Physical Function and Activity Post Cardiac Event in Females: Effects of Movement-Related Anxiety - PROJECT SUMMARY Women experiencing a major acute cardiovascular event (MACE) typically display prolonged physical inactivity and more severe functional decline during hospitalization than men. To regain independence, resumption of free-living physical activity (PA) and recovery of physical function (i.e., balance, mobility, strength) are crucial, yet women also demonstrate a recovery gap post-MACE relative to men. One possible explanation for this recovery gap is avoidance of PA due to heightened attention to bodily sensations and an overabundant perception of risk for recurrent cardiac events, injury, or falling. By reducing exercise as well as everyday movements such as those associated with activities of daily living (e.g., carrying laundry up the stairs), individuals paradoxically increase their risk of falling, reinfarction, injury, deconditioning, and ultimately loss of independence. Given that anxiety is up to twice as prevalent in women as in men, and that women are at especially elevated risk of falls and injury relative to men due to estrogen-related declines in muscle mass, strength, and balance, anxiety-driven activity avoidance may disproportionately undermine women’s physical recovery. We will recruit 489 women aged 18 or older hospitalized for MACE and treated with percutaneous coronary intervention (PCI) prior to discharge from hospitals affiliated with the University of Texas Medical Branch, Rutgers University, and Brown University Health. Participants will be prospectively evaluated at their index hospitalization and again at 1 week and 1, 3-, 6-, 9-, and 12-months post-discharge. Our multi-pronged approach will include accelerometry using novel algorithms that better capture steps in this unique population, as well as assessments of functional physical performance, psychosocial factors, symptoms, and cognition. First, we will examine biopsychosocial predictors of anxiety and low physical function during hospitalization, hypothesizing that biopsychosocial characteristics will distinctly cluster with anxiety and lower physical function. Second, we will determine age-based trajectories of anxiety, physical function, and PA post- discharge, hypothesizing that these trajectories will differ by age. We will use parallel process longitudinal latent class analysis to investigate associations over time between movement-related anxiety and physical function across different classes. Finally, we will examine time-invariant biopsychosocial individual difference factors associated with class membership, hypothesizing that some women will demonstrate persistently high anxiety and low physical function in the recovery year. This empirically guided approach will allow us to define and characterize women at high risk for both anxiety and poor functional recovery who would be best targeted by a future augmentative treatment. Our ultimate goals are to inform theories of MACE recovery in women and improve psychological and physical function in women to preserve health, independence, and functioning across the adult lifespan.
