Latent change models of lifestyle in acute coronary syndrome patients: Are lifestyle changes associated with resilience changes?

This study aimed to examine the role of resilience resources in patients' lifestyle changes after the first Acute Coronary event. 275 Italian patients (84.0% men; mean age = 57.5, SD = 7.9) participated in a longitudinal study. Resilience resources (Self-esteem, Dispositional Optimism, Sense of Coherence - SOC, General and Disease-specific Self-efficacy), and lifestyles (diet, physical activity, and smoking) were assessed twice (at baseline and after 6 months). Path analysis using latent change models was performed to model the combined effect of levels and changes of the resilience resources over lifestyle changes. Patients with strong SOC at baseline were less prone to smoke and more prone to decrease smoking; enhancement in SOC was associated with a smoking decrease. High Disease-specific Self-efficacy at baseline was associated with an improvement in all lifestyles; enhancement in Disease-specific Self-efficacy predicted an increase in physical activity. Findings underline the need to design psychological interventions that promote patients' Disease-specific Self-efficacy and SOC.

Associations between Lifestyle Changes and Adherence to COVID-19 Restrictions in Older Adults with Hypertension.

COVID-19 has changed people's routines and imposed new ways of living. This study investigated variations in lifestyles (namely, physical activity, diet, alcohol consumption, and cigarette smoking) between the prepandemic and the pandemic period in a sample of older adults with hypertension. Moreover, it investigated predictors of adherence to government restrictions during the first lockdown period, evidencing the role of relevant sociodemographic indicators and lifestyle changes. A sample of 105 older Italian adults (M_age = 70 years; SD = 5.83) with hypertension was enrolled from a previous longitudinal study and interviewed on the phone between May and August 2020. Updated information about sociodemographic indicators and lifestyle changes was collected. Adherence to restrictions was explored through several questions regarding compliance with home confinement, facemask use, and the observance of social distancing. Results evidenced that only 33% of the respondents abided by all the national restrictions. During the first pandemic peak, considerable changes in lifestyles occurred, particularly regarding physical activity, which diminished in 70% of the sample. Women, unemployed/retired people, and individuals who decreased their amount of physical activity reported higher adherence to rules. Maintaining a healthy lifestyle over time is essential for disease prevention. Therefore, it is essential to continue to inform the population about the importance of a healthy lifestyle, and it is necessary to provide guidelines to maintain and promote it even during housebound periods.

Sense of Coherence Predicts Physical Activity Maintenance and Health-Related Quality of Life: A 3-Year Longitudinal Study on Cardiovascular Patients.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. A physically active lifestyle can improve the health-related quality of life (HRQoL) of people with CVD. Nevertheless, adherence to a physically active lifestyle is poor. This study examined the longitudinal (pre-event, 6-, 12-, 24-, and 36-month follow-ups) physical activity profiles in 275 patients (mean age = 57.1 years; SD = 7.87; 84% men) after the first acute coronary event. Moreover, it investigated the associations among physical activity, sense of coherence (SOC), and HRQoL. Physical activity profiles were identified through latent class growth analysis, and linear regressions were then performed to explore the association between physical activity, SOC, and HRQoL. After the cardiovascular event, 62% of patients reached adequate physical activity levels and maintained them over time (virtuous profile). The remaining 38% could not implement (23%) or maintain (15%) a healthy behavior. A strong SOC at baseline (standardized ß = 0.19, p = 0.002) predicted the probability of belonging to the virtuous profile. Moreover, a strong SOC at baseline (standardized ß = 0.27, p < 0.001), together with the probability of belonging to the virtuous profile (standardized ß = 0.16, p = 0.031), predicted a better HRQoL at the final follow-up. Findings showed a strong relationship between SOC, the ability to adopt a physically active lifestyle stably over time, and HRQoL in patients with CVD. They suggest the importance of tailoring physical activity interventions by promoting resilience resources such as SOC to improve patients' quality of life after an acute coronary event.

Impulsivity assessed ten years earlier and sociodemographic factors predict adherence to COVID-19 related behavioral restrictions in old individuals with hypertension.

BACKGROUND: The COVID-19 pandemic has had clear and dramatic repercussions on health, the economy, and psychosocial well-being. Behavioral measures, such as wearing facemasks and maintaining distance from others, have proven crucial in fighting the contagion's spread. This study aimed to investigate Type A personality traits and sociodemographic predictors of adherence to governmental measures in a sample of frail individuals. METHODS: A sample of 105 Italians over age 60 (Mean age = 70 years; 60.6% male) affected by hypertension who participated in a previous longitudinal study were assessed through a telephone structured interview. Sociodemographic information and Type A personality traits were retrieved from the original longitudinal study. Adherence behaviors were investigated through several questions regarding the compliance with home confinement, the use of facemasks and the observance of social distancing. Repeated measures Analyses of Variance (RMANOVA), Reliable Change Index, and binomial logistic regression analysis were performed. RESULTS: Only 33.3% of the participants reported adherence to all the governmental COVID-19 measures. Being a woman (OR = 4.84; 95% CI = 1.58, 14.90; p < 0.01), being retired (OR = 4.89; 95% CI = 1.09, 21.86; p < 0.05), and suffering from hypertension for a relatively short time (OR = 4.20; 95% CI = 1.22, 14.44; p < 0.05) positively predicted adherence to the governmental measures. Impulsivity resulted in a stable personality characteristic over the last ten years (p = 0.30). Having high levels of impulsivity (OR = 2.28; 95% CI = 1.13, 4.59; p < 0.05) negatively predicted adherence. CONCLUSIONS: Our results demonstrate that impulsivity is a stable personality facet that can have a robust negative impact on adherence behaviors to health claims. Overall, results show the importance to tailor communication strategies that consider the role of sociodemographic indicators and impulsivity to achieve a high level of adherence.

Depression symptoms as longitudinal predictors of the psychological impact of COVID-19 pandemic in hypertensive patients.

COVID-19 has brought considerable changes and caused critical psychological responses, especially among frail populations. So far, researchers have explored the predictive effect of diverse factors on pandemic-related psychological distress, but none have focused on the impact of prior depression and anxiety symptomatology adopting an extended (10-year) longitudinal design. 105 patients aged over 60, affected by hypertension who participated in a previous longitudinal study were assessed through a follow-up telephone structured interview. The Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale-Revised (IES-R) were used for assessing depression and anxiety symptoms and the psychological impact of COVID-19, respectively. Multiple linear regression analyses were conducted. At the assessment, participants did not report clinically relevant depression, anxiety, and psychological pandemic-related distress symptoms. However, significant mean differences between baseline and current follow-up evaluations for both depression and anxiety were found, reflecting a decrease in symptomatology over time (p < .001). Baseline depression symptoms (ß = 1.483, p = .005) significantly predicted the psychological impact of COVID-19 after 10 years. Conversely, their decrease (ß = -1.640, p < .001) and living with others (ß = -7.274, p = .041) significantly contributed to lower psychological distress scores. Our findings provide insight into the predisposing influence of depressive symptoms on pandemic-related psychological distress ten years later. Preventive interventions and strategies considering these factors are needed to better pre-empt the severe mental consequences of the pandemic.

Cardiac rehabilitation outcome after transcatheter aortic valve implantation.

Patients with severe aortic stenosis are increasingly treated with transcatheter aortic valve implantation (TAVI) as a safer option to surgical aortic valve replacement (sAVR).  Similar to many other heart diseases, after the specific therapeutic intervention patients are eligible for cardiac rehabilitation (CR) for the purpose of functional recovery. Thus far, CR after both sAVR and TAVI has been used to a limited extent, as shown by the availability of only two meta-analyses including 5 studies and 6 studies, respectively. Recent observational studies reported a significant improvement in functional indexes such as the Barthel scale and the 6-minute walk test (6MWT). We evaluated the outcome of CR in patients after TAVI treatment by measuring changes in the commonly used Barthel scale and 6MWT and adding the short physical performance battery (SPPB) scale as an index to assess lower extremity function. All indexes demonstrated a significant improvement, namely p<0.001 with the Barthel scale, p=0.043 for the 6MWT, and p=0.002 for SPPB. These results confirm the significant improvement of the Barthel scale and 6MWT reported in the previous meta-analysis and suggest the utility of SPPB as a further index of efficacy of CR in patients with severe aortic stenosis treated with TAVI.

Protein Intake and Physical Activity in Newly Diagnosed Patients with Acute Coronary Syndrome: A 5-Year Longitudinal Study.

Cardiovascular disease is one of the most common causes of hospitalization and is associated with high morbidity and mortality rates. Among the most important modifiable and well-known risk factors are an unhealthy diet and sedentary lifestyle. Nevertheless, adherence to healthy lifestyle regimes is poor. The present study examined longitudinal trajectories (pre-event, 6-, 12-, 24-, 36-, and 60-month follow-ups) of protein intake (fish, legumes, red/processed meat) and physical activity in 275 newly-diagnosed patients with acute coronary syndrome. Hierarchical Generalized Linear Models were performed, controlling for demographic and clinical variables, the season in which each assessment was made, and the presence of anxiety and depressive symptoms. Significant changes in protein intake and physical activity were found from pre-event to the six-month follow-up, suggesting the adoption of healthier behaviors. However, soon after the six-month follow-up, patients experienced significant declines in their healthy behaviors. Both physical activity and red/processed meat intake were modulated by the season in which the assessments took place and by anxiety symptoms over time. The negative long-term trajectory of healthy behaviors suggests that tailored interventions are needed that sustain patients' capabilities to self-regulate their behaviors over time and consider patient preference in function of season.

Stability and change of lifestyle profiles in cardiovascular patients after their first acute coronary event.

BACKGROUND: Acute coronary syndrome (ACS) is a major cause of morbidity and mortality. Lifestyle and health behavior changes play an important role in the primary and secondary prevention of ACS recurrence. Changes in unhealthy lifestyles after an acute coronary event have been analyzed by considering separate behaviors individually, even though research on the healthy population has demonstrated that unhealthy behaviors tend to co-occur. PURPOSE: The aim of this study was to identify lifestyle profiles of ACS patients and to explore their pathways of change for one year after their first coronary event by adopting a typological approach. METHODS: Two hundred and twenty-three patients (84% male; mean age = 57.14) completed self-report measures of health-related behaviors at the beginning of cardiac rehabilitation, and six months and twelve months after. At each wave depression, anxiety and heart rate were also evaluated. Cluster analysis was performed to identify lifestyle profiles and to analyze their change over time. Differences in psychological factors and heart rate among clusters were assessed. RESULTS: Patients' diet, physical activity, and smoking behavior greatly improved six months after their first coronary event. No further improvements were detected after one year. At each wave specific lifestyle profiles were identified, ranging from more maladaptive to healthier clusters. Patients with multiple unhealthy behaviors experience greater difficulties in maintaining a healthier lifestyle over time. Moreover, the results demonstrated the association between lifestyle profiles at twelve months after the acute coronary event and depression measured six months earlier. Finally, the most maladaptive lifestyle profile had many members with elevated heart rate at twelve months after the cardiac rehabilitation. CONCLUSIONS: Current findings may have a strong practical impact in the development and implementation of personalized secondary prevention programs targeting lifestyles of ACS patients.

Validity of the Talk Test for exercise prescription after myocardial revascularization.

BACKGROUND: For exercise prescription, rating of perceived exertion is the subjective tool most frequently used in addition to methods based on percentage of peak exercise variables. The aim of this study was the validation of a subjective method widely called the Talk Test (TT) for optimization of training intensity in patients with recent myocardial revascularization. DESIGN AND METHODS: Fifty patients with recent myocardial revascularization (17 by coronary artery bypass grafting and 33 by percutaneous coronary intervention) were enrolled in a cardiac rehabilitation programme. Each patient underwent three repetitions of the TT during three different exercise sessions to evaluate the within-patient and between-operators reliability in assessing the workload (WL) at TT thresholds. These parameters were then compared with the data of a final cardiopulmonary exercise testing, and the WL range between the individual aerobic threshold (AeT) and anaerobic threshold (AnT) was considered as the optimal training zone. RESULTS: The within-patient and between-operators reliability in assessing TT thresholds were satisfactory. No significant differences were found between patients' and physiotherapists' evaluations of WL at different TT thresholds. WL at Last TT+ was between AeT and AnT in 88% of patients and slightly