Enhancing Cardiac Rehabilitation With Stress Management Training

Abstract

Background Cardiac rehabilitation (CR) is the standard of care for patients with coronary heart disease (CHD). Despite considerable epidemiologic evidence that high stress is associated with worse health outcomes, stress management training (SMT) is not included routinely as a component of CR. Methods and Results 151 outpatients with CHD aged 36 to 84 years were randomized to 12-weeks of comprehensive CR or comprehensive CR combined with SMT (CR+SMT), with assessments of stress and CHD biomarkers obtained before and after treatment. A matched sample of CR-eligible patients who did not receive CR comprised a No-CR comparison group. All participants were followed for up to 5.3 years (median = 3.2 years) for clinical events. Patients randomized to CR+SMT exhibited greater reductions in composite stress levels compared with those randomized to CR alone (P = 0.022), an effect that was driven primarily by improvements in anxiety, distress, and perceived stress. Both CR groups achieved significant, and comparable, improvements in CHD biomarkers. Participants in the CR+SMT group exhibited lower rates of clinical events compared with CR alone (18% vs. 33%, HR = 0.49 [0.25, 0.95], P = 0.035) and both CR groups had lower event rates compared to the No-CR group (47%, HR = 0.44 [0.27, 0.71], P < .001). Conclusions CR enhanced by SMT produced significant reductions in stress and greater improvements in medical outcomes compared with standard CR. Our findings indicate that SMT may provide incremental benefit when combined with comprehensive CR and suggest that SMT should be incorporated routinely into CR. Clinical Trial Registration Information www.Clinicaltrials.gov. Identifier: NCT00981253.

Physical activity and psychosocial function following cardiac rehabilitation: One-year follow-up of the ENHANCED study

“…However, as previously reported, self-reported activity was significantly associated with objectively measured physical activity using actigraphy-assessed physical activity, collected both at baseline and again following 3-months of CR after controlling for demographic characteristics and medical comorbidities. [10] Second, only 80% of participants were available at follow-up, although our findings were not altered when missing data were accounted for statistically using multiple imputation. Third, we were unable to obtain data on other possible psychological treatments during the 1-year follow up period (e.g., psychotherapy, psychotropic medication, etc.)…”

“…The CR+SMT condition was comprised of standard CR plus weekly, group-based SMT sessions t. [15] The methods and primary results of the trial have been reported previously. [10] The present report describes results for data collected nine months after completing CR (i.e., 12-months following randomization).…”

“…[9] Furthermore, despite the fact that most CR programs do not systematically integrate stress management training (SMT), the recently completed ENHANcing Cardiac rEhabilitation (ENHANCED) trial showed that SMT provided added benefits to comprehensive, exercise-based CR, including greater reductions in psychological stress and fewer clinical events. [10]…”

Spontaneous Coronary Artery Dissection (SCAD)

“…16 However, only a handful of studies have examined the impact of CR on patients’ physical and emotional recovery from SCAD. 17–19 More information regarding SCAD patients’ experience with CR is needed to better meet the needs of this population subset.…”

The Protective Role of Positive Well-Being in Cardiovascular Disease: Review of Current Evidence, Mechanisms, and Clinical Implications

“…Thus, novel approaches for improving psychological functioning should be considered. For example, programs focusing on exercise and comprehensive lifestyle changes (e.g., stress management training combined with cardiac rehabilitation) have been shown to improve mental and physical health [119–121]. Given the evidence linking positive well-being to better health outcomes, efforts to target positive well-being may serve as important components of broader CVD management programs.…”