 |
|
Effects of Exercise and Stress Management Training on Markers of Cardiovascular Risk in Patients With Ischemic Heart Disease
A Randomized Controlled Trial
James A. Blumenthal, PhD;
Andrew Sherwood, PhD;
Michael A. Babyak, PhD;
Lana L. Watkins, PhD;
Robert Waugh, MD;
Anastasia Georgiades, PhD;
Simon L. Bacon, PhD;
Junichiro Hayano, MD;
R. Edward Coleman, MD;
Alan Hinderliter, MD
JAMA. 2005;293:1626-1634.
Context Observational studies have shown that psychosocial factors are associated with increased risk for cardiovascular morbidity and mortality, but the effects of behavioral interventions on psychosocial and medical end points remain uncertain.
Objective To determine the effect of 2 behavioral programs, aerobic exercise training and stress management training, with routine medical care on psychosocial functioning and markers of cardiovascular risk.
Design, Setting, and Patients Randomized controlled trial of 134 patients (92 male and 42 female; aged 40-84 years) with stable ischemic heart disease (IHD) and exercise-induced myocardial ischemia. Conducted from January 1999 to February 2003.
Interventions Routine medical care (usual care); usual care plus supervised aerobic exercise training for 35 minutes 3 times per week for 16 weeks; usual care plus weekly 1.5-hour stress management training for 16 weeks.
Main Outcome Measures Self-reported measures of general distress (General Health Questionnaire [GHQ]) and depression (Beck Depression Inventory [BDI]); left ventricular ejection fraction (LVEF) and wall motion abnormalities (WMA); flow-mediated dilation; and cardiac autonomic control (heart rate variability during deep breathing and baroreflex sensitivity).
Results Patients in the exercise and stress management groups had lower mean (SE) BDI scores (exercise: 8.2 [0.6]; stress management: 8.2 [0.6]) vs usual care (10.1 [0.6]; P = .02); reduced distress by GHQ scores (exercise: 56.3 [0.9]; stress management: 56.8 [0.9]) vs usual care (53.6 [0.9]; P = .02); and smaller reductions in LVEF during mental stress testing (exercise: –0.54% [0.44%]; stress management: –0.34% [0.45%]) vs usual care (–1.69% [0.46%]; P = .03). Exercise and stress management were associated with lower mean (SE) WMA rating scores (exercise: 0.20 [0.07]; stress management: 0.10 [0.07]) in a subset of patients with significant stress-induced WMA at baseline vs usual care (0.36 [0.07]; P = .02). Patients in the exercise and stress management groups had greater mean (SE) improvements in flow-mediated dilation (exercise: mean [SD], 5.6% [0.45%]; stress management: 5.2% [0.47%]) vs usual care patients (4.1% [0.48%]; P = .03). In a subgroup, those receiving stress management showed improved mean (SE) baroreflex sensitivity (8.2 [0.8] ms/mm Hg) vs usual care (5.1 [0.9] ms/mm Hg; P = .02) and significant increases in heart rate variability (193.7 [19.6] ms) vs usual care (132.1 [21.5] ms; P = .04).
Conclusion For patients with stable IHD, exercise and stress management training reduced emotional distress and improved markers of cardiovascular risk more than usual medical care alone.
Author Affiliations: Departments of Psychiatry and Behavioral Sciences (Drs Blumenthal, Sherwood, Babyak, Watkins, Georgiades, and Bacon), Medicine (Dr Waugh), and Radiology (Dr Coleman), Duke University Medical Center, Durham, NC; Center for Mental Health and Care, Nagoya City University Hospital, Nagoya, Japan (Dr Hayano); and Department of Medicine, University of North Carolina Hospitals, Chapel Hill (Dr Hinderliter).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Optimism, Cynical Hostility, and Incident Coronary Heart Disease and Mortality in the Women's Health Initiative
Tindle et al.
Circulation 2009;120:656-662.
ABSTRACT
| FULL TEXT
QTL Underlying Voluntary Exercise in Mice: Interactions with the "Mini Muscle" Locus and Sex
Nehrenberg et al.
J Hered 2009;0:esp066v1-esp066.
ABSTRACT
| FULL TEXT
The Prescribed Amount of Physical Activity in Randomized Clinical Trials in Older Adults
Kruger et al.
The Gerontologist 2009;49:S100-S107.
ABSTRACT
| FULL TEXT
Treatment of Depression After Coronary Artery Bypass Surgery: A Randomized Controlled Trial
Freedland et al.
Arch Gen Psychiatry 2009;66:387-396.
ABSTRACT
| FULL TEXT
CHAPTER 35 Psychological Factors and Heart Disease
Pedersen et al.
ESC Textbook of Cardiovascular Medicine 2009;2:med-9780199566990-chapter-med-9780199566990-chapter.
ABSTRACT
| FULL TEXT
Depressive Symptoms, Health Behaviors, and Risk of Cardiovascular Events in Patients With Coronary Heart Disease
Whooley et al.
JAMA 2008;300:2379-2388.
ABSTRACT
| FULL TEXT
Psychological Stress and Cardiovascular Disease
Dimsdale
J Am Coll Cardiol 2008;51:1237-1246.
ABSTRACT
| FULL TEXT
Stress at work--an independent risk factor for coronary heart disease?
Yarnell
Eur Heart J 2008;29:579-580.
FULL TEXT
Associations of Psychosocial Factors With Heart Rate and Its Short-Term Variability: Multi-Ethnic Study of Atherosclerosis
Ohira et al.
Psychosom. Med. 2008;70:141-146.
ABSTRACT
| FULL TEXT
Psychological treatment of cardiac patients: a meta-analysis
Linden et al.
Eur Heart J 2007;28:2972-2984.
ABSTRACT
| FULL TEXT
Do Men and Women Differ on Measures of Mental Stress-Induced Ischemia?
York et al.
Psychosom. Med. 2007;69:918-922.
ABSTRACT
| FULL TEXT
Understanding prognostic benefits of exercise and antidepressant therapy for persons with depression and heart disease: the UPBEAT study rationale, design, and methodological issues
Blumenthal et al.
Clin Trials 2007;4:548-559.
ABSTRACT
European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts)
Authors/Task Force Members et al.
Eur Heart J 2007;28:2375-2414.
FULL TEXT
Psychological Stress and Myocardial Ischemia: Understanding the Link and the Implications
Sheps et al.
Psychosom. Med. 2007;69:491-492.
FULL TEXT
Autonomic cardiac control with xenon anaesthesia in patients at cardiovascular risk
Baumert et al.
Br J Anaesth 2007;98:722-727.
ABSTRACT
| FULL TEXT
The Year in Epidemiology, Health Services Research, and Outcomes Research
Krumholz and Masoudi
J Am Coll Cardiol 2006;48:1886-1895.
FULL TEXT
Barriers to the Integration of Psychosocial Factors in Medicine: Results of a National Survey of Physicians
Astin et al.
J Am Board Fam Med 2006;19:557-565.
ABSTRACT
| FULL TEXT
Tai Chi Chuan: Mind-Body Practice or Exercise Intervention? Studying the Benefit for Cancer Survivors
Mansky et al.
Integr Cancer Ther 2006;5:192-201.
ABSTRACT
Cardiac Rehabilitation, Exercise Training, and Psychosocial Risk Factors: Reply
Rozanski and Blumenthal
J Am Coll Cardiol 2006;47:212-213.
FULL TEXT
Cardiac Rehabilitation, Exercise Training, and Psychosocial Risk Factors: REPLY
Rozanski and Blumenthal
J Am Coll Cardiol 2005;0:j.jacc.2005.10.003v1-11500.
FULL TEXT
Benefits of Stress Management and Exercise Training in Ischemic Heart Disease
Journal Watch Cardiology 2005;2005:4-4.
FULL TEXT
|
