Effects of Health Action Process Approach (HAPA)-Guided Exercise Rehabilitation on Cardiovascular Risk Factors in Perimenopausal Women with CHD: A Randomized Controlled Trial

Background: Perimenopausal women with coronary heart disease (CHD) face accelerated metabolic disturbances that complicate secondary prevention, yet adherence to conventional exercise rehabilitation remains a significant barrier. Objective: To evaluate the effectiveness of Health Action Process Approach (HAPA)-guided cardiac rehabilitation in managing modifiable risk factors and improving secondary prevention outcomes among perimenopausal patients with CHD. Methods: A total of 106 perimenopausal CHD patients were randomly assigned to a control group (conventional exercise rehabilitation) or an experimental group (HAPA-based risk factor intervention). Objective measures (BMI, fasting glucose, lipid profiles, blood pressure, 6-minute walk distance) and subjective scales (SAS, SDS, CCQQ) were assessed at admission and 3 months post-discharge. Clinical outcomes (all-cause mortality, recurrent angina, non-fatal MI, revascularization, heart failure) were also recorded. Results: At the 3-month follow-up, the experimental group showed significantly greater improvements compared to the control group in BMI, blood lipid profiles (TC, TG, LDL-C), blood pressure (SBP, DBP), fasting glucose, 6-minute walk distance, and psychological scores (SAS, SDS) (all P < 0.05), along with a superior quality of life (CCQQ score, P < 0.001). Within-group improvements were significant across all measures in the experimental group (all P < 0.001), while limited to quality of life in the control group. No all-cause mortality, non-fatal myocardial infarction, revascularization, or heart failure occurred. Recurrent angina was reported in 1 patient (1.9%) in the experimental group versus 5 patients (9.4%) in the control group. Conclusion: HAPA-guided exercise cardiac rehabilitation suggests potential improvements in short-term controllable risk factors, psychological status, and quality of life without increasing adverse outcomes in perimenopausal CHD patients.