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J Cardiopulm Rehabil Prev. 2009 Nov-Dec;29(6):358-64. doi: 10.1097/HCR.0b013e3181be7a8f.

Effects of depression and anxiety on adherence to cardiac rehabilitation.

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Department of Psychiatry, The University of Toledo, Health Science Campus, Mail Stop #1193, Toledo, OH 43614, USA.



To determine the effects of depression and anxiety on patient completion of structured cardiac rehabilitation.


Retrospective chart review of 380 patients with myocardial infarction, coronary artery bypass graft, angina, or chronic heart failure referred to cardiac rehabilitation. Patient physical capacity was tested by the standard 12-minute walk test (WT). Depression, anxiety, and quality of life were assessed by standard questionnaires. Program completers were contrasted to dropouts on dependent variables at baseline. Baseline and postprogram WT, depression, anxiety, and quality of life were also compared in completers by using ANOVA and paired t tests.


One-half of entering patients completed the program. Statistically significant differences were observed in baseline depression, anxiety, and quality of life between program completers and dropouts. Dropouts had higher depression and anxiety scores and lower quality of life, but there were no differences in WT. Younger, female patients had higher dropout rates. Women also had higher psychological distress, lower quality of life, and less feet walked than men. Dropout rate was lowest in patients with coronary artery bypass graft and highest in patients with chronic heart failure. Both male and female completers evidenced significant improvements in WT, depression, anxiety, and quality of life.


Psychological distress makes completion of cardiac rehabilitation difficult. Patients need to be assessed early in the intervention so that depression and anxiety can be identified and managed. Completion of the program is advantageous because it is associated with improvement in all measured variables.

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