Association between changes in exercise capacity and psychological distress in a remote cardiac rehabilitation cohort

Background/Introduction

Psychological distress is common in patients with cardiovascular disease and is associated with reduced adherence and adverse outcomes. Cardiac rehabilitation (CR) improves functional capacity and emotional wellbeing; however, whether the physiological–psychological relationship observed in conventional CR is preserved in remote models remains incompletely understood.

Purpose

To evaluate the association between changes in exercise capacity and psychological distress in patients undergoing remote CR, and to explore potential heterogeneity according to age and sex.

Methods

We conducted a prospective cohort study of patients enrolled in a remote CR programme. Exercise capacity (metabolic equivalents, METs) and psychological distress, assessed using the Hospital Anxiety and Depression Scale (HADS-Anxiety and HADS-Depression), were measured at baseline (T1) and post-intervention (T2). Change scores (Δ) were calculated as T2−T1. Associations between ΔMETs and ΔHADS scores were analysed using Pearson correlation coefficients. Subgroup analyses were performed according to the cohort median age (58 years) and sex. Continuous variables are presented as mean±SD. Statistical significance was defined as p<0.05.

Results

Fifty-three patients completed T1–T2 assessments (48 male; mean age 59±11 years). In the overall cohort, improvement in exercise capacity demonstrated modest inverse correlations with reductions in anxiety (r=−0.20, p=0.156) and depression (r=−0.21, p=0.142).

In patients below the cohort median age (58 years, n=24), greater improvement in METs was significantly associated with reduction in anxiety symptoms (r=−0.45, p=0.027), whereas the association was not statistically significant in those at or above the median age. Exploratory analyses suggested stronger correlations in women; however, the female subgroup was small (n=8), limiting interpretation.

Conclusion(s)

In this remote CR cohort, improvements in exercise capacity were accompanied by parallel reductions in psychological distress, with a significant association between fitness gain and anxiety reduction in patients below the median age. These findings support a physiological–psychological linkage within remote CR models, reinforcing the concept of rehabilitation as a holistic mind–body intervention. Further research is warranted to clarify age-related differences and to optimise emotional recovery strategies within digitally delivered CR programmes.METs Change vs Depression (Full Cohort)Change in METs vs Anxiety (Below Median Age)