Factors Influencing Walking Fitness Following Cardiac Rehabilitation in Patients With and Without New‐Onset Depression

Aim To investigate potential factors that might influence the achievement of the minimum clinically important difference (MCID) in walking fitness following cardiac rehabilitation (CR) in patients with and without new‐onset depression. Methods The clinical data from the National Audit of CR (NACR) indicated that between January 1, 2016, and January 31, 2020, 2027 acute coronary syndrome (ACS) patients with new‐onset depression (15.5%) and 11,059 without new‐onset depression (84.5%) underwent pre‐ and postincremental shuttle walk test (ISWT) measurements. Patients with new‐onset depression had a mean age of 61.7 ± 10.5 years (27.5% female), compared to 64.8 ± 10.3 years (20.6% female) among those without. Comparative analyses were conducted to examine differences in walking fitness between these groups. Subsequently, a binary logistic regression analysis was executed to investigate the factors associated with achieving the MCID in walking fitness, defined as > 70 m improvement in ISWT, following CR. Results The multivariate analysis results revealed that having new‐onset depression (OR: 0.89, 95% CI: 0.80 and 0.99), older age (OR: 0.96, 95% CI: 0.95 and 0.96), female gender (OR: 0.61, 95% CI: 0.56 and 0.68), physical inactivity (OR: 0.84, 95% CI: 0.78 and 0.91), and obesity (OR: 0.65, 95% CI: 0.60 and 0.71) were all associated with being less likely to achieve MCID in walking fitness adjusting for baseline fitness levels. Patients with new‐onset depression had reduced walking fitness at baseline compared to those without, and they were less likely to meet the MCID for ISWT following CR. The study also generated a novel set of walking fitness reference values for patients with new‐onset depression.