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      Evaluation of the Impact of Virtual Reality-Enhanced Cardiac Rehabilitation on Depressive and Anxiety Symptoms in Patients with Coronary Artery Disease: A Randomised Controlled Trial

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          Abstract

          The aim of this study was to assess the efficacy of virtual reality (VR)-enhanced cardiac rehabilitation (CR) in reducing the intensity of depression and anxiety symptoms in patients undergoing phase II of CR in ambulatory conditions. One hundred participants (mean age 65.7 years) were divided randomly into two groups. Both groups took part in eight sessions of standard CR (three times per week). The experimental group was additionally supported by eight sessions of VR therapy using the VR TierOne device and the control group by eight sessions of Schultz Autogenic Training. The Hospital Anxiety and Depression Scale (HADS) was used as the primary outcome measure. The Perception of Stress Questionnaire was used as the secondary outcome measure. The data from 77 participants were subject to analysis. Post-intervention, in the experimental group, the overall HADS score was statistically significantly reduced by 13.5%, HADS-Depression by 20.8%, and the general stress level by 12.8% ( p < 0.05). In the control group, the scores of the HADS, HADS-Anxiety and the general stress level were statistically significantly higher, by 4.8%, 6.5%, and 4.9%, respectively. VR-enhanced CR for individuals with cardiovascular disease reduced the level of anxiety and depression symptoms compared to standard CR.

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          The validity of the Hospital Anxiety and Depression Scale

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            Measures of depression and depressive symptoms: Beck Depression Inventory-II (BDI-II), Center for Epidemiologic Studies Depression Scale (CES-D), Geriatric Depression Scale (GDS), Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire-9 (PHQ-9).

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              Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association.

              Although prospective studies, systematic reviews, and meta-analyses have documented an association between depression and increased morbidity and mortality in a variety of cardiac populations, depression has not yet achieved formal recognition as a risk factor for poor prognosis in patients with acute coronary syndrome by the American Heart Association and other health organizations. The purpose of this scientific statement is to review available evidence and recommend whether depression should be elevated to the status of a risk factor for patients with acute coronary syndrome. Writing group members were approved by the American Heart Association's Scientific Statement and Manuscript Oversight Committees. A systematic literature review on depression and adverse medical outcomes after acute coronary syndrome was conducted that included all-cause mortality, cardiac mortality, and composite outcomes for mortality and nonfatal events. The review assessed the strength, consistency, independence, and generalizability of the published studies. A total of 53 individual studies (32 reported on associations with all-cause mortality, 12 on cardiac mortality, and 22 on composite outcomes) and 4 meta-analyses met inclusion criteria. There was heterogeneity across studies in terms of the demographic composition of study samples, definition and measurement of depression, length of follow-up, and covariates included in the multivariable models. Despite limitations in some individual studies, our review identified generally consistent associations between depression and adverse outcomes. Despite the heterogeneity of published studies included in this review, the preponderance of evidence supports the recommendation that the American Heart Association should elevate depression to the status of a risk factor for adverse medical outcomes in patients with acute coronary syndrome.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                J Clin Med
                J Clin Med
                jcm
                Journal of Clinical Medicine
                MDPI
                2077-0383
                16 May 2021
                May 2021
                : 10
                : 10
                : 2148
                Affiliations
                [1 ]Faculty of Physiotherapy, University School of Physical Education in Wroclaw, 51-612 Wroclaw, Poland; sandra.jozwik@ 123456awf.wroc.pl (S.J.); joanna.szczepanska@ 123456awf.wroc.pl (J.S.-G.);
                [2 ]Faculty of Health Sciences, Jan Dlugosz University in Czestochowa, 42-200 Czestochowa, Poland
                [3 ]Center for Sports Cardiology at the Gajda-Med Medical Center in Pultusk, 06-102 Pultusk, Poland; gajda@ 123456gajdamed.pl
                Author notes
                [* ]Correspondence: b.cieslik@ 123456ujd.edu.pl
                Author information
                https://orcid.org/0000-0002-8305-8130
                https://orcid.org/0000-0001-5191-3799
                Article
                jcm-10-02148
                10.3390/jcm10102148
                8156884
                34065625
                f0dfd2e2-4dde-4d1f-83ed-d970a479fd83
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

                History
                : 17 April 2021
                : 14 May 2021
                Categories
                Article

                cardiovascular disease,cvd,depression,anxiety,cardiac rehabilitation,virtual reality

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