Author ORCID Identifier
https://orcid.org/0000-0001-9511-8287
Date Available
12-15-2026
Year of Publication
2024
Document Type
Doctoral Dissertation
Degree Name
Doctor of Philosophy (PhD)
College
Nursing
Department/School/Program
Nursing
Advisor
Drs. Debra K. Moser
Co-Director of Graduate Studies
Martha J. Biddle
Abstract
With the aging population on the rise, more patients are experiencing cardiovascular disease. Engaging in physical activity is essential for older adults diagnosed with cardiovascular disease. Although many patients complete formal sessions of facility-based cardiac rehabilitation, older cardiac patients often struggle to sustain physical activity after program completion. Sustaining activity after completing formal cardiac rehabilitation is particularly challenging for older cardiac patients because they face more barriers than younger patients. Psychological distress, such as depressive symptoms, anxiety, or stress, is prevalent in cardiac patients, but it is often masked in older adults. Furthermore, limitations in physical activity typically increase with age. Yoga has been demonstrated to improve psychological and physical health outcomes in cardiac patients. However, it remains unknown whether online-based modified yoga is effective in managing psychological distress and maintaining physical activity in older cardiac patients who have completed facility-based cardiac rehabilitation. The purpose of this dissertation was to (1) identify factors associated with psychological distress and physical activity and (2) determine the effects of an online yoga intervention on physical and psychological health outcomes among cardiac patients over 65 years who have completed a facility-based cardiac rehabilitation program.
Three research studies and one protocol paper were included in this dissertation. In the first published study, I employed a longitudinal predictive design to determine whether the interaction between engagement in physical activity and depressive symptoms predicts all-cause hospitalization or mortality. In the second study, I used a cross-sectional design to examine the direct and indirect effects of sociodemographic characteristics on total sedentary time, mediated by sleep disturbances, in depressed patients with coronary heart disease from rural areas. The third paper is a published comprehensive review of the yoga intervention protocol that guided my final study. In the fourth study, I conducted a parallel-arm, two-group randomized controlled pilot trial in which I tested the effects of an online-based modified yoga program for older adults who had completed phase II cardiac rehabilitation.
Results from the three studies indicated that (1) the interaction between depressive symptoms and a lack of physical activity increases the risk of mortality and hospitalization; (2) sleep quality mediates the relationship between age and sedentary time; and (3) the yoga intervention had a significant effect on muscle strength in the lower extremities, subjective sleep quality, and maintenance self-efficacy.
Together this body of work demonstrates the impact of depressive symptoms and sedentary lifestyle on morbidity and mortality in patients with heart failure, the role played by sleep disturbances in sedentary behavior among rural depressed cardiac patients, and the potential for an online yoga intervention to improve physical and psychological outcomes among older cardiac patients. My future studies will include a large scale randomized controlled trial of online yoga for older cardiac patients who have never engaged in cardiac rehabilitation.
Digital Object Identifier (DOI)
https://doi.org/10.13023/etd.2024.471
Funding Information
This study was supported by the College of Nursing at the University of Kentucky through the RICH Heart Research Award in 2022 and 2023 and the PhD Student Dissertation Research Award in 2023, the Delta Psi Chapter, Sigma Theta Tau Nursing Research Awards in 2024, and the Global Korean Nursing Foundation through the GKNF-USA/DNP Scholarship Award in 2023.
Recommended Citation
Cha, Geunyeong, "Improving Physical and Psychological Outcomes for Older Adults with Cardiovascular Diseases" (2024). Theses and Dissertations--Nursing. 71.
https://uknowledge.uky.edu/nursing_etds/71
