Relationship of physical fitness, depression and mortality in a cardiac rehabilitation cohort
Turner, Sally, 1946- (2007) Relationship of physical fitness, depression and mortality in a cardiac rehabilitation cohort. PhD thesis, University of Warwick.
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The study aimed to establish whether levels of fitness and depression, or
changes in those levels, in coronary heart disease patients are associated
with survival time.
The cohort consisted of 2,714 coronary patients who were followed up for 13
[median 6.4] years after enrolment into a cardiac rehabilitation [CR]
All participants underwent fitness testing and psychological assessment at
the start of Phase III CR. These tests were repeated approximately 12
weeks later. Fitness levels were categorised into low, medium and high.
Depression scores were divided into none, borderline and clinical depression.
Primary endpoints were all-cause mortality and cardiovascular mortality.
At the end of the study period 16.6% of the cohort had died. The
improvement in fitness over the 3 months of physical training was 16.8%.
Fitness category improved in 33% of the cohort and deteriorated in less than
1%. Baseline fitness was predictive of all-cause and cardiovascular mortality
with adjusted hazard ratios [HR] for low fitness of 2.83 [2.02,3.96] (p<0.001)
and 5.40 [3.36,8.69] (p<0.001) respectively. Low fitness at the end of CR
was predictive of mortality, HRs 4.23 [2.64,6.79] (p<0.001) and 6.37
[3.37,12.0] respectively (p<0.001). An increase in fitness amongst the least
fit at baseline was associated with an 11 % reduction in the risk of
cardiovascular mortality [0.80,0.98] for each unit increase in fitness of
Baseline clinical depression was 4.6%. This had reduced to 1.1% by the exit
assessment. Fitness levels were related to depressions scores; the least fit
participants were more likely to be depressed. The study showed an
association between baseline clinical depression and all-cause and
cardiovascular mortality, before adjusting for fitness, HRs 1.60 and 1.79.
Initial fitness and baseline depression are associated with prognosis in
coronary patients who have attended CR. These findings may help target
patients at risk in order to maximise treatments.
|Item Type:||Thesis or Dissertation (PhD)|
|Subjects:||R Medicine > RC Internal medicine|
|Library of Congress Subject Headings (LCSH):||Physical fitness, Depression, Mental, Coronary heart disease -- Treatment, Exercise -- Physiological aspects, Exercise -- Psychological aspects|
|Official Date:||July 2007|
|Institution:||University of Warwick|
|Theses Department:||Warwick Medical School|
|Supervisor(s)/Advisor:||Thorogood, Margaret ; Weich, Scott|
|Sponsors:||Chartered Society of Physiotherapy (Great Britain) ; Rehab Charity Education Fund ; Great Britain. National Health Service|
|Extent:||ix, 364 leaves|
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