Health Behaviors and Influencing Factors Among Middle-Aged and Young Patients With Coronary Heart Disease During Home-Based Cardiac Rehabilitation: A Cross-Sectional Study
Objective: To assess the current status of cardiovascular health behaviors and examine the influencing psychological and cognitive factors based on intertemporal decision-making and motivation theories among young and middle-aged patients with coronary heart disease (CHD) during home-based cardiac rehabilitation (HBCR). Methods: A cross-sectional study was conducted from November 2025 to January 2026. A total of 210 young and middle-aged CHD patients undergoing HBCR were surveyed using a set of instruments, including the Cardiovascular Health Behaviors Questionnaire, the Delay Discounting Questionnaire, the Brief Self-Control Scale, the Anticipated Emotion Questionnaire, the Time Focus Scale, and the Behavioral Inhibition/Activation Systems Scale. A multiple linear regression analysis was performed to identify independent influencing factors. Results: The overall cardiovascular health behavior score was 49.43 ± 6.09, indicating a moderate-to-low level. Regression analysis revealed that behavioral activation system sensitivity (β = 0.181), self-control (β = 0.195), future time focus (β = 0.175), negative anticipated emotions (β = 0.148), and positive anticipated emotions (β = 0.111) were positive predictors of health behaviors. In contrast, behavioral inhibition system sensitivity (β = -0.206) and delay discounting (β = -0.143) were negative predictors. These factors collectively explained 85.20% of the total variance in health behavior scores. Conclusion: The health behavior level among young and middle-aged CHD patients during HBCR requires improvement and is predominantly influenced by modifiable psychological and cognitive factors. Future interventions should aim to enhance approach motivation, self-regulatory capacity, and future orientation through targeted psychological and behavioral strategies to optimize HBCR outcomes.
[1] Baman, J. R., Sekhon, S., & Maganti, K. (2021). Cardiac rehabilitation. JAMA, 326(4), 366. https://doi. org/10.1001/jama.2021.5952
[2] Baumgartner, H., Pieters, R., & Bagozzi, R. P. (2008). Future-oriented emotions: Conceptualization and behavioral effects. European Journal of Social Psychology, 38(4), 685-696. https://doi.org/10.1002/ejsp.467
[3] Beckie, T. M. (2019). Utility of home-based cardiac rehabilitation for older adults. Clinics in Geriatric Medicine, 35(4), 499-516. https://doi. org/10.1016/j.cger.2019.07.003
[4] Carver, C. S., & White, T. L. (1994). Behavioral inhibition, behavioral activation, and affective responses to impending reward and punishment: The BIS/BAS Scales. Journal of Personality and Social Psychology, 67(2), 319-333. https://doi. org/10.1037/0022-3514.67.2.319
[5] Celano, C. M., Freedman, M. E., Beale, E. E., Gomez-Bernal, F., & Huffman, J. C. (2018). A positive psychology intervention to promote health behaviors in heart failure: A proof-of-concept trial. The Journal of Nervous and Mental Disease, 206(10), 800-808. https://doi. org/10.1097/NMD.0000000000000883
[6] Chen, C., Zhang, S., Hong, H., Qiu, S., Zhou, Y., Zhao, M., … & Qian, Q. (2024). Psychometric properties of the Chinese version of the Quick Delay Questionnaire (C-QDQ) and ecological characteristics of reward-delay impulsivity of adults with ADHD. BMC Psychiatry, 24(1), 251. https://doi.org/10.1186/s12888-024-05706-2
[7] Clare, S., Helps, S., & Sonuga-Barke, E. J. S. (2010). The quick delay questionnaire: A measure of delay aversion and discounting in adults. Attention Deficit and Hyperactivity Disorders, 2(1), 43-48. https://doi. org/10.1007/s12402-010-0020-4
[8] Dixon, M. L., & Christoff, K. (2012). The decision to engage cognitive control is driven by expected rewardvalue: Neural and behavioral evidence. PloS One, 7(12), e51637. https://doi.org/10.1371/journal.pone. 0051637
[9] Duan, Y. P., Liang, W., Guo, L., Wienert, J., Si, G. Y., & Lippke, S. (2018). Evaluation of a Web-Based Intervention for Multiple Health Behavior Changes in Patients With Coronary Heart Disease in Home-Based Rehabilitation: Pilot Randomized Controlled Trial. Journal of Medical Internet Research, 20(11), e12052. https://doi.org/10.2196/12052
[10] Ge, C., Ma, J., Xu, Y., Shi, Y. J., Zhao, C. H., Gao, L., … & Chen, Y. D. (2019). Predictors of adherence to home-based cardiac rehabilitation program among coronary artery disease outpatients in China. Journal of Geriatric Cardiology, 16(10), 749-755. https://doi. org/10.11909/j.issn.1671-5411.2019.10.003
[11] Huang, K., Liu, W., He, D., Huang, B., Xiao, D., Peng, Y., … & Huang, D. (2015). Telehealth interventions versus center-based cardiac rehabilitation of coronary artery disease: A systematic review and meta-analysis. European Journal of Preventive Cardiology, 22(8), 959-971. https://doi.org/10.1177/2047487314561168
[12] Kaplan, B. A., Reed, D. D., & Jarmolowicz, D. P. (2016). Effects of episodic future thinking on discounting: Personalized age-progressed pictures improve risky longterm health decisions. Journal of Applied Behavior Analysis, 49(1), 148-169. https://doi.org/10.1002/jaba.277
[13] Knudsen, M. V., Petersen, A. K., Angel, S., Hjortdal, V. E., Maindal, H. T., & Laustsen, S. (2020). Telerehabilitation and hospital-based cardiac rehabilitation are comparable in increasing patient activation and health literacy: A pilot study. European Journal of Cardiovascular Nursing, 19(5), 376-385. https://doi. org/10.1177/1474515119885325
[14] Li, A., Ji, S., Nie, Y., Chi, M., Wang, N., Zhu, Z., & Hou, Y. (2024). The content and nature of rumination in Chinese young and middle-aged patients with acute coronary syndrome: A qualitative study. Healthcare, 12(16), 1651. https://doi.org/10.3390/healthcare12161651
[15] Li, L., Ringeval, M., Wagner, G., Paré, G., Ozemek, C., & Kitsiou, S. (2025). Effectiveness of home-based cardiac rehabilitation interventions delivered via mHealth technologies: A systematic review and meta-analysis. The Lancet Digital Health, 7(4), e238-e254. https://doi.org/10.1016/j.landig.2025.01.011
[16] Li, Y., Zhang, Y., Jiang, Y., Li, H., Mi, S., Yi, G., … & Jiang, Y. (2008). Reliability and validity of the Chinese version of the behavioral inhibition system/behavioral activation system scales. Chinese Journal of Mental Health, 8, 613-616.
[17] Liu, W., Yang, W., & Qian, S. (2023). The mediating effect of self-efficacy on health literacy and social support in young and middle-aged patients with coronary heart disease after PCI. Vascular Health and Risk Management, 19, 341-349. https://doi. org/10.2147/VHRM.S417401
[18] Lloyd-Jones, D. M., Allen, N. B., Anderson, C. A. M., Black, T., Brewer, L. C., Foraker, R. E., … & American Heart Association. (2022). Life’s Essential 8: Updating and enhancing the American Heart Association’s construct of cardiovascular health: A presidential advisory from the American Heart Association. Circulation, 146(5), e18-e43. https://doi. org/10.1161/CIR. 0000000000001078
[19] Luo, T., Cheng, L., Qin, L., & Xiao, S. (2021). Reliability and validity of Chinese version of Brief Self-Control Scale. Chinese Journal of Clinical Psychology, 1, 83-86. https://doi. org/10.16128/j. cnki. 1005-3611.2021.01.017
[20] Marin, T. S., Kourbelis, C., Foote, J., Newman, P., Brown, A., Daniel, M., … & Clark, R. A. (2019). Examining adherence to activity monitoring devices to improve physical activity in adults with cardiovascular disease: A systematic review. European Journal of Preventive Cardiology, 26(4), 382-397. https://doi.org/10.1177/2047487318805580
[21] Michaelsen, M. M., & Esch, T. (2023). Understanding health behavior change by motivation and reward mechanisms: A review of the literature. Frontiers in Behavioral Neuroscience, 17, 1151918. https://doi. org/10.3389/fnbeh.2023.1151918
[22] Miró -Padilla, A., Adrián-Ventura, J., Cherednichenko, A., Monzonís-Carda, I., Beltran-Valls, M. R., Moliner-Urdiales, D., & Ávila, C. (2023). Relevance of the anterior cingulate cortex volume and personality in motivated physical activity behaviors. Communications Biology, 6(1), 1106. https://doi. org/10.1038/s42003-023-05423-8
[23] Moghei, M., Turk-Adawi, K., Isaranuwatchai, W., Sarrafzadegan, N., Oh, P., Chessex, C., & Grace, S. L. (2017). Cardiac rehabilitation costs. International Journal of Cardiology, 244, 322-328. https://doi.org/10.1016/j.ijcard.2017.06.030
[24] Nagatomi, Y., Ide, T., Higuchi, T., Nezu, T., Fujino, T., Tohyama, T., … & Tsutsui, H. (2022). Home-based cardiac rehabilitation using information and communication technology for heart failure patients with frailty. ESC Heart Failure, 9(4), 2407-2418. https://doi. org/10.1002/ehf2.13934
[25] Nan, X., & Qin, Y. (2019). How thinking about the future affects our decisions in the present: Effects of time orientation and episodic future thinking on responses to health warning messages. Human Communication Research, 45(2), 148-168. https://doi. org/10.1093/hcr/hqy017
[26] O’Hora, D., Carey, R., Kervick, A., Crowley, D., & Dabrowski, M. (2016). Decisions in motion: Decision dynamics during intertemporal choice reflect subjective evaluation of delayed rewards. Scientific Reports, 6, 20740. https://doi.org/10.1038/srep20740
[27] Shipp, A. J., Edwards, J. R., & Lambert, L. S. (2009). Conceptualization and measurement of temporal focus: The subjective experience of the past, present, and future. Organizational Behavior and Human Decision Processes, 110(1), 1-22. https://doi.org/10.1016/j. obhdp.2009.05.001
[28] Stefanakis, M., Batalik, L., Antoniou, V., & Pepera, G. (2022). Safety of home-based cardiac rehabilitation: A systematic review. Heart & Lung: The Journal of Critical Care, 55, 117-126. https://doi. org/10.1016/j. hrtlng.2022.04.016
[29] Stillman, P. E., Medvedev, D., & Ferguson, M. J. (2017). Resisting temptation: Tracking how self-control conflicts are successfully resolved in real time. Psychological Science, 28(9), 1240-1258. https://doi. org/10.1177/0956797617705386
[30] Story, M., Kaphingst, K. M., Robinson-O’Brien, R., & Glanz, K. (2008). Creating healthy food and eating environments: Policy and environmental approaches. Annual Review of Public Health, 29, 253-272. https://doi. org/10.1146/annurev.publhealth.29.020907.090926
[31] Sun, S., Cao, X., Li, X., Nyeong, Y., Zhang, X., & Wang, Z. (2023). Avoiding threats, but not acquiring benefits, explains the effect of future time perspective on promoting health behavior. Heliyon, 9(9), e19842. https://doi.org/10.1016/j.heliyon.2023.e19842
[32] Tangney, J. P., Baumeister, R. F., & Boone, A. L. (2004). High self-control predicts good adjustment, less pathology, better grades, and interpersonal success. Journal of Personality, 72(2), 271-324. https://doi. org/10.1111/j.0022-3506.2004.00263.x
[33] Thomas, R. J., Beatty, A. L., Beckie, T. M., Brewer, L. C., Brown, T. M., Forman, D. E., … & Whooley, M. A. (2019). Home-based cardiac rehabilitation: A scientific statement from the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. Circulation, 140(1), e69-e89. https://doi. org/10.1161/CIR.0000000000000663
[34] Wang, Y., Tian, J., & Yang, Q. (2024). Experiential avoidance process model: A review of the mechanism for the generation and maintenance of avoidance behavior. Psychiatry and Clinical Psychopharmacology, 34(2), 179-190. https://doi.org/10.5152/pcp.2024.23777
[35] World Medical Association. (2025). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human participants. JAMA, 333(1), 71-74. https://doi.org/10.1001/jama.2024.21972
[36] Yang, Y., Yuan, Q., Wu, C., & Yang, L. (2025). Barriers and facilitators to improved sedentary behaviour in coronary heart disease patients: A scoping review. BMJ Open, 15(1), e088111. https://doi.org/10.1136/bmjopen-2024-088111
[37] Yang, Z., Hu, N., Zhang, F., Gao, Y., Zhang, C., & Wang, A. (2024). A practical tool for measuring homebased cardiac rehabilitation self-management behavior: A multiphase cross-sectional study. Journal of the American Heart Association, 13(9), e034486. https://doi.org/10.1161/JAHA.124.034486
[38] Yang, Z., Xu, L., Gao, Y., Zhang, C., & Wang, A. (2025). Tailored personas for self-management in homebased cardiac rehabilitation for patients with coronary heart disease: A qualitative study. International Journal of Nursing Studies, 163, 105000. https://doi.org/10.1016/j.ijnurstu.2025.105000
[39] Zhang, Y. Y., Xu, L., Rao, L. L., Zhou, L., Zhou, Y., Jiang, T., … & Liang, Z. Y. (2016). Gain-loss asymmetry in neural correlates of temporal discounting: An approach-avoidance motivation perspective. Scientific Reports, 6, 31902. https://doi.org/10.1038/srep31902