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J Cardiovasc Nurs. 2018 Jul/Aug;33(4):E26-E34. doi: 10.1097/JCN.0000000000000491.

Do Depressive Symptoms Moderate the Effects of Exercise Self-efficacy on Physical Activity Among Patients With Coronary Heart Disease?

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Elaine Siow, PhD, RN Professional Consultant, The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories. Doris Yin Ping Leung, PhD Assistant Professor, The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories. Eliza Mi Ling Wong, PhD, RN Assistant Professor, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon. Wai Han Lam, MN, BN, RN Registered Nurse, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. Shuk Man Lo, MPH, BN(Hons), RN Nursing Officer and Deputy Ward Manager, Accident and Emergency Department, Alice Ho Miu Ling Nethersole Hospital, Tai Po, New Territories, Hong Kong.



Exercise self-efficacy is an important predictor of physical activity. Patients with coronary heart disease are at risk of developing depressive symptoms that could further weaken their self-efficacy and interfere with their ability to engage in physical activity.


The aim of this study was to examine the relationship between depressive symptoms, exercise self-efficacy, and physical activity among patients with coronary heart disease and how the efficacy-activity relationship is affected by the patient's level of depression.


A survey was conducted on 149 participants at the time of discharge from the emergency and in-patient medical wards at 2 regional hospitals.


The sample was mostly male, married, living with families, and of lower socioeconomic status. The mean exercise self-efficacy was 4.26 ± 2.73, and the median physical activity was 12 (interquartile range, 6-21). Approximately 26% of participants had high depressive symptoms. Those with more depressive symptoms reported lower self-efficacy scores and lower physical activity. In multivariate regressions, self-efficacy was an independent predictor of physical activity (b = 1.48, P < .001). After including depressive symptoms as the interaction term, exercise self-efficacy had a significantly stronger and positive relationship with physical activity (b = 0.14, P = .043).


Exercise self-efficacy had a positive association with physical activity, and this relationship was stronger among coronary heart disease patients with depressive symptoms. This finding suggests that self-efficacy might be important in encouraging individuals with depressive symptoms to participate in physical activity. More efforts should target the development of effective strategies to improve exercise self-efficacy as a way of promoting physical activity among depressed coronary heart disease patients.

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