Abstract 14: Post-Traumatic Stress Disorder Symptoms and Physical Activity Behavior After Hospitalization for Suspected Acute Coronary Syndromes

Abstract

Background: An acute coronary syndrome (ACS) related event can induce post-traumatic stress disorder (PTSD), and post-ACS PTSD is associated with a greater risk for secondary clinical outcomes among ACS survivors. While moderate-vigorous physical activity (MVPA) has been shown to reduce the risk of adverse outcomes after ACS, its impact on PTSD symptoms remains largely unknown. There is a notable absence of empirical evidence, especially from large-scale observational cohort studies with device-based measures of physical activity, on this topic. Aim: To investigate the relationship between physical activity behaviors over the first month post-discharge with PTSD symptoms at one month among patients with suspected ACS. Methods: Patients (n = 434, 48.6% female, 62.6±12.4yrs) evaluated for ACS in the emergency department were fitted with a GENEActiv wrist accelerometer in-hospital and wore the device on their non-dominant wrist for 30 days post-discharge to measure MVPA. Presence and severity of PTSD symptoms were assessed at 1-month follow-up using the PCL-5. Multilevel structural equation modeling was used to simultaneously 1) fit a linear growth curve (GC) model to patients’ 30-day trajectories of MVPA and 2) predict total PTSD symptoms from a) mean daily MVPA, b) average daily change in MVPA (GC slope), and c) covariates (age, biological sex, education, and Charlson Comorbidity Index). Results: Patients engaged in an average of 20.8 (95% CI: 18.4, 23.3, p < 0.001) minutes of MVPA per day. MVPA levels increased at an average rate of 0.11 mins/day (95% CI: 0.05, 0.16, p < 0.001) over the 30 days post-discharge. There was substantial between-patient variability in both average MVPA minutes (SD = 26.0) and daily rate of change in MVPA minutes (SD = 0.38). The daily rate of change in MVPA was significantly associated with 1-month PTSD symptoms (β per 0.5 mins/day difference in daily rate of change in MVPA minutes = -4.5 points on the PCL-5; 95% CI: -6.5, -2.5, p < 0.001), controlling for the above-mentioned covariates. The association between average MVPA minutes and PCL-5 score was small and not statistically significant (β = 0.02; 95% CI: -0.04, 0.07, p = 0.60). Conclusion: PTSD symptoms appear to be mitigated in patients whose MVPA minutes increased over the 30 days post-discharge, whereas no evident association was observed between PTSD symptoms and average daily MVPA minutes. These findings suggest that progressively increasing MVPA by as little as .5 mins/day (i.e., ~1 SD above the mean rate of increase) within the immediate first month post-discharge, as opposed to maintaining a consistent daily average of MVPA, may impede the development of PTSD symptoms in ACS survivors.