Dispositional traits, such as repressive coping (avoiding the experience of negative emotions), alexithymia (difficulty identifying or communicating negative emotions), and optimism, as well as coping style, negative affect, and illness knowledge are associated with health behavior change, adherence, and quality of life among cardiac patients. However, prior studies have not examined the influence of interactions among these factors for cardiac rehabilitation (CR) outcomes and adherence. Aims of the current study included: 1) To examine the impact of dispositional traits on treatment adherence, rehabilitation outcomes, and quality of life in CR patients; 2) to investigate the mediating influence of coping strategies on the relationship between dispositional traits and treatment adherence; 3) to examine effects of acute change in affect and illness knowledge among repressors on treatment adherence, CR outcomes, and quality of life; and, 4) to evaluate depressive and anxiety symptoms as mediators of the relationship between dispositional traits and CR treatment adherence/quality of life. The current study included 56 CR patients (65% male, 59% Caucasian, mean age = 59.5, SD = 12.2 years) who participated in a 12-week CR program that included 36 exercise sessions and 10 educational classes. Participants completed self-report measures at the initiation and completion of CR. At baseline, measures included repressive coping, alexithymia, optimism, depressive and anxiety symptoms, physical and emotional quality of life, and
illness knowledge. At the completion of CR, participants completed measures of depressive and anxiety symptoms, physical and emotional quality of life, and illness knowledge. In addition, CR outcomes (e.g., change in VO2max, change in lipid consumption) and adherence (e.g., number of session attended and time spent exercising) were recorded. Visual analogue scales were completed before and after each education class to measure the impact of receiving illness knowledge on affect. Analyses of variance were employed to determine differences between repressors and non-repressors on CR outcomes and adherence. Linear regression was used to examine whether alexithymia and optimism were associated with change in CR outcomes and adherence. Hierarchical linear modeling was utilized to explore whether repressive coping, alexithymia, or optimism was associated with change in time spent exercising as prescribed over the course of CR. Results revealed overall improvement in lipid consumption,VO2max, and physical functioning, as well as increased positive affect and decreased negative affect after attending the education classes. Knowledge about heart disease increased by the conclusion of CR. Repressors engaged in less avoidance coping than non-repressors, and repressors reported increased negative affect post-CR. Greater illness knowledge among repressors at baseline was associated with reduced depressive symptoms following CR. Alexithymia was associated with both poorer attendance and avoidance coping. Contrary to study hypotheses, repressive coping was not associated with poorer CR outcomes or adherence; and optimism did not predict CR outcomes or adherence. Coping style moderated the relationship between repressive coping and change in emotional quality of life, but did not moderate the relationship between alexithymia and attendance, suggesting that the reason for non-attendance is not explained by avoidance of CR. Relatively low levels of repression in the study sample may have contributed to the limited findings for repressive coping. Some dispositional traits may not be important predictors of CR outcomes and adherence. In sum, results indicated physical benefits of CR, and dispositional traits are important for understanding CR outcomes and adherence.