The Impact of Cardiovascular Rehabilitation on Psychophysiological Stress, Personality and Tryptophan Metabolism: A Randomized Pilot Feasibility Study

Abstract

Multicomponent cardiac rehabilitation (CR) is a secondary prevention strategy for cardiac patients to tackle stress and psychosocial wellbeing. However, there is a lack of data on its psychoneuroimmunological effects and of biomarkers to determine individual risk and to develop treatment strategies. We conducted a pilot randomized controlled trial (RCT) to investigate the feasibility of deriving psychophysiological stress markers in patients with cardiovascular diseases. Thirty individuals with cardiovascular disease (mean age 58.8 years; 23.3% female) were enrolled and randomized into three treatment groups: standard rehabilitation, yoga, or transcendental meditation (TM). Depression, anxiety, sleep, stress perception, personality functioning, hair cortisol, serum tryptophan, kynurenine and neopterin concentrations were estimated at baseline and after a four-week intervention. Hair cortisol levels decreased significantly after rehabilitation in all groups (F = 15.98, p < 0.001). In addition, personality functioning improved in all patients over time. Participants with impairments in personality functioning showed a positive correlation with baseline neopterin that did not remain significant after Bonferroni correction. Concentrations of serum tryptophan and its metabolite kynurenine did not change significantly. This pilot RCT provides preliminary evidence of multicomponent CR leading to stabilization of hair cortisol levels and improved psychophysiological wellbeing and personality functioning. Impairments in personality functioning were correlated with neopterin levels, which may impact the symptomatology and outcome.

Long‐term glucocorticoids in relation to the metabolic syndrome and cardiovascular disease: A systematic review and meta‐analysis

“…Some studies—although they were cross‐sectional in the sense of a one‐time HairGC measurement—showed higher HairGC levels in the months preceding an acute myocardial event among people with CVD compared to either (1) patients who were hospitalized for another reason or (2) healthy controls, suggesting a potential causative association [40, 43]. Partly in‐line with this, longitudinal data suggest that recovery from CVD has a positive effect on HairGC levels [45, 46] but also point out the predictive value of HairF for future disease recovery and deterioration [42, 44, 47], indicating a potentially bidirectional relationship. It is unfortunate that HairE was not reported in these longitudinal studies.…”

“…Wagner‐Skacel et al. [45] measured HairF levels in a group of n = 30 CVD patients ( n = 7 women) undergoing a 4‐week rehabilitation program aimed to reduce stress (either using standard care, yoga, or meditation). The authors report that HairF levels decreased at the end of rehabilitation, compared to the 2 months before the start of rehabilitation, irrespective of the treatment group.…”

“…(n = 2), studies investigating the role of HairF and HairE exclusively in the context of subclinical cardiometabolic deterioration (n = 49), one out of two studies that were performed in the same population (n = 1), and a study in patients undergoing glucocorticoid replacement therapy (n = 1). Finally, a total of n = 24 articles were included, out of which n = 7 investigated the role of HairGC in relation to MetS [29][30][31][32][33][34][35], n = 16 examined the relation of HairGC with CVD [17,21,27,[36][37][38][39][40][41][42][43][44][45][46][47][48] and n = 1 reported results regarding both [28] (see Fig. S2).…”

“…We found five studies investigating the longitudinal relation of HairGC with health outcomes in the context of CVD. Diagnoses included CAD [44,45], stable chronic systolic heart failure [42], structural heart disease [46], and stroke [47]. In total, data of n = 346 individuals were included (42.50% women, see Table S8).…”

“…Two studies compared HairF levels before and after CVD treatment [45,46]. Younge et al [46] compared HairF levels in n = 151 patients with structural heart disease (n = 95 women) before and after a 12-week CVD treatment (standard care or mindfulness training) and found decreased levels at the end of treatment, which was independent of whether someone received mindfulness training or not.…”