As a health professional working with cardiac patients, you are no doubt aware of the importance of behaviour change as a means of secondary prevention of cardiovascular disease.
The survival benefits of increased physical activity, dietary modification, and smoking cessation in cardiac patients have been convincingly demonstrated in numerous studies. Weight loss and reduced waist girth are amongst the mechanisms through which physical activity and dietary improvement exert their protective effect. The international REACH study reported that when secondary prevention goals are not met at one year post-event, the incidence of adverse cardiovascular events increases. Unfortunately, a large majority of cardiac patients do not meet recommended targets for secondary prevention, with high rates of unhealthy diets, physical inactivity, and obesity in the year post-event.
Post-event depression puts patients at a distinct disadvantage in terms of engagement in activities that promote health and wellbeing. International and Australian studies, including research undertaken at the Heart Research Centre, shows that depressed cardiac patients are more likely to smoke and to relapse after quitting, are less physically active, and consume more dietary fat and less fruit and vegetables than their non-depressed counterparts. Depressed patients are also significantly less likely to attend cardiac rehabilitation programs. These poor health behaviours in part explain the higher morbidity and mortality rates amongst depressed cardiac patients.
Why is behaviour change so difficult for depressed patients?
- Loss of interest and pleasure in activities that have previously been enjoyed. People with depression stop their usual activities and withdraw from friends and family. The pleasure is gone out of life.
- Loss of motivation and will. It’s difficult to complete even simple daily tasks. Sometimes it seems impossible to get out of bed.
- Fatigue and exhaustion. People with depression generally feel tired and have no energy for usual daily activities. Sleep is disrupted which exacerbates the problem.
- Worry and negative thinking. People with depression have negative thoughts about themselves and lose self-esteem and confidence. It’s difficult to think positively.
- Feelings of hopelessness. People with depression have trouble seeing the light at the end of the tunnel. The future looks bleak.
In the midst of serious depression, which is experienced by one in five cardiac patients in the year post-event, major lifestyle change can seem impossible. Patients simply lack the motivation, interest and desire to implement or maintain healthy lifestyle choices. They are simply too tired to plan a walk or a swim. They lack the confidence to join a gym or participate in group activities. They have no motivation to quit smoking and can’t see the point of it anyway.
Unfortunately, people with depression therefore tend to miss out on the sense of pleasure and mastery that comes from engaging in healthy behaviour changes, such as physical activity, healthy eating and smoking cessation. They need extra monitoring and support to give them the best chance of a positive and full recovery.