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The causal attributions and perceived risk factors can affect patients' health behaviors. Therefore, the present study aimed to assess (i) the effect of an outpatient cardiac rehabilitation (CR) program on perceived heart risk factors (PHRFs) and on psychological stress, and (ii) the role of changes of PHRFs at pre-post CR in predicting changes in psychological stress.  Methods:  In this longitudinal study, 110 CR patients were assessed from June to November 2016 in a hospital in Iran. Perceived heart risk factors and perceived stress were investigated using the PHRFs scale and the Depression, Anxiety, Stress Scale-21, respectively. PHRFs and DASS-21 Stress scale scores were compared before and after 26 sessions of exercise-based CR through paired sample t-tests. In addition, we investigated the effect of PHRF's change scores on DASS-21 Stress scale scores using linear regression analysis.  Results:  Results showed that CR has a little impact in improving the patients' perception of heart risk factors, However, CR is significantly effective in reducing stress ( P &lt; 0.05). Regression analysis evidenced that improvements in patients' perception of risk factors can significantly predict a reduction in psychological stress (P = 0.030). The model explained 11.2% of the variance in the results.  Conclusion:  PHRFs appear to be significant predictive components of CR's stress reduction. Practitioners should focus on patients' perception of risk factors to facilitate stress management in CR program.

Subjective correlates of stress management in outpatient cardiac rehabilitation: the predictive role of perceived heart risk factors