Home exercise can ease feelings of hopelessness in people with coronary heart disease, according to a small study presented at the American Heart Association's Scientific Sessions 2014.
Feeling hopeless can be dangerous because it can discourage people from taking healthful steps such as exercising or quitting smoking, said Susan L. Dunn, Ph.D., R.N., lead author of the study and a professor of nursing at Hope College in Holland, Michigan.
People with hopelessness may also suffer from depression, which is marked by a loss of interest in activities they normally enjoy.
"For the first time, we show the beneficial effect of exercise in helping patients to feel more hopeful. With home exercise, patients are likely thinking more positively about the future and feeling more capable of making positive changes for a healthy lifestyle," Dunn said.
Past studies have linked the feeling of hopelessness to the development and worsening of coronary heart disease and a higher risk of complications and death. Yet, little research has been done on helping these patients and many healthcare professionals overlook things like mental state, attitude, perspective and outlook as aspects of patient care.
The new study involved 324 patients (average age 66, 33 percent women and 93 percent white) with coronary heart disease.
Researchers developed an instrument to measure feelings of hopelessness: "state" hopelessness, which is how pessimistic and helpless patients feel currently, and "trait" hopelessness, which captures how patients typically feel over much longer periods.
At the study's outset, while still in the hospital, 24 percent of the patients had current feelings of hopelessness, 28 percent expressed long-term feelings of hopelessness and 30 percent had both types, at moderate to severe levels.
During a year, those who walked or biked at home at least three days a week had a 12 percent reduction in state hopelessness scores -- even when considering other relevant circumstances such as age, participation in hospital-based exercise and factors of depression. This reduction was statistically significant and so was not due to chance.
The researchers were surprised to find that hospital-based cardiac rehabilitation exercise didn't impact current hopelessness. Perhaps the initiative required to exercise at home increased patients' sense of empowerment about their health, Dunn said.
"Individuals with trait hopelessness feel chronically helpless about many areas of their life," Dunn said, suggesting that longer-term hopelessness may be harder to treat.
A key limitation of the small study was that some patients who felt the most hopeless dropped out over time. Also, further research is needed to examine hopelessness and exercise in racially diverse groups.
Healthcare providers need to assess the presence and severity of hopelessness in patients before hospital discharge, Dunn said.
"All patients should be encouraged to participate in a regular exercise program," she said. "Special encouragement is needed for patients who are moderately to severely hopeless, as they may be the most vulnerable and the least likely to exercise, yet benefit the most."
Co-authors are Maureen Dunn, Ph.D.; Nicole Rieth, B.S.N., R.N.; Jacob Clark, B.S.; and Nathan Tintle, Ph.D. Author disclosures are on the manuscript.
The Howard Hughes Medical Institute, Great Lakes Colleges Association and Kappa Epsilon Chapter-at-Large of Sigma Theta Tau Honor Society of Nursing funded the study.
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Coronary Artery Disease - Coronary Heart Disease
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Note: Presentation is 3 p.m. CT/4 p.m. ET, Tuesday, Nov. 18, 2014 (Hall A2, Core 2).
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