title: Influence of Depression and Hostility on Exercise Tolerance and Improvement in Patients with Coronary Heart Disease.
abstract: Although hostility and depression have been linked to higher cardiac risk and poor prognosis of patients with coronary heart disease (CHD), there is a lack of research that studies how they may influence the short-term outcomes among patients participating in cardiac rehabilitation (CR). This study aimed to investigate the influence of hostility and depression on patients' exercise tolerance and improvement trajectory in a CR program over 6 weeks.
  
  
  
  Participants were 142 patients with CHD, with a mean age of 62 years. Latent growth curve modeling was conducted to determine whether hostility and depression predicted patients' baseline exercise tolerance and rates of improvement on treadmill, while controlling for age and severity of illness. In addition, analysis was conducted to examine whether depression mediated the influence of hostility on exercise outcomes.
  
  
  
  Patients with CHD with higher hostility scores had a lower baseline exercise tolerance and slower rates of improvement over 6 weeks. Depressive symptom severity mediated the influence of hostility on exercise baseline and improvement. Patients with higher hostility were more likely to have more severe depressive symptoms, which in turn were associated with lower baseline exercise tolerance and slower improvement.
  
  
  
  While both hostility and depression predicted the exercise outcomes in CR, depression explained the influence of hostility. The findings underscore the importance of addressing psychosocial issues in treatment of CHD patients and provide support for psychosocial interventions in CR to facilitate patients' recovery.
authors.affiliation: Division of Psychology, Nanyang Technological University, Singapore, 637332, Singapore. bshen@alumni.uchicago.edu.|Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA. bshen@alumni.uchicago.edu.
authors.forename: Biing-Jiun
authors.identifier: 0000-0001-5733-0869
authors.initials: BJ
authors.lastname: Shen
authors.affiliation: Department of Geriatric Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA.
authors.forename: Jen-Tzer
authors.initials: JT
authors.lastname: Gau
mesh_terms: D000368:Aged; D000072038:Cardiac Rehabilitation; D003327:Coronary Disease / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D015444:Exercise; D005080:Exercise Test; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D006791:Hostility; D006801:Humans; D008297:Male; D008875:Middle Aged; D012306:Risk
keywords: Coronary heart disease; Depression; Exercise tolerance; Hostility; Rehabilitation