Health-promoting lifestyle in cardiac patients: The mediating role of cognitive flexibility in the relationship between intimate relationships and distress tolerance.

Abstract

Background: The present study aimed to determine the predictive model of health-promoting lifestyle in cardiovascular patients based on intimate relationships and distress tolerance, mediated by cognitive flexibility.

Methods: The research design was a cross-sectional correlational study using structural equation modeling. The statistical population included cardiovascular patients in 2025 who referred to three specialized cardiology clinics for outpatient examination. A total of 265 individuals were selected as the sample using convenience sampling. Standard questionnaires for health-promoting behaviors (Walker et al.), social intimacy (Miller and Lefcourt), distress tolerance (Simons and Gaher), and cognitive flexibility (Dennis and Vander Wal) were used. Statistical data analysis was performed using the Pearson correlation coefficient and path analysis with bootstrap testing, employing AMOS 24 and SPSS 26 software.

Results: The results of path analysis and bootstrap testing showed that the proposed model had a good statistical fit (χ²/df = 2.94, RMSEA = 0.071, CFI = 0.939, GFI = 0.990). The indirect effect of intimate relationships on health-promoting lifestyle through cognitive flexibility (β = 0.1148, p = 0.001) and the indirect effect of distress tolerance on health-promoting lifestyle through cognitive flexibility (β = 0.0924, p = 0.001) were confirmed.

Conclusion: The structural model, with good fit, explained the mediating role of cognitive flexibility in the relationship between intimate relationships and distress tolerance with health-promoting lifestyle in cardiovascular patients. These findings provide an operational framework for psychotherapy interventions based on strengthening distress tolerance and interpersonal relationships to improve cardiovascular health.