Predicting Physical Activity and Quality of Life in Coronary Heart Disease Patients: An 18-Month Path Analysis of Motivational and Emotional Factors

Objective: Investigating factors that promote cardiovascular health outcomes is essential for secondary prevention. In a sample of coronary heart disease patients, we examined the direct and indirect effects of selected psychological factors on physical activity behavior and health-related quality of life (HRQoL) over 18 months. Method: Patient-reported data were collected over three time points. Through structured equation modeling, a longitudinal path analysis was conducted to estimate the indirect effects of baseline HRQoL and cardiac self-efficacy on reported physical activity behavior and HRQoL (evaluated at 18 months) through the mediation of anxiety and depression symptoms, patients' reported intention to change the behavior, and emotions regulation strategies (evaluated at 9 months). Results: A total of 410 patients were included. Significant indirect effects of baseline HRQoL (beta = .05, 95% CI [-0.001, 0.111]) and cardiac self-efficacy (beta = .105, 95% CI [0.06, 0.16]) on physical activity behavior were found, with anxiety symptoms and emotions regulation strategies as significant mediators. Additionally, the mediation of reported intention in the association between cardiac self-efficacy and physical activity levels was estimated. At the final follow-up, we also found a significant direct association between physical activity behavior and HRQoL (beta = .12, p < .01), which was indirectly impacted by baseline HRQoL (beta = .006, 95% CI [0.000, 0.017]) and cardiac self-efficacy (beta = .012, 95% CI [0.003, 0.027]). Conclusions: This study underlines the significance of addressing stress management, anxiety symptoms reduction, and cardiac self-efficacy enhancement when targeting better cardiovascular health outcomes. Identifying cardiovascular risk profiles based on these findings may benefit future clinical practice and further inform secondary prevention policy guidelines.