TILBURG, THE NETHERLANDS — The association between a positive emotional state of mind and lower mortality in patients with ischemic heart disease is mediated by exercise, according to the results of a new study.
Patients with higher levels of positive affect, which reflects a pleasurable response to the environment and typically includes feelings of happiness, joy, excitement, contentment, and enthusiasm, had a 42% lower risk of all-cause mortality at five years and were 50% more likely to participate in an exercise program than those with lower levels of positive affect.
"When adding exercise to the model, with exercise being significantly associated with mortality, the relationship between positive affect and mortality became marginally significant," according to Dr Madelein Hoogwegt(Tilburg University, the Netherlands) and colleagues. "These results indicate that exercise might act as a mediator in this relationship, independent of demographic and clinical risk factors."
In the paper, published online September 10, 2013 in Circulation, the researchers state that mortality rates from ischemic heart disease have declined steadily in the past 20 years. As a result, it is now considereda chronic disease and is frequently accompanied by impaired psychological functioning and quality of life. Heart-disease patients often have higher rates of depression, anxiety, and other negative affective states, and these negative emotions have all been associated with adverse cardiac events, including hospitalizations and mortality.
Previous studies have focused on negative affect and its relationship to cardiovascular outcomes, but less is known about positive psychological well-being and health outcomes. In addition, the mechanism underlying the association between positive psychological well-being and improved health outcomes is unknown. In 607 patients with ischemic heart disease, Hoogwegt and colleagues sought to determine whether positive affect predicted time to first cardiac-related hospitalization and all-cause mortality and whether exercise mediated this relationship.
In an adjusted regression model, there was no significant association between positive affect, as measured using the global mood scale (GMS), and cardiac-related hospitalizations. Ischemic heart disease patients with higher levels of positive affect on the GMS had a significant 42% lower risk of all-cause mortality at five years. In addition, these happier patients were also 48% more likely to exercise.
In a risk model that adjusted for positive affect, patients who exercised were less likely to die during the five-year follow-up. And the relationship between positive affect and mortality became marginally significant once exercise was included in the model. According to the investigators, this suggests that the mortality benefit among those with positive affect is mediated by exercise.
"Because positive affect is related to exercise, interventions aimed at positive-affect induction in combination with exercise promotion may induce better outcomes for patients, both in terms of increasing the likelihood of the accomplishment and maintenance of a healthy exercise pattern and in terms of better psychological functioning, than interventions focusing on the promotion of exercise alone," conclude the researchers.
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