Association Of Anxiety And Executive Function With Attendance And Fitness Improvement In Cardiac Rehabilitation

William A. Middleton, University of Vermont


Psychological factors such as anxiety and executive function (EF) may impact patient health outcomes from cardiac rehabilitation (CR). High anxiety and low executive function could reduce attendance or impede fitness improvements yielded from CR. Other research on exercise performance suggests, in certain circumstances, moderate levels of anxiety can be beneficial towards fitness gains. The current study evaluated the associations of anxiety and EF with attendance and fitness improvement in CR through retrospective analyses of two datasets from studies conducted at the University of Vermont Medical Center CR program. One sample contained a representative sample of CR patients, and the other, lower-SES patients. No relationships between anxiety or EF and attendance or fitness improvement were detected in the representative sample of patients. However, higher anxiety and lower executive function were associated with diminished fitness improvement among lower-SES patients. Moderate anxiety levels were not found to be beneficial for fitness improvement. Maximizing patient attendance and fitness improvement in CR is integral to long-term survival rates. Lower-SES patients are already at higher risk for earlier dropout, nonattendance, and more severe psychological impairments. Even when lower-SES patients do attend, it appears that the benefits they gain may be impeded by elevated levels of anxiety or executive dysfunction. Lower-SES patients should be the focus of efforts to treat anxiety and support executive function deficits within CR.