Electronic Thesis and Dissertation Repository

Thesis Format



Master of Science


Pathology and Laboratory Medicine


Frisbee, Stephanie J.


Cardiac Rehabilitation (CR) is an exercise-based program, aimed at improving ones’ cardiovascular health. A substantial majority of patients referred to CR do not enroll, complete, or achieve clinical targets in the program due to patient-level factors. The objective of this thesis was to investigate relationships between anxiety sensitivity (AnxS) and patient outcomes in CR. Self-reported questionnaires were completed across two time points, with patient information being abstracted from medical records. Stakeholders associated with reducing the burden of AnxS in CR were also identified using snow-ball sampling. Findings suggest that resting diastolic blood pressure is associated with the interrelationships between AnxS, anxiety, and depression. A larger sample size is needed to establish concrete relationships between AnxS and patient outcomes in CR. This evidence may support the need to target AnxS for treatment. Stakeholders with high power and influence may also be beneficial in implementing changes to CR guidelines, if necessary.

Summary for Lay Audience

Cardiac Rehabilitation (CR) is an effective exercise-based program with the goal of improving the cardiovascular health of its patients. Across Ontario, most patients who are referred to CR do not fully participate, complete, or achieved guideline recommended targets of the program. Research has shown that depression and anxiety play a role with these observations. Anxiety sensitivity (AnxS) is a personality trait of interest that we believe may impact ones’ ability to obtain the full benefits of CR. Individuals with high AnxS feel unsafe or threatened when they experience anxiety related symptoms (i.e., increased heart rate). We explored whether individuals with high AnxS would engage in less physical activity, less exercise, and not achieve guideline recommended targets. We administered 5 self-reported questionnaires at two different times, separated by 6 weeks. We also collected clinical information from each patient’s medical record. We observed that individuals with high AnxS, high symptoms of anxiety, and high symptoms of depression were more likely to report an at-risk diastolic blood pressure. Establishing relationships between AnxS and patient outcomes in CR may be important as research suggests that AnxS may be easier to treat compared to other psychological factors. This study must be done with more participants to make more accurate conclusions of our findings. We also identified stakeholders of high influence and power who could potentially help reduce the burden of AnxS in CR. If after further exploration AnxS shows evidence of impacting patient outcomes in CR, these stakeholders could help treat AnxS in CR. This can be done by conducting research-based initiatives leading to the modification of existing CR guidelines.