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. 2023 Aug;16(8):544-553.
doi: 10.1161/CIRCOUTCOMES.122.009840. Epub 2023 Jul 20.

Longitudinal Pathways Between Physical Activity, Depression, and Perceived Stress in Peripheral Artery Disease

Idil Yazgan  1 , Victoria Bartlett  2 , Gaëlle Romain  1   3 , Jacob Cleman  1   3 , Pamela Petersen-Crair  4 , John A Spertus  5   6 , Madeleine Hardt  4 , Carlos Mena-Hurtado  1   3 , Kim G Smolderen  1   3   4
Affiliations

Longitudinal Pathways Between Physical Activity, Depression, and Perceived Stress in Peripheral Artery Disease

Idil Yazgan et al. Circ Cardiovasc Qual Outcomes. 2023 Aug.

Abstract

Background: One-fifth of the patients with peripheral artery disease (PAD) experience depression and stress. Depression and stress may impact patients' abilities to be physically active, a key recommendation for supporting overall PAD management to improve symptoms and reduce the risk of cardiovascular events. We aimed to study interrelationships between 1-year longitudinal trajectories of depression, stress, and physical activity following a PAD diagnosis.

Methods: Patients with new or worsening PAD symptoms enrolled at 10 US PORTRAIT study (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) vascular specialty clinics (CT, LA, MI, MO, NC, OH, and RI) were assessed at baseline, 3, 6, and 12 months between June 2, 2011 and December 3, 2015. Depressive symptoms were measured with the 8-item Patient Health Questionnaire, perceived stress with the 4-item Perceived Stress Scale and physical activity with items from the INTERHEART study. Path analysis was used to examine the longitudinal relationship between depression and physical activity and perceived stress and physical activity.

Results: A total of 766 patients were included (mean age of 68.2 [±9.4] years; 57.7% male). Overall, 17.8% reported significant depressive symptoms, 36.0% experienced increased perceived stress, and 44.1% were sedentary upon PAD diagnosis. A decrease in physical activity preceded a rise in subsequent depressive symptoms (β ranges -0.45 [95% CI, -0.80 to -0.09]; -0.81 [95% CI, -1.19 to 0.42]) over the course of 1 year. Low physical activity scores at the initial presentation were followed by high perceived stress at 3 months (β=-0.44 [95% CI, -0.80 to -0.07]).

Conclusions: In symptomatic PAD, a decrease in physical activity was followed by an increased risk of depressive symptoms and perceived stress at subsequent intervals over the course of 1 year following PAD diagnosis and treatment. Integrated behavioral health approaches for PAD, addressing physical activity and managing depression or distress, are indicated as collective PAD treatment goals.

Keywords: anxiety; depression; life style; peripheral artery disease; walking.

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Conflict of interest statement

Disclosures Dr Smolderen reports unrestricted research grants from Philips, Merck, Shockwave, and Johnson & Johnson; she is a consultant for Optum Labs, Cook, Tegus, Twill Inc. and Abbott Vascular. Dr Spertus reports research grants from Janssen, Bristol Meyers Squibb, and Abbott Vascular; consulting for Janssen, Bristol Meyers Squibb, Bayer, United Healthcare, Terumo, Merck, Imbria Pharmaceuticals, Sanofi Aventis; serving on the board of directors for Blue Cross Blue Shield of Kansas City; and owning the copyright to the KCCQ, SAQ, and PAQ. Dr Mena-Hurtado reports unrestricted research grants from Abbott Vascular, Philips, and Shockwave and is a consultant for Abbott Vascular, Cook, Optum Labs. The other authors report no conflicts.

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