Dunn Susan L, Dunn L Maureen, Rieth Nicole P, Olamijulo Grace B, Swieringa Lien L, Holden Theresa P, Clark Jacob A, DeVon Holli A, Tintle Nathan L
College of Nursing, Michigan State University, East Lansing (Dr Dunn); Departments of Kinesiology (Dr Dunn) and Nursing (Mss Rieth, Olamijulo, Swieringa, and Holden), Hope College, Holland, Michigan; Mercy Health Saint Mary's, Grand Rapids, Michigan (Ms Rieth); New York Presbyterian Hospital, New York (Ms Olamijulo); Sparrow Health System, Lansing, Michigan (Ms Swieringa); Department of Statistics, Dordt College, Sioux Center, Iowa (Mr Clark and Dr Tintle); Center for Public Health Statistics, University of Iowa, Iowa City (Mr Clark); and Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago (Dr DeVon).
J Cardiopulm Rehabil Prev. 2017 Jan;37(1):39-48. doi: 10.1097/HCR.0000000000000205.
Hopelessness is associated with increased adverse events and decreased survival in patients with coronary heart disease (CHD). The purpose of this research was to examine the effect of regular home- and hospital-based cardiac rehabilitation (CR) exercise on hopelessness levels in patients with CHD, hypothesizing that increased exercise in either setting would lead to decreased state hopelessness.
A descriptive longitudinal design was used at a large teaching hospital in Michigan. A total of 324 patients provided data during hospitalization and at least 1 followup time point (3, 8, and 12 months).
The patients had persistent, modest levels of state and trait hopelessness across all time points. Among home exercisers with moderate to severe state hopelessness at baseline, both mean state (P = .002) and trait (P = .02) hopelessness were reduced at later time points compared with those who quit or did not start exercise. Multivariable models showed that when individuals had moderate to severe baseline state hopelessness, home exercise remained associated with decreases in state hopelessness compared with no exercise, even after adjusting for hospital exercise, depression, and demographic variables.
Exercise may be effective in reducing moderate to severe hopelessness in patients with CHD. Moderate to severe baseline state hopelessness was a predictor of attrition in this cohort, especially for home exercisers, but this was mediated in hospital-based programs. Further research is needed to determine how hopeless individuals can be encouraged to exercise and whether home- or a hospital-based CR exercise is superior in impacting hopelessness.
绝望与冠心病（CHD）患者不良事件增加及生存率降低相关。本研究旨在探讨基于家庭和医院的定期心脏康复（CR）运动对CHD患者绝望水平的影响，假设在任何一种环境下增加运动都会导致状态绝望感降低。
在密歇根州的一家大型教学医院采用描述性纵向设计。共有324名患者在住院期间及至少1个随访时间点（3个月、8个月和12个月）提供了数据。
患者在所有时间点的状态和特质绝望水平都持续处于中等程度。在基线时存在中度至重度状态绝望的家庭运动者中，与那些停止运动或未开始运动的人相比，后期时间点的平均状态绝望（P = .002）和特质绝望（P = .02）均有所降低。多变量模型显示，当个体在基线时存在中度至重度状态绝望时，即使在调整了医院运动、抑郁和人口统计学变量后，与不运动相比，家庭运动仍与状态绝望的降低相关。
运动可能对降低CHD患者中度至重度绝望有效。中度至重度基线状态绝望是该队列中失访的一个预测因素，尤其是对于家庭运动者，但在基于医院的项目中这一因素得到了调节。需要进一步研究以确定如何鼓励绝望个体进行运动，以及基于家庭或医院的CR运动在影响绝望方面是否更具优势。
