# The association of social support with functional status and physical activity in patients with coronary heart disease from The Heart and Soul study

## TL;DR

This study examines how social support affects physical activity and independence in older adults with heart disease over 20 years.

## Contribution

The study provides a 20-year longitudinal analysis of social support's impact on functional outcomes in coronary heart disease patients.

## Key findings

- Better appraisal and belonging social support scores were associated with higher physical activity.
- These associations remained significant after adjusting for sociodemographic factors but not after controlling for depression.
- No significant interaction between social support and time was found after adjusting for covariates.

## Abstract

Coronary heart disease (CHD) is a significant public health problem among older adults that is associated with reduced physical activity (PA) and impaired functional capacity, commonly measured by activities of daily living (ADL) and instrumental activities of daily living (iADL). Maintaining independence in ADLs is critical for older adults' quality of life and healthcare outcomes. While social support is known to improve health outcomes, its long-term impact on PA and functional status in CHD patients has not been fully explored.

This study aimed to investigate the association between social support and functional outcomes, including PA, in a cohort of long-term survivors with established CHD.

This study leverages 2 decades of the Heart and Soul Study, a multicenter investigation into mental health factors and clinical outcomes in individuals with CHD. We report a longitudinal analysis of baseline (2000–2002) and 20-year follow-up data (2022) to detect differences in social support and its association with functional status and PA over 20 years of surviving participants. Social support was measured using the 12-item Interpersonal Support Evaluation List (ISEL) subscales. Functional status was assessed using a combination of Katz and Lawton ADL scales, and PA was measured with self-reported data. Logistic regression models assessed associations between social support, ADL, and PA, accounting for change over time (baseline and 20 years), adjusting for sociodemographic factors and depressive symptoms.

The sample included 129 participants (mean age 80.9 years, SD ± 9.1), 72.9% of whom were male. In unadjusted analyses, better appraisal and belonging social support scores were associated with greater independence in iADL. These associations were insignificant after adjusting for sociodemographic characteristics (age, sex, income, race/ethnicity) and depression. Better appraisal and belonging scores were also significantly associated with higher PA. These associations remained significant after adjusting for sociodemographic factors, but did not remain significant after controlling for depression. After adjusting for the same covariates, we found no significant interaction between social support and time (20 years).

This study provides a 20-year perspective on the role of social support in maintaining physical activity and independence in older adults with CHD. Our findings suggest that while social support is linked to better functional status and PA, these benefits are not sustained, accounting for sociodemographic characteristics and depression. Highlighting the need for integrating mental health support alongside social support strategies in long-term interventions to improve functional outcomes.