student research day - Case Western Reserve University School of ...

Anne Newcomer
Assessing the Relationship between Depression and Other Exercise Predictors in Older Cardiac Patients
Anne Newcomer, Jacqueline Charvat, MS, Shirley Moore, RN, PhD, FAAN
Frances Payne Bolton School of Nursing
Case Western Reserve University
Background and Objectives:
Exercise after cardiac rehabilitation improves health outcomes. Depression, problem-solving skills, exercise selfefficacy
and health beliefs are all factors that influence exercise adoption and maintenance. The purpose of this
study was to determine: (1) Is there an association between depression and social problem-solving, self-efficacy
and health beliefs at the end of cardiac rehabilitation? (2) Does depression at the end of cardiac rehabilitation
predict problem-solving, self-efficacy and health beliefs 2 and 6 months later?
Methods:
A sample of 171 older adults (x=68.2 years ± 8.2; 76% male) was analyzed. All subjects were enrolled in a
randomized controlled trial comparing two different theoretically-based interventions as compared to usual care to
improve the adoption and maintenance of exercise after cardiac rehabilitation. The subjects completed a baseline
survey at the end of cardiac rehabilitation that included measures of depression (Geriatric Depression Scale),
problem solving (Problem Solving Inventory), health beliefs (Benefits and Barriers to Exercise questionnaire),
barriers self-efficacy (Self-Efficacy for Overcoming Barriers to Exercise), and adherence self-efficacy, (Self-Efficacy
for Adherence). Subjects completed the same battery of measures at 2 and 6 months after completion of cardiac
rehabilitation. To investigate the relationship between depression and social problem-solving, self-efficacy and
health beliefs scores, Pearson correlations and linear regression analyses were employed.
Results:
Mean depression score at the end of cardiac rehabilitation was 1.48 (scale of 0-15, range 0-11) and this remained
constant at 2 and 6 months after cardiac rehabilitation. At the end of cardiac rehabilitation, there were negative
associations between baseline depression and problem-solving (r = -.39, p ≤ 0.01), barriers self-efficacy (r = -.29,
p ≤ 0.01), and health beliefs (r = -.30, p ≤ 0.01) There was no significant relationship between depression and
adherence self-efficacy at baseline. Linear regression analyses indicate that baseline depression explained 14.4%
of the variance in baseline problem-solving (F = 29.51, p ≤ 0.01), 8.3% of the variance in self-efficacy barriers to
exercise (F = 15.21, p ≤ 0.01) and 8.3% of the variance in health beliefs. (F = 16.40, p ≤ 0.01). However, at two
months after cardiac rehabilitation, the only significant association with baseline depression levels was problem
solving (r = -.33, p ≤ 0.01). Baseline depression explained 9.8% of the variance in problem solving 2 months
after cardiac rehabilitation (F = 9.43, p ≤ 0.01). At six months after cardiac rehabilitation, the only significant
association with baseline depression levels was problem solving (r = -.45, p ≤ 0.01); depression explained 18.6%
of the variance in problem solving at 6 months (F = 12.90, p ≤ 0.01). At 2 and 6 months following cardiac
rehabilitation, depression did not predict health beliefs or self efficacy.
Conclusion:
Our data indicate that at the end of cardiac rehabilitation, higher depression levels are associated with lower social
problem-solving abilities, lower perceived benefit of exercise/higher perceived barriers to exercise, and lower selfefficacy
in overcoming exercise barriers. Baseline depression levels continued to predict worse problem solving
skills at 2 and 6 months after cardiac rehabilitation. Baseline depression levels failed to predict self-efficacy and
health beliefs 2 and 6 months after cardiac rehabilitation. These results imply that current depression levels affect
current and future social problem-solving ability; however, current depression levels affect current, but not future
self-efficacy and health beliefs. Treating depression pharmacologically could potentially benefit cardiac
rehabilitation patients’ problem-solving abilities, possibly helping them solve problems related to exercising more
effectively. Beyond pharmacological treatment of depression, increasing exercise levels has been shown to improve
depression levels. Previous research has also shown that a converse relationship between problem-solving and
depression may exist, with problem-solving ability predicting depression levels. Interventions focusing on
improving problem-solving skills may also aid in decreasing depression and increasing problem solving abilities.
Other factors such as gender differences, antidepressant medication use, and adoption and maintenance of
exercise might also be considered.
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