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  1. Jackson, Jamie L. PhD
  2. Emery, Charles F. PhD


PURPOSE: The purpose of this study was to examine emotional distress, alexithymia, and coping styles as predictors of cardiac rehabilitation (CR) outcomes and attendance.


METHODS: Participants included 56 patients in an outpatient CR program (65% male, 59% white, M = 61.1 years) who completed self-report measures of emotional distress (ie, depressive and anxiety symptoms), alexithymia, and coping styles (ie, approach and avoidance coping). CR outcomes recorded at entry and completion of the program included blood cholesterol, oxygen uptake (



O2max), knowledge about cardiac disease, and self-reported lipid consumption. Attendance was also recorded as a measure of adherence.


RESULTS: Significant improvements were observed in oxygen uptake, high-density lipoprotein levels, disease knowledge, and self-reported lipid consumption. Older age was associated with less distress, and anxiety and higher education were associated with better attendance. Higher alexithymia (ie, greater difficulty processing emotion) was associated with increased low-density lipoprotein cholesterol, and alexithymia predicted increased self-reported lipid consumption in the context of higher approach coping.


CONCLUSIONS: CR is associated with physical and quality-of-life benefits, as well as increased knowledge about cardiac disease management. However, coping strategies that are generally beneficial (approach coping) may be associated with negative health behavior among individuals who have difficulty processing emotion. Anxiety and lower education were associated with poorer attendance, perhaps indicating the need for intervention to prevent dropout.