The role of psychosocial factors in cardiac rehabilitation

 
Audio is AI-generated
2

Abstract

Background and Relevance. Adherence to cardiac rehabilitation represents a primary challenge in the organization of secondary prevention of cardiovascular complications. Objective. To synthesize current research on adherence to cardiac rehabilitation and to identify psychosocial targets for collaborative practice within a multidisciplinary rehabilitation team. Methods. The multifactorial psychosocial model developed by A.B. Kholmogorova and N.G. Garanyan, encompassing macrosocial, family, personal, and interpersonal levels, was utilized as the theoretical and methodological framework for this literature review. Results. At the family level, the regulatory, informational, and emotionally supportive functions of the family were identified as key contributors to adherence to cardiac rehabilitation and its efficacy. At the interpersonal level, the influence of social relationships, including the patient's perception of interactions with healthcare providers, on physical health status and long-term treatment attitudes was highlighted. At the personal level, the impact of depressive and anxiety states on achieving cardiac rehabilitation outcomes and maintaining treatment adherence was established. Conclusion. The application of the multifactorial psychosocial model by A.B. Kholmogorova and N.G. Garanyan enabled the structuring of heterogeneous data regarding cardiac rehabilitation adherence, thereby delineating the role of psychosocial factors and identifying specific targets for future clinical interventions and research.

General Information

Keywords: cardiac rehabilitation, adherence, compliance

Journal rubric: Medical Psychology

Article type: review article

DOI: https://doi.org/10.17759/jmfp.2026150312

Received 08.12.2025

Revised 20.07.2026

Accepted

Published

For citation: Gerasimova, A.A. (2026). The role of psychosocial factors in cardiac rehabilitation. Journal of Modern Foreign Psychology, 15(3), 126–134. (In Russ.). https://doi.org/10.17759/jmfp.2026150312

© Gerasimova A.A., 2026

License: CC BY-NC 4.0

References

  1. Барбараш, О.Л., Карпов, Ю.А., Панов, А.В., Акчурин, Р.С., Алекян, Б.Г., Алехин, М.Н., Аронов, Д.М., Арутюнян, Г.К., Беленков, Ю. Н., Бойцов, С.А., Болдуева, С.А., Бощенко, А.А., Бубнова, М.Г., Булкина, О.С., Васюк, Ю.А., Галявич, А.С., Глезер, М.Г., Голубев, Е.П., Голухова, Е.З., ... Якушин, С.С. (2024). Стабильная ишемическая болезнь сердца. Клинические рекомендации. Российский кардиологический журнал, 29(9), 166—229. https://doi.org/10.15829/1560-4071-2024-6110
    Barbarash, O.L., Karpov, Yu.A., Panov, A.V., Akchurin, R.S., Alekyan, B.G., Alekhin, M.N., Aronov, D.M., Harutyunyan, G.K., Belenkov, Yu.N., Boytsov, S.A., Boldueva, S.A., Boschenko, A.A., Bubnova, M.G., Bulkina, O.S., Vasyuk, Yu.A., Galyavich, A.S., Glezer, M.G., Golubev, E.P., Golukhova, E.Z., ... Yakushin, S.S. (2024). 2024 Clinical practice guidelines for Stable coronary artery disease. Russian Journal of Cardiology, 29(9), 166—229. (In Russ.). https://doi.org/10.15829/1560-4071-2024-6110
  2. Вайсман, Д.Ш., Енина, Е.Н. (2024). Показатели смертности от ишемической болезни сердца в Российской Федерации и ряде регионов: Особенности динамики и структуры. Кардиоваскулярная терапия и профилактика, 23(7), 23—30. https://doi.org/10.15829/1728-8800-2024-3975
    Vaisman D.Sh., Enina E.N. (2024). Сoronary artery disease mortality rates in the Russian Federation and a number of regions: Dynamics and structure specifics. Cardiovascular Therapy and Prevention, 23(7), 23—30. (In Russ.). https://doi.org/10.15829/1728-8800-2024-3975
  3. Герасимова, А.А., Холмогорова, А.Б., Погосова, Н.В., Аушева, А.К. (2025). Психосоциальные факторы, влияющие на приверженность кардиореабилитации у пациентов после перенесенного инфаркта миокарда. Журнал им. Н.В. Склифосовского «Неотложная медицинская помощь», 14(2), 379—386. https://doi.org/10.23934/2223-9022-2025-14-2-379-386
    Gerasimova, A.A., Kholmogorova, A.B., Pogosova, N.V., Ausheva, A.K. (2025). Psychosocial factors influencing adherence to cardiac rehabilitation in patients after myocardial infarction. Russian Sklifosovsky Journal «Emergency Medical Care», 14(2), 379—386. (In Russ.). https://doi.org/10.23934/2223-9022-2025-14-2-379-386
  4. Фитилев, С.Б., Возжаев, А.В., Шкребнева, И.И., Клюев, Д.А., Саакова, Л.Н., Оваева, А.О. (2024). Единая медицинская информационно-аналитическая система (ЕМИАС) как инструмент для нового уровня понимания и диагностики приверженности фармакотерапии у пациентов, перенесших инфаркт миокарда, в амбулаторной практике г. Москвы. Качественная клиническая практика, 2, 16—32. https://doi.org/10.37489/2588-0519-2024-2-16-32
    Fitilev, S.B., Vozzhaev, A.V., Shkrebniova, I.I., Kliuev, D.A., Saakova, L.N., Ovaeva, A.O. (2024). Electronic medical information and analytical system (EMIAS) as a tool for the new level of understanding and diagnosis of medication adherence in patients with myocardial infarction in primary care practice in Moscow. Good Clinical Practice, 2, 16—32. (In Russ.). https://doi.org/10.37489/2588-0519-2024-2-16-32
  5. Холмогорова, А.Б. (2011). Интегративная психотерапия расстройств аффективного спектра. М.: МЕДПРАКТИКА.
    Kholmogorova, A.B. (2011). Integrative psychotherapy for affective disorders. Moscow: Medpraktika. (In Russ.).
  6. Шепель, Р.Н., Самородская, И.В., Какорина, Е.П., Драпкина, О.М. (2025). Динамика и структура числа случаев госпитализации пациентов по поводу ишемической болезни сердца в Российской Федерации в 2014—2023 гг. Комплексные проблемы сердечно-сосудистых заболеваний, 14(3), 81—95. https://doi.org/10.17802/2306-1278-2025-14-3-81-95
    Shepel, R.N., Samorodskaya, I.V., Kakorina, E.P., Drapkina, O.M. (2025). Dynamics and structure of the number of patients hospitalized for coronary artery disease in the Russian Federation in 2014—2023. Complex Issues of Cardiovascular Diseases, 14(3), 81—95. (In Russ.). https://doi.org/10.17802/2306-1278-2025-14-3-81-95
  7. Beleigoli, A., Foote, J., Gebremichael, L.G., Bulamu, N.B., Astley, C., Keech, W., Tavella, R., Gulyani, A., Nesbitt, K., Pinero de Plaza, M.A., Ramos, J.S., Ludlow, M., Nicholls, S.J., Chew, D.P., Beltrame, J., Clark, R.A. (2024). Clinical effectiveness and utilisation of cardiac rehabilitation after hospital discharge: Data linkage analysis of 84,064 eligible discharged patients (2016—2021). Heart, Lung and Circulation, 33(7), 1036—1045. https://doi.org/10.1016/j.hlc.2024.01.018
  8. Betancourt-Peña, J., Portela-Pino, I., Amaral-Figueroa, M. (2024). Factors related to non-adherence to cardiac rehabilitation in patients with heart failure. Revista Clínica Española (English Edition), 224(1), 24—33. https://doi.org/10.1016/j.rceng.2023.12.010
  9. Birtwistle, S.B., Jones, I., Murphy, R., Gee, I., Watson, P.M. (2021). Family support for physical activity post‐myocardial infarction: A qualitative study exploring the perceptions of cardiac rehabilitation practitioners. Nursing & Health Sciences, 23(1), 277—236. https://doi.org/10.1111/nhs.12806
  10. Birtwistle, S.B., Jones, I., Murphy, R., Gee, I., Watson, P.M. (2022). «Do what you can with a happy heart»: A longitudinal study of patient and family members’ lived experiences of physical activity post-myocardial infarction. Disability and Rehabilitation, 44(14), 3661—3670. https://doi.org/10.1080/09638288.2021.1878560
  11. Bush, M., Kucharska-Newton, A., Simpson, R.J., Fang, G., Stürmer, T., Brookhart, M.A. (2020). Effect of initiating cardiac rehabilitation after myocardial infarction on subsequent hospitalization in older adults. Journal of Cardiopulmonary Rehabilitation and Prevention, 40(2), 87—93. https://doi.org/10.1097/HCR.0000000000000452
  12. Chong, M.S., Sit, J.W.H., Choi, K.C., Suhaimi, A., Chair, S.Y. (2024). Barriers to cardiac rehabilitation and patient perceptions on the usage of technologies in cardiac rehabilitation: A cross‐sectional study. Journal of Clinical Nursing, 33(3), 1084—1093 https://doi.org/10.1111/jocn.16919
  13. Chong, R.J., Hao, Y., Tan, E.W.Q., Mok, G.J.L., Sia, C.-H., Ho, J.S.Y., Chan, M.Y.Y., Ho, A.F.W. (2025). Prevalence of depression, anxiety and Post-Traumatic Stress Disorder (PTSD) after acute myocardial infarction: A systematic review and meta-analysis. Journal of Clinical Medicine, 14(6), Article 1786. https://doi.org/10.3390/jcm14061786
  14. Cobb, L.K., McAdams-DeMarco, M.A., Huxley, R.R., Woodward, M., Koton, S., Coresh, J., Anderson, C.A.M. (2014). The association of spousal smoking status with the ability to quit smoking: The atherosclerosis risk in communities study. American Journal of Epidemiology, 179(10), 1182—1187. https://doi.org/10.1093/aje/kwu041
  15. Colbert, J.D., Martin, B.-J., Haykowsky, M.J., Hauer, T.L., Austford, L.D., Arena, R.A., Knudtson, M.L., Meldrum, D.A., Aggarwal, S.G., Stone, J.A. (2015). Cardiac rehabilitation referral, attendance and mortality in women. European Journal of Preventive Cardiology, 22(8), 979—986. https://doi.org/10.1177/2047487314545279
  16. Daniel, J.A., Kim-Mozeleski, J.E., Poudel, K.C., Sun, A., Burke, N.J., Tsoh, J.Y., Ward, K. (2021). Family support and readiness to consider smoking cessation among chinese and vietnamese American male smokers. Journal of Smoking Cessation, 2021, Article 6678219. https://doi.org/10.1155/2021/6678219
  17. Domić, A., Pilipović-Broćeta, N., Grabež, M., Divac, N., Igić, R., Škrbić, R. (2024). Intensive intervention on smoking cessation in patients undergoing elective surgery: The role of family physicians. Medicina, 60(6), Article 965. https://doi.org/10.3390/medicina60060965
  18. Duarte, C.K., de Silva, L.A., de Andrade, P.M.B., Martins, T.M.M., de Ghisi, G.L.M. (2024). Barriers and facilitators to nutritional recommendations identified by participants of a cardiovascular rehabilitation program in a low resource context in Brazil. Nutrition, 124, Article 112451. https://doi.org/10.1016/j.nut.2024.112451
  19. Gaalema, D.E., Khadanga, S., Savage, P.D., Yant, B., Katz, B.R., DeSarno, M., Ades, P.A. (2024). Improving cardiac rehabilitation adherence in patients with lower socioeconomic status: A randomized clinical trial. JAMA Internal Medicine, 184(9), 1095—1104. https://doi.org/10.1001/jamainternmed.2024.3338
  20. García-Sánchez, E., Santamaría-Peláez, M., González-Bernal, J.J., González-Santos, J., Sedano García, M.A., De Juana Velasco, I., Sánchez Hernández, J., García Pardo, H., Fernández-Solana, J. (2025). Impact of cardiac rehabilitation on anxiety, depression, and health-related quality of life in cardiovascular patients. The Egyptian Heart Journal, 77(1), Article 64. https://doi.org/10.1186/s43044-025-00658-8
  21. Guan, Z., Wang, Q. (2023). A retrospective analysis of empathy-centric care strategies on negative emotional states and expectation levels in acute heart failure patients. Medicine, 102(47), Article e36264. https://doi.org/10.1097/MD.0000000000036264
  22. Iyngkaran, P., Appuhamilage, P.Y., Patabandige, G., Sarathchandra Peru Kandage, P.S., Usmani, W., Hanna, F. (2024). Barriers to cardiac rehabilitation among patients diagnosed with cardiovascular diseases — a scoping review. International Journal of Environmental Research and Public Health, 21(3), Article 339. https://doi.org/10.3390/ijerph21030339
  23. Jurišić, M., Jakovljević, M. (2025). The synergy of the empathy of healthcare professionals and the resilience of cardiovascular patients. Cardiologia Croatica, 20(3—4), 84—89. https://doi.org/10.15836/ccar2025.84
  24. Kabboul, N.N., Tomlinson, G., Francis, T.A., Grace, S.L., Chaves, G., Rac, V., Daou-Kabboul, T., Bielecki, J.M., Alter, D.A., Krahn, M. (2018). Comparative effectiveness of the core components of cardiac rehabilitation on mortality and morbidity: A systematic review and network meta-analysis. Journal of Clinical Medicine, 7(12), Article 514. https://doi.org/10.3390/jcm7120514
  25. Kowalewska, K., Radecki, K., Cieślik, B. (2024). Does psychological state influence the physiological response to cardiac rehabilitation in older adults? Medicina, 60(3), Article 361. https://doi.org/10.3390/medicina60030361
  26. Lawler, P.R., Filion, K.B., Eisenberg, M.J. (2011). Efficacy of exercise-based cardiac rehabilitation post—myocardial infarction: A systematic review and meta-analysis of randomized controlled trials. American Heart Journal, 162(4), 571—584. https://doi.org/10.1016/j.ahj.2011.07.017
  27. Lidin, M., Michelsen, H.Ö., Hag, E., Stomby, A., Schlyter, M., Bäck, M., Hagström, E., Leosdottir, M. (2025). The nurses’ role in the cardiac rehabilitation team: Data from the Perfect-CR study. Journal of Cardiovascular Nursing, 40(4), 386—394. https://doi.org/10.1097/JCN.0000000000001113
  28. Marchwinski, L.E. (2025). Exploring gender differences in social support in cardiac rehabilitation: A comprehensive review. Cureus, 17(8), Article e89333. https://doi.org/10.7759/cureus.89333
  29. Mehra, V.M., Gaalema, D.E., Pakosh, M., Grace, S.L. (2020). Systematic review of cardiac rehabilitation guidelines: Quality and scope. European Journal of Preventive Cardiology, 27(9), 912—928. https://doi.org/10.1177/2047487319878958
  30. Mueller, A.S., Kim, S.M. (2025). Cardiac rehabilitation in the modern era: Evidence, equity, and evolving delivery models across the cardiovascular spectrum. Journal of Clinical Medicine, 14(15), Article 5573. https://doi.org/10.3390/jcm14155573
  31. Owen, O., O’Carroll, V. (2024). The effectiveness of cardiac telerehabilitation in comparison to centre-based cardiac rehabilitation programmes: A literature review. Journal of Telemedicine and Telecare, 30(4), 631—646. https://doi.org/10.1177/1357633X221085865
  32. Pollak, K.I., Olsen, M.K., Yang, H., Prose, N., Jackson, L.R.II, Pinheiro, S.O., Dunbar, T. K., Johnson, K.S. (2023). Effect of a coaching intervention to improve cardiologist communication: A randomized clinical trial. JAMA Internal Medicine, 183(6), 544—553. https://doi.org/10.1001/jamainternmed.2023.0629
  33. Posa, S., Wasilewski, M.B., Mercer, S.W., Simpson, S., Robinson, L.R., Simpson, R. (2022). Conceptualization, use, and outcomes associated with empathy and compassion in physical medicine and rehabilitation: A scoping review. International Journal of Rehabilitation Research, 45(4), 291—301. https://doi.org/10.1097/MRR.0000000000000542
  34. Resurrección, D.M., Motrico, E., Rigabert, A., Rubio-Valera, M., Conejo-Cerón, S., Pastor, L., Moreno-Peral, P. (2017). Barriers for nonparticipation and dropout of women in cardiac rehabilitation programs: A systematic review. Journal of Women’s Health, 26(8), 849—859. https://doi.org/10.1089/jwh.2016.6249
  35. Singh, S.K.D., Noor, A.B.Y.A., Ahmedy, F., Abdullah, K.L., Abidin, I.Z., Suhaimi, A.B., Sator, P. (2022). Exploring social support for women coping with a cardiac rehabilitation programme after acute coronary syndrome: A systematic review of qualitative studies. Journal of Rehabilitation Medicine, 54, Article jrm00295. https://doi.org/10.2340/jrm.v54.160
  36. Tanaka, A., Aggarwal, S., Arena, R., Wang, M., Liang, Z., Campbell, T., Rouleau, C. (2025). The potential influence of depressive symptoms on outcomes from a brief motivational intervention in patients referred to cardiac rehabilitation. Patient Education and Counseling, 138, Article 109206. https://doi.org/10.1016/j.pec.2025.109206
  37. Vahedian-Azimi, A., Sanjari, M.J., Rahimi-Bashar, F., Gohari-Mogadam, K., Ouahrani, A., Mustafa, E.M.M., Ait Hssain, A., Sahebkar, A. (2024). Cardiac rehabilitation using the family-centered empowerment model is effective in improving long-term mortality in patients with myocardial infarction: A 10-year follow-up randomized clinical trial. High Blood Pressure & Cardiovascular Prevention, 31, 189—204. https://doi.org/10.1007/s40292-024-00636-2
  38. Wang, L., Liu, J., Fang, H., Wang, X. (2023). Factors associated with participation in cardiac rehabilitation in patients with acute myocardial infarction: A systematic review and meta-analysis. Clinical Cardiology, 46(11), 1450—1457. https://doi.org/10.1002/clc.24130
  39. Weddell, J., Shi, W., Redfern, J., Buckley, T., Gallagher, R. (2025). Effectiveness of coronary heart disease peer support interventions: A systematic review and meta-analysis. European Journal of Preventive Cardiology, Article zwaf241. https://doi.org/10.1093/eurjpc/zwaf241
  40. Weeger, S., Farin, E. (2017). The effect of the patient — physician relationship on health-related quality of life after cardiac rehabilitation. Disability and Rehabilitation, 39(5), 468—476. https://doi.org/10.3109/09638288.2016.1146360
  41. Yang, Z., Huang, H., Xu, L., Gao, Y., Zhang, C., Wang, A. (2024b). From need to action: Decoding the role of motivation in adherence to home-based cardiac rehabilitation exercise in chronic heart failure patients. BMC Nursing, 23, Article 913. https://doi.org/10.1186/s12912-024-02617-1
  42. Yang, Z., Jia, H., Zhang, F., Huang, H., Hao, X., Wang, A. (2024a). A behavioural driving model of adherence to home-based cardiac rehabilitation exercise among patients with chronic heart failure: A mixed-methods study. Journal of Clinical Nursing, 33(2), 531—542. https://doi.org/10.1111/jocn.16901
  43. Zambetti, E., Crepaldi, M., Lanfranchi, F., Zenoni, E., Bariletti, I., Quarenghi, F., Viscardi, L., Rizzola, G., Regazzoni, V., Bigoni, A., Brivio, F., Soddu, I.M., Anselmi Kaiser, M., Giudici, V., Greco, A. (2025). Can psychological interventions affect cardiac rehabilitation patients’ well-being? Preliminary results from a longitudinal study. International Journal of Cardiology Cardiovascular Risk and Prevention, 26, Article 200474. https://doi.org/10.1016/j.ijcrp.2025.200474
  44. Zeng, J., Qiu, Y., Yang, C., Fan, X., Zhou, X., Zhang, C., Zhu, S., Long, Y., Hashimoto, K., Chang, L., Wei, Y. (2025). Cardiovascular diseases and depression: A meta-analysis and Mendelian randomization analysis. Molecular Psychiatry, 30(9), 4234—4246. https://doi.org/10.1038/s41380-025-03003-2

Information About the Authors

Anna A. Gerasimova, Clinical Psychologist, Medical Rehabilitation (Cardiac Rehabilitation) Department, National Medical Research Centre of Cardiology named after Academician E.I. Chazov, Moscow, Russian Federation, ORCID: https://orcid.org/0000-0001-5298-6084, e-mail: anna.al.gerasimova@gmail.com

Conflict of interest

The author declares no conflict of interest.

Ethics statement

This article is a review and does not require ethics committee approval.

Metrics

 Web Views

Whole time: 10
Previous month: 4
Current month: 6

 PDF Downloads

Whole time: 2
Previous month: 1
Current month: 1

 Total

Whole time: 12
Previous month: 5
Current month: 7