringa); Department of Statistics, Dordt College, Sioux Center, Iowa (Mr Clark and Dr Tintle); Center for Public Health Statistics, University of Iowa, Iowa City (Mr Clark); and Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago (Dr DeVon).
Susan L
SL
Dunn
L Maureen
LM
Dunn
Nicole P
NP
Rieth
Grace B
GB
Olamijulo
Lien L
LL
Swieringa
Theresa P
TP
Holden
Jacob A
JA
Clark
Holli A
HA
DeVon
Nathan L
NL
Tintle
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072038:Cardiac Rehabilitation / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000523:psychology / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services / Q000706:statistics & numerical data*; D065026:Hope; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008824:Michigan; D008875:Middle Aged; D016896:Treatment Outcome