The relationship between prematurity and maternal mental health during the first postpartum year

Studies concerning the effect of a premature birth on maternal mental health suggest symptoms of depression and anxiety are more prevalent in mothers of premature infants compared to mothers of term infants. However, most studies investigating depressive symptoms only relate to a few months postpartum, whilst no anxiety measures used have been postpartum-specific. Additionally, symptoms of anxiety and depression in mothers of extremely premature infants (<28 weeks’ gestation) are relatively understudied. The aim of this study was to investigate the relationship between early gestational age and symptoms of anxiety and depression, with a secondary emphasis on mothers of extremely premature infants. 225 mothers of infants aged between birth and 12 months completed the Edinburgh Postnatal Depression Scale and the Postpartum Specific Anxiety Scale via an online questionnaire. Hierarchical regression models revealed that gestational age was associated with postpartum specific anxieties and was differentially associated with subscales of the PSAS. Furthermore, mothers of extremely premature infants experience specific subscales in the PSAS to a higher extent than mothers of term infants. There was no association between prematurity and depressive symptoms. These findings demonstrate the need for specific, targeted interventions for mothers of premature infants.     

Contributing factors to diaper dermatitis and NICU length of stay

ObjectiveDiaper dermatitis (DD) among NICU infants is preventable and under-recognized. The role of clinical characteristics (CC) on DD is also poorly described. This study examined the: 1) prevalence of DD in NICU; 2) relationship of factors including CC and DD; and 3) contribution of DD and CC factors on NICU Length of stay (LOS).MethodRetrospective chart review data was collected on all infants admitted to the NICU. Analyses included bivariate and multivariable logistic regression for DD outcome and negative binomial regression model for predicting infants’ NICU LOS.ResultsDD prevalence in the NICU sample was 34% (n = 180), 70% White, 56% male, 72% infants born at higher gestational age, and 62.2% born vaginally. Logistic regression results showed that Black infants have lower AOR of DD, whereas, NICU LOS (OR 1.02; 95% CI 1.01, 1.03), number of skin injuries (OR 1.22; 95% CI 1.01–1.47), and older gestational age (OR 3.73; 95%CI 0.83–0.95) increased the odds of DD. Significant interaction of gestational age group and days to full feed was identified.ConclusionDD is common among NICU infants and several CC play an integral role as risk and moderating factors for DD. Routine collection of infant skin integrity data is currently lacking in large collaborative databases, which limits better understanding of DD in NICU. Improvements in preventative measures could benefit from continued study of the impact nutrition and LOS have on DD development. Better systems of collecting and analyzing DD data and its impact on NICU LOS are needed.     

Involvement of mothers in high-risk neonatal care: A capacity building program for neonatal nurses

The quality of mother-infant interaction directly impacts neonatal and maternal health and well-being. Nurses play a significant role in facilitating and supporting the mothers to participate in the care of their neonates admitted to Neonatal Intensive Care Unit (NICU). Capacity-Building Program (CBP) was conducted to empower the neonatal nurses to facilitate and support mothers in routine care of their neonates admitted to NICU. A total of 53 neonatal nurses participated in the program. This program focused on empowering the neonatal nurses on the responsibilities and strategies to involve mothers in routine care of neonates at NICU. The program was evaluated by testing nurses’ knowledge through pre-test and post-test score analysis. Neonatal nurses demonstrated a higher level of knowledge post-implementation of the program. It was found that the capacity-building program intervention was effective (p < 0.001) in improving the knowledge of neonatal nurses on the role of nurses in facilitating and supporting mothers in the care of their neonates admitted to NICU.     

Respiratory distress and its associated factors among preterm neonates admitted to Mizan Tepi University teaching hospital,Bench Maji Zone,South West Ethiopia, 2020

BackgroundRespiratory distress (RD) is a common problem in the neonatal period and one of the most common reasons for neonates to be admitted to the neonatal intensive care unit (NICU) which frequently leads to neonatal mortality. However, there are few studies on neonatal respiratory distress and its associated factors in Ethiopia. This study was aimed to determine the prevalence and associated factors of respiratory distress in the neonatal intensive care unit at Mizan Tepi University teaching hospital.MethodsAn institutional based retrospective cross sectional study was conducted among preterm infants admitted in a neonatal intensive care unit (NICU) of Mizan Tepi University teaching hospital from May 9/2016 to December 30/2019. Simple random sampling technique was used to recruit a predetermined sample size by using registration numbers of the clients enrolled through computer generated random numbers. Binary Logistic regression was used to analyze the association between neonatal respiratory distress and explanatory variables. Explanatory variables that had a P-value of less than 0.25 and fulfilled the assumption of logistic regression from bi-variable logistic regression were considered for the multivariable logistic regression model. The strength of association was evaluated using an odds ratio at 95% confidence interval and a P-value < 0.05 was considered to declare significant associations.ResultThe proportion of respiratory distress in the current study was 34.0% at 95% CI 29.4%–38.6%. Respiratory distress was significantly associated with being a multiple (twin) AOR = 1.8(1.05–3.09), non-cephalic presentation at delivery AOR = 4.9(1.96–12.2), presence of asphyxia AOR = 1.85(1.01–3.69), an APGAR of <7 at 5-min AOR = 1.64(1.18–2.7), and a gestational age between 31 and 34 weeks AOR = 1.85(1.12–3.5).ConclusionThe prevalence of neonatal respiratory distress in the current study was high. Nearly one out of three neonates admitted to Mizan Tepi University teaching hospital NICU's had respiratory distress. Respiratory distress was significantly associated with a low 5-min APGAR score, a gestational age between 28 and 31, a multiple (twin) pregnancy, non-cephalic presentation, and neonatal asphyxia. Therefore, health professionals working in the delivery room and/or the neonatal intensive care unit should be mindful of these associated factors for early detection and appropriate management of RD to ensure better outcomes in all infants presenting with respiratory distress.     

Cost-Related Nonadherence to Medications Among US Adults With Chronic Liver Diseases

ObjectiveTo estimate the prevalence, risk factors, and consequences of cost-related medication nonadherence (CRN) in individuals with chronic liver diseases (CLDs) in the United States.Patients and MethodsUsing the National Health Interview Survey from January 1, 2014, to December 31, 2018, we identified individuals with CLDs. Using complex weighted survey analysis, we obtained national estimates and risk factors for CRN and its association with cost-reducing behaviors and measures of financial toxicity. We evaluated the association of CRN with unplanned health care use, adjusting for age, sex, race/ethnicity, insurance, income, education, and comorbid conditions.ResultsOf 3237 respondents (representing 4.6 million) US adults with CLDs, 813 (representing 1.2 million adults, or 25%; 95% CI, 23% to 27%) reported CRN, of whom 68% (n=554/813) reported maladaptive cost-reducing behaviors. Younger age, female sex, low income, and multimorbidity were associated with a higher prevalence of CRN. Compared with patients without CRN, patients experiencing CRN had 5.1 times higher odds of financial hardship from medical bills (adjusted odds ratio [aOR], 5.05; 95% CI, 3.73 to 6.83) and 2.9 times higher odds of food insecurity (aOR, 2.85; 95% CI, 2.02 to 4.01). The CRN was also associated with 1.5 times higher odds of emergency department visits (aOR, 1.46; 95% CI, 1.11 to 1.94).ConclusionWe observed a high prevalence of CRN and associated consequences such as high financial distress, financial hardship from medical bills, food insecurity, engagement in maladaptive cost-reducing strategies, increased health care use, and work absenteeism among patients with CLD. These financial determinants of health have important implications in the context of value-based care.     

In asymptomatic late preterm and term infants,with neonatal hypoglycaemia,is the administration of 40% glucose gel effective in establishing normoglycaemia and reducing neonatal admissions?: A literature review

IntroductionTransient neonatal hypoglycaemia (TNH) is a common condition affecting newborn infants in homeostatic transition from maternal glucose supply to own metabolic adaptation.ObjectivesTo review published research after the cochrane systematic review in 2016 on the use of 40% glucose gel for the treatment of asymptomatic TNH.DesignCritical analysis was undertaken through a literature review and themes amongst the studies were categorised.Databases sourcesGrey literature, trial documents and databases inclusive of CINAHL, Cochrane, Medline and PubMed were searched between April 2017 and February 2018.Findings40% glucose gel may reduce NICU admissions, reduce length of stay in hospital, reduce maternal and infant separation and decrease hospital expenditure for asymptomatic hypoglycaemic infants.ConclusionAlthough with limitations, the studies add to the growing evidence of support for 40% glucose gel as a safe, simple and effective intervention for asymptomatic hypoglycaemic infants. Future large-scale studies may increase the evidence and support the development of a national protocol/guideline.     

Gestational Diabetes Mellitus Is Associated with Altered Abundance of Exosomal MicroRNAs in Human Milk

PurposeHuman milk (HM) is a unique biological fluid that is enriched with a variety of factors, including microRNAs (miRNAs) that potentially provide both short- and long-term benefits to the infants. miRNAs are packaged within exosomes, making them bioavailable to infants. Gestational diabetes mellitus (GDM) may affect the abundance of exosomal miRNAs in HM, providing a mechanism for growth and adiposity variation in infants of mothers with GDM in early life. Therefore, the purposes of this study were to examine the impact of GDM on select miRNAs (miRNA-148a, miRNA-30b, miRNA-let-7a, and miRNA-let-7d) involved in metabolism and to examine the association of these miRNAs with measures of infant body composition in the first 6 months of life.MethodsMilk samples were collected from a cohort of 94 mothers (62 mothers without GDM and 32 mothers with GDM) matched on body mass index strata at 1 month post partum. miRNA abundance was measured by real-time polymerase chain reaction. Linear regression models were used to examine potential differences in miRNA abundance in women with and without GDM, testing associations between miRNA abundance and infant growth and body composition measures from 1 to 6 months.FindingsThe abundances of miRNA-148a, miRNA-30b, miRNA-let-7a, and miRNA-let-7d were reduced in milk from mothers with GDM. Independent of GDM status, higher maternal diet quality was associated with increased abundance of each of the measured miRNAs. miRNA-148a was negatively associated with infant weight, percentage of body fat, and fat mass, whereas miRNA-30b was positively associated with infant weight and fat mass at 1 month of age. There was no association of milk miRNA-148a and miRNA-30b with infant weight at 1 month of age or with body composition measures at 3 months of age; however, miRNA-148a was negatively associated with infant weight at 6 months of age.ImplicationsIf supported by randomized dietary supplementation or other intervention trials, HM miRNAs may be a therapeutic target to mitigate risk of metabolic outcomes in offspring of women with GDM.     

Health risk management behaviors and related factors among Japanese university students participating in short-term study abroad programs

BackgroundOverseas travelers should prepare for health problems at their destinations prior to travel. No prospective studies have evaluated factors related to health risk management behaviors among overseas travelers, specifically young travelers.MethodsWe prospectively collected data from pre- and post-travel questionnaire surveys, targeting students of a university in Japan who participated in short-term study abroad programs (n = 532, 6 to 38 travel days and 11 countries). We examined health information collection, receipt of travel vaccinations for the programs and medical kit preparation as health risk management behavior outcomes and their related factors among the participants (82.7% follow-up rate).ResultsIn total, 17.5%, 8.0% (28.6% in Southeast Asia) and 68.9% of participants, respectively, collected travel health information via the Japanese or foreign official websites, received travel vaccinations and carried commonly used medicines. Female, travel experience to study destination, parental medical occupation and presence of illness in treatment were positively associated with the health risk management behaviors after adjusting for the covariates including study destination. For example, the adjusted odds ratio (OR) (95% confidence interval [CI]) of receiving travel vaccinations was 4.16 (1.70–10.2) for parental medical occupation relative to non-medical occupation. The adjusted OR (95% CI) of collecting travel health information was 2.54 (1.04–6.21) for travel experience to study destination relative to no overseas travel experience.ConclusionsPersonal characteristics including overseas travel experience and parental occupation provide a useful insight into approaches to promoting health risk management among university students traveling abroad.     

Association of Cardiovascular Disease Risk Factors With Sociodemographic Characteristics and Health Beliefs Among a Community-Based Sample of African American Adults in Minnesota

ObjectiveTo assess cardiovascular disease (CVD) and CVD risk factors and their association with sociodemographic characteristics and health beliefs among African American (AA) adults in Minnesota.MethodsA cross-sectional analysis was conducted of a community-based sample of AA adults enrolled in the Minnesota Heart Health Program Ask About Aspirin study from May 2019 to September 2019. Sociodemographic characteristics, health beliefs, and self-reported CVD and CVD risk factors were collected. Prevalence ratio (PR) estimates were calculated using Poisson regression modeling to assess the association between participants’ characteristics and age- and sex-adjusted CVD risk factors.ResultsThe sample included 644 individuals (64% [412] women) with a mean age of 61 years. Risk factors for CVD were common: hypertension (67% [434]), hyperlipidemia (47% [301]), diabetes (34% [219]), and current cigarette smoking (25% [163]); 19% (119) had CVD. Those with greater perceived CVD risk had a higher likelihood of prevalent hyperlipidemia (PR, 1.34; 95% CI, 1.14 to 1.57), diabetes (PR, 1.61; 95% CI, 1.30 to 1.98), and CVD (PR 1.61; 95% CI, 1.16 to 2.23) compared with those with lower perceived risk. Trust in health care provider was high (83% [535]) but was not associated with CVD or CVD risk factors.ConclusionIn this community sample of AAs in Minnesota, CVD risk factors were high, as was trust in health care providers. Those with greater CVD risk perceptions had higher CVD prevalence. Consideration of sociodemographic and psychosocial influences on CVD and CVD risk factors could inform development of effective cardiovascular health promotion interventions in the AA Minnesota community.     

Nonlinear Associations Between Cumulative Dietary Risk Factors and Cardiovascular Diseases,Cancer, and All-Cause Mortality: A Prospective Cohort Study From UK Biobank

ObjectiveTo develop a score from cumulative dietary risk factors and examine its nonlinear associations with cardiovascular disease (CVD) and cancer incidence and mortality, as well as all-cause mortality.Patients and MethodsThere were 422,702 participants from UK Biobank included in this prospective study. Cumulative dietary risk factors were represented using a score ranging from 0 (healthiest) to 9 (least healthy). This was derived from 9 food items based on current UK guidelines using baseline data. Associations between the cumulative score and health outcomes were investigated using nonlinear penalized cubic splines fitted in Cox proportional hazard models. Follow-up was conducted until June 2020 for mortality, and for incidence, up to June 2020 in England and March 2017 in Wales and Scotland.ResultsThe median follow-up period was 9.0 years for incidence outcomes and 9.3 years for mortality outcomes. Each 1-point increment in the cumulative dietary risk factors score was associated with higher risk for incidence and mortality of the outcomes studied. The highest risks were identified for mortality due to heart failure (8.0% higher), CVD, and ischemic heart disease (both 7.0% higher). In addition, a higher diet score accounted for 18.8% of all deaths, 4.47% of incident cases of CVD, 25.5% of CVD deaths, 7.7% of incident cancers, and 18.2% of all cancer deaths.ConclusionOur findings show that dietary risk factors contributed to a large proportion of CVD and cancer events, as well as deaths, among those who did not meet most dietary recommendations.     

Incidence and Risk of Various Types of Arterial Thromboembolism in Patients With Cancer

ObjectiveTo describe the temporal association and identify risk factors between cancer diagnosis and various types of arterial thromboembolism (ATE).Patients and MethodsWe inquired an aggregated electronic health record database (Explorys, IBM Corp., Armonk, New York) and identified patients with cancer from January 1999 to October 2019, with various types of ATE, including myocardial infarction, acute ischemic stroke, acute limb ischemia, acute mesenteric ischemia, acute renal infarction, and retinal artery occlusion. We investigated the temporal relationship between cancer diagnosis and ATE events by examining the incidence ratio (IR) of ATE before and after diagnosis of cancer.ResultsWe identified 305,384 patients with cancer and ATE. The 30-day interval IR of total ATE was elevated shortly before and after cancer diagnosis, which was consistent among different ATE and cancer types. The incidence was highest within a 330-day window (90 days before and 240 days after cancer diagnosis), and IR peaked at 13.9 (95% confidence interval [CI], 13.6 to 14.2) in the first 30 days following diagnosis of cancer. Compared with patients with cancer who never developed ATE, patients with ATE had more cardiovascular risk factors at baseline. Patients with brain cancer, lung cancer, colorectal cancer, and pancreatic cancer had the highest risk of developing ATE, whereas ATE type was anatomically associated with cancer type.ConclusionIn this observational study of an aggregated US patient population, those with newly diagnosed cancer had increased risk of ATE events. This risk was most elevated in a 330-day window around cancer diagnosis and was consistent across different types of ATE and cancer.     

Proactive delivery of nicotine replacement therapy to families of hospitalized infants in a NICU: A randomized controlled pilot trial

Neonatal ICU (NICU) hospitalizations provide opportunities to engage individuals/families who smoke with evidence-based cessation treatments to protect infants from tobacco smoke exposure. The aim of this pilot study was to establish the feasibility and potential efficacy of providing motivational advice and NRT (MA + NRT) to families of NICU infants. RCT methodology equally allocated participants who reported ≥1 household smoker (N = 32) from a large NICU to MA + NRT or referral to a Quitline. The primary outcome was accepting NRT patches (MA + NRT) and use of NRT. Bayesian analyses modeled NRT use as a function of treatment group. Most MA + NRT participants (81.3%; n = 13) accepted the patches. No Quitline participants called the Quitline. NRT use differed across groups, indicating a 0.907 posterior probability that a positive effect for MA + NRT exists (RR = 2.32, 95% CI = [0.68–11.34]). This study demonstrated feasibility and acceptability for offering NRT and motivational advice to NICU parents and supports further intervention refinement with NICU families.     

Risk Factors for Silent Brain Infarcts and White Matter Disease in a Real-World Cohort Identified by Natural Language Processing

ObjectiveTo assess the frequency of silent brain infarcts (SBIs) and white matter disease (WMD) and associations with stroke risk factors (RFs) in a real-world population.Patients and MethodsThis was an observational study of patients 50 years or older in the Kaiser Permanente Southern California health system from January 1, 2009, through June 30, 2019, with head computed tomography or magnetic resonance imaging for nonstroke indications and no history of stroke, transient ischemic attack, or dementia. A natural language processing (NLP) algorithm was applied to the electronic health record to identify individuals with reported SBIs or WMD. Multivariable Poisson regression estimated risk ratios of demographic characteristics, RFs, and scan modality on the presence of SBIs or WMD.ResultsAmong 262,875 individuals, the NLP identified 13,154 (5.0%) with SBIs and 78,330 (29.8%) with WMD. Stroke RFs were highly prevalent. Advanced age was strongly associated with increased risk of SBIs (adjusted relative risks [aRRs], 1.90, 3.23, and 4.72 for those aged in their 60s, 70s, and ≥80s compared with those in their 50s) and increased risk of WMD (aRRs, 1.79, 3.02, and 4.53 for those aged in their 60s, 70s, and ≥80s compared with those in their 50s). Magnetic resonance imaging was associated with a reduced risk of SBIs (aRR, 0.87; 95% CI, 0.83 to 0.91) and an increased risk of WMD (aRR, 2.86; 95% CI, 2.83 to 2.90). Stroke RFs had modest associations with increased risk of SBIs or WMD.ConclusionAn NLP algorithm can identify a large cohort of patients with incidentally discovered SBIs and WMD. Advanced age is strongly associated with incidentally discovered SBIs and WMD.     

The impact of a mobile health intervention on the sense of coherence and quality of life of mothers with premature infants

BackgroundThe birth of a premature infant imposes a physical and psychological burden for mothers, which in turn affects the sense of coherence (SOC) and quality of life (QoL) of the mothers.PurposeThe aim of the present study was to investigate the effect of education through mobile health software on QoL and SOC of mothers with premature infants.Study designA quasi-intervention study with control group design was conducted on 72 mothers. Both groups received mobile phone software for three months. Changes in the two variables of QoL and SOC were assessed through WHO QoL questionnaires and an SOC scale.ResultsThere were no statistically significant differences between groups in the QoL and SOC scores obtained in the pre-test stage. For the intervention group, after the education, there were significantly improved QoL and SOC scores.Implication for PracticeThe results of the present study show the beneficial effects of a distance education program through mobile health software on QoL and SoC of mothers with premature infants.     

Mental Stress and Its Effects on Vascular Health

Coronary artery disease continues to be a major cause of morbidity and mortality despite significant advances in risk stratification and management. This has prompted the search for alternative nonconventional risk factors that may provide novel therapeutic targets. Psychosocial stress, or mental stress, has emerged as an important risk factor implicated in a higher incidence of cardiovascular events, and although our understanding of this far ranging and interesting phenomenon has developed greatly over recent times, there is still much to be learned regarding how to measure mental stress and how it may impact physical health. With the current coronavirus disease 2019 global pandemic and its incumbent lockdowns and social distancing, understanding the potentially harmful biological effects of stress related to life-changing events and social isolation has become even more important. In the current review our multidisciplinary team discusses stress from a psychosocial perspective and aims to define psychological stress as rigorously as possible; discuss the pathophysiologic mechanisms by which stress may mediate cardiovascular disease, with a particular focus to its effects on vascular health; outline existing methods and approaches to quantify stress by means of a vascular biomarker; outline the mechanisms whereby psychosocial stressors may have their pathologic effects ultimately transduced to the vasculature through the neuroendocrine immunologic axis; highlight areas for improvement to refine existing approaches in clinical research when studying the consequences of psychological stress on cardiovascular health; and discuss evidence-based therapies directed at reducing the deleterious effects of mental stress including those that target endothelial dysfunction. To this end we searched PubMed and Google Scholar to identify studies evaluating the relationship between mental or psychosocial stress and cardiovascular disease with a particular focus on vascular health. Search terms included “myocardial ischemia,” “coronary artery disease,” “mental stress,” “psychological stress,” “mental1 stress1,” “psychologic1 stress1,” and “cardiovascular disease1.” The search was limited to studies published in English in peer-reviewed journals between 1990 and the present day. To identify potential studies not captured by our database search strategy, we also searched studies listed in the bibliography of relevant publications and reviews.     

Effectiveness of mHealth application in improving knowledge of mothers on preterm home care

mHealth intervention can be an important tool for health education. The study aimed to determine the effectiveness of a mHealth application in improving mothers' knowledge of preterm home care. One hundred sixty mothers of preterm infants hospitalized in the Neonatal Intensive Care Unit (NICU) of a tertiary care teaching hospital in Karnataka, India participated in a randomized controlled trial. The mothers in the intervention group showed a statistically significant increase in knowledge scores (pre = 17, post = 27, (p < .001) compared to mothers in the control group (pre = 18, post = 20). Knowledge scores didn't differ across age (U = 2629.00, p .051), employment status (χ² = 3.060, p = .80), parity (χ2 = 0.025, p = .874) and socio-economic status (χ2 = 6.702, p = .57). Only education was significantly associated with baseline knowledge score (χ2 = 6.163, p = .013). The mHealth educational app effectively improved the knowledge of mothers on preterm home care.     

Information and interaction opportunities: Experiences of mothers of babies at the neonatal intensive care unit,Accra, Ghana: A qualitative study

Despite calls to improve information and interaction opportunities between preterm mothers and healthcare workers in order to enhance optimal care in the neonatal intensive care unit (NICU), evidence is lacking in lower and middle-income countries like Ghana. Therefore, this paper attempts to address this knowledge gap by exploring mothers' experiences of information and interaction opportunities with healthcare workers about their preterm at the neonatal intensive care unit in the 37 Military Hospital, Ghana. A qualitative research investigation was used for the study. The authors further employed the narrative inquiry qualitative approach. A purposive sampling technique was used to select an estimated number of 18 participants to participate in the study. However, after saturation was reached where new themes no longer emerged, (15) participants were allowed to participate in the study. Thus, fifteen (15) in-depth interviews (IDIs) were conducted for the mothers, as well as (2) focus group discussions (FGDs). The authors discovered that a mother's socioeconomic status influenced information and interaction opportunities between mothers and health care workers. Second, the mood of the healthcare worker at a given time shaped information and interaction about their babies at the NICU; and lastly, doctors were in possession of more adequate information about babies than nurses, which sometimes affected mothers' access to information about their babies. To enhance information and interaction opportunities, there is a need to address the shortfalls in delivering optimal care at the NICU.     

Exercise Counteracts the Cardiotoxicity of Psychosocial Stress

Physical inactivity and psychosocial stress are prevalent in residents of the United States. The purpose of this article is to review the interaction between these 2 conditions and examine the effects of exercise on stress and cardiovascular (CV) health. A query of scientific references between 1974 to 2018 was performed using the PubMed search engine accessing the MEDLINE database using the search terms psychosocial stress, CV disease (CVD), physical activity, exercise, cardiac rehabilitation, and team sports. Psychosocial stress is a strong independent risk factor for adverse CV events. Conversely, people who experience CV events subsequently have drastically elevated rates of new-onset mental health disorders, including depression and anxiety. Psychosocial stress and CVD often trigger self-reinforcing feedback loops that can worsen mental health and cardiac prognosis. Exercise predictably improves CV health and prognosis and also is effective at lowering levels of psychosocial stress. Group exercise in particular seems to provide social support while at the same time boosting fitness levels and, thus, may be the single most important intervention for patients with concomitant CVD and emotional stress. Collaborative physical activity, such as group exercise, team sports, interactive physical play, and cardiac rehabilitation programs, have the potential to improve mental health and CV prognosis.