International Journal of Behavioral Medicine

, Volume 24, Issue 2, pp 312–320 | Cite as

Influence of Depression and Hostility on Exercise Tolerance and Improvement in Patients with Coronary Heart Disease




Although hostility and depression have been linked to higher cardiac risk and poor prognosis of patients with coronary heart disease (CHD), there is a lack of research that studies how they may influence the short-term outcomes among patients participating in cardiac rehabilitation (CR). This study aimed to investigate the influence of hostility and depression on patients’ exercise tolerance and improvement trajectory in a CR program over 6 weeks.


Participants were 142 patients with CHD, with a mean age of 62 years. Latent growth curve modeling was conducted to determine whether hostility and depression predicted patients’ baseline exercise tolerance and rates of improvement on treadmill, while controlling for age and severity of illness. In addition, analysis was conducted to examine whether depression mediated the influence of hostility on exercise outcomes.


Patients with CHD with higher hostility scores had a lower baseline exercise tolerance and slower rates of improvement over 6 weeks. Depressive symptom severity mediated the influence of hostility on exercise baseline and improvement. Patients with higher hostility were more likely to have more severe depressive symptoms, which in turn were associated with lower baseline exercise tolerance and slower improvement.


While both hostility and depression predicted the exercise outcomes in CR, depression explained the influence of hostility. The findings underscore the importance of addressing psychosocial issues in treatment of CHD patients and provide support for psychosocial interventions in CR to facilitate patients’ recovery.


Depression Hostility Exercise tolerance Coronary heart disease Rehabilitation 



The authors would like to extend our sincere gratitude to Dr. Charles McCreary and Ms. Frances Weber for their support and assistance in completion of this study.

Compliance with ethical standards

Conflict of interest

Both authors declare that there is no conflict of interest to report.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the IRB of Greater LA VA Hospital.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© International Society of Behavioral Medicine 2016

Authors and Affiliations

  1. 1.Division of PsychologyNanyang Technological UniversitySingaporeSingapore
  2. 2.Department of Psychological and Brain SciencesUniversity of DelawareNewarkUSA
  3. 3.Department of Geriatric MedicineOhio University Heritage College of Osteopathic MedicineAthensUSA

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